Blood in the urine (hematuria)

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What is it about ?

The presence of blood in the urine is evident when the urine is bright red to almost black. But it is also possible that there is blood in the urine that cannot be seen with the naked eye. Your doctor can detect it by examining the urine under a microscope or by using a test strip.

The presence of blood in the urine is not always linked to an illness. This can be due to menstruation, sexual trauma, or even after very intense physical exertion.

The main cause of blood in the urine is urinary tract infection. It can also be a symptom of kidney stones, kidney and prostate disease, and bleeding disorders, or it may also indicate kidney or bladder damage after an accident.

Urine may also turn red without the presence of blood, for example after eating beetroot and taking certain medicines.

What is its frequency?

Every year, 2 in 1,000 people consult their general practitioner for the presence of blood in the urine.

How to recognize it?

The urine is “bloody”, its color ranging from bright red to almost black. They are sometimes slightly lumpy.

In addition, you may have symptoms of the condition that causes the hematuria:

  • In the case of inflammation of the urethra, you see blood when you start to urinate, and in the case of a bladder infection, blood appears instead at the end of urination. In these cases, you often urinate small amounts but frequently, and the urination is painful;
  • with kidney stones, you may have sudden, sharp, spasmodic pain in your back, flanks or lower abdomen;
  • with progressive kidney disease, kidney function gradually decreases. The waste is then no longer sufficiently filtered from the blood. You may therefore have general symptoms such as fatigue, loss of appetite, etc. ;
  • bleeding disorders can also cause spontaneous bleeding in other places, such as on the skin. You get bruises (bruises) all over the place.

How is the diagnosis made?

There is not necessarily a relationship between the amount of blood in your urine and the severity of the condition. Therefore each case should be analyzed in more detail.

Your doctor will always check for other symptoms, such as painful urination (painful urination), more frequent urinations, fever, abdominal or joint pain, skin rashes or if you have recently traveled abroad. It also controls the medications you take. He will ask you if you still have blood in your urine, at regular intervals or only occasionally.

Since a bladder infection is the most common cause, your doctor will first perform a simple urine test (urine test and / or microscopic examination). If in doubt, he sends a urine sample to the lab to check for bacteria.

If things are not yet clear, additional examinations are indicated:

  • clinical examination of the abdomen, kidney area, prostate and glands in the groin,
  • ultrasound bladder and kidneys,
  • blood test to check for anemia, bleeding disorders and worsening of the kidney function.

If a serious condition is suspected or if there is no cause for the visibly reddish urine, the doctor will refer you to the kidney specialist (nephrologist) or the urinary tract specialist (urologist). They may do a special CT scan and, if necessary, a visual inspection of the bladder (cystoscopy) or the removal and examination of a piece of kidney tissue (kidney biopsy).

Bloody urination resulting from an accident should also be investigated further.

Without an obvious cause, the urine is rechecked after two months.

What can you do ?

As soon as you have any doubt about the origin of the blood, it is best to consult the doctor without delay. It is important to find the source of the problem.

If you have stones, you can try to pass them by urinating through a sieve or tissue. Take the stone to the doctor. He can have the composition analyzed in the laboratory and give you dietary advice.

At the time of a painful attack related to a calculus, it is important not to drink too much. However, to prevent bladder infections and kidney stones, it is very important to drink enough water.

What can your doctor do?

Treatment depends on the cause. A bladder or urinary tract infection is treated with short course antibiotics. In case of chronic inflammation, you are sometimes prescribed a longer course of antibiotics, for example for three weeks.

In case of kidney stones, anti-inflammatory drugs are prescribed.

For all other causes of the presence of blood in the urine, you are referred to the specialist.

Want to know more?

Source

Foreign clinical practice guide ‘Hematuria’ (2000), updated on 20.07.2017 and adapted to the Belgian context on 04.10.2017 – ebpracticenet

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