The medical term for blood in urine is “hematuria”. The “heme” refers to the hemoglobin in red blood cells and the “uria” means that it is in the urine. Also, when we talk about blood in the urine, we really mean red blood cells in the urine.
Urine is normally a light yellow to dark amber, depending on how concentrated it is. The most common symptom of blood in the urine a change in urine color because it takes very little blood in the urine to turn it pink or red. However, many people have blood in their urine without a change in the color and have no symptoms.
The easiest way to make a diagnosis is to use a urine dipstick because it is very sensitive for hemoglobin. However, a positive dipstick doesn’t always mean there is blood in the urine. To confirm the diagnosis, your doctor needs to find red blood cells in your urine using a microscope.
There are two different types of blood in urine depending on how much blood is in the urine. If there is enough blood that it is obvious to the naked eye, it is called gross hematuria. If you need a microscope to see it, then it is called microscopic hematuria. Despite the quantity of blood in the urine being different, the types of diagnoses that can cause the problem are the same, and the workup or evaluation that is needed is identical.
Since blood in the urine must come from one of the organs involved in making or transporting the urine, the evaluation of hematuria requires that we consider the entire urinary tract. This organ system includes the kidneys, ureter (the tube that carries the urine from the kidney to the bladder), bladder, prostate, or urethra (tube leading out of the bladder).
There are multiple causes of blood in urine. Some are serious, including cancers, trauma, stones, infections, and obstructions of the urinary tract. Others are less important, and may require no treatment. These may include viral infections, nonspecific inflammations of the kidney, medications which thin the blood's clotting ability, and benign prostate enlargement.
No matter how obvious the reason for hematuria appears to be, a complete evaluation is almost always necessary to rule out a serious underlying disease, such as a cancer. There are usually three diagnostic tests necessary to give us a look at the entire urinary tract, and these include the intravenous pyelogram (IVP), cystoscopy, and a urine cytology.
The intravenous pyelogram, or IVP, is an x-ray evaluation of the urinary tract. In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A series of x-rays are then taken over a thirty-minute period, looking for abnormalities. This study is especially useful for evaluating the kidneys and ureter, but not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is necessary. In this procedure, a small viewing tube, or cystoscope, is used to visually inspect the bladder and the urethra. In most instances, this can be done without discomfort by the use of local anesthetic jelly. The cystoscope is passed up the urethra into the bladder, and the inspection is carried out. The entire examination takes less than ten minutes. The final test is a urine cytology, which involves voiding urine into a cup and having that urine examined by a pathologist to look for cancer cells
Management of blood in urine depends upon the underlying cause. Many times a cause cannot be found, which is fortunate, because it generally suggests that there is not a harmful situation present. Remember that the real reason for a hematuria workup is not to prove a specific cause, but to rule out a serious problem. If no cause is found for the hematuria, the urine should be checked on a yearly basis to make certain that no changes are occurring. However, if gross hematuria were to recur, repeat evaluation may be necessary, and a physician should be consulted. A blood test to check kidney function and a blood pressure check should be done as well. Men over fifty should have a yearly PSA, or prostate specific antigen, to screen for prostate cancer.
Further discussion of the treatment for hematuria would depend upon the results of the previously mentioned workup and the exact cause for the hematuria. The urologist who performs this examination would direct any further treatment or workup that would be necessary.