Q: Is finding a small amount of blood in the urine always a sign of something really bad?
A: Although alarming, blood in the urine (hematuria) is not unusual—it’s estimated to affect 10 percent of our population. In some cases the blood is easy to see as a pink, red, brown, tea or cola color (gross hematuria), while at other times, it is seen only when a urine sample is examined under a microscope (microscopic hematuria).
The cause of the hematuria can be serious (cancer, kidney or urinary stones, kidney disease, blockage, injury, etc.) and require treatment. Or the cause could be fairly innocuous, such as from strenuous exercising (running), blood thinning medications (warfarin or aspirin), prostate enlargement, and require little or no treatment. Furthermore, urine may be pink or off color due to causes that have nothing to do with bleeding. These include certain foods (beets, berries and others), menstrual flow, liver disease, even food coloring. But no matter what the cause might be, hematuria needs to be evaluated by your health-care professional to make sure your urinary tract system is fine.
Our urinary system consists of the kidneys, ureter (tube carrying urine from the kidneys into the bladder), bladder, prostate gland (in men), and urethra (the tube that carries the urine out of the bladder). If hematuria is present, we need to evaluate each and every stop along the urinary pathway to ensure the cause is not from a serious health concern.
Your medical work-up would include a repeat urine analysis to check for growth of bacteria or malignant cells, a physical examination, and a thorough history of the problem. Your doctor will likely ask you:
- When did you first notice the blood (hours, days, weeks, months or years earlier)?
- Does it occur every time you urinate?
- If you are a woman, does it occur along with your menstrual flow?
- Is there any pain or a burning sensation with the hematuria?
- Does the blood occur in the beginning, end, or throughout the whole time you are urinating?
- Are you a smoker (higher incidence of cancer) or do you work with toxic chemicals?
- Have you had any injuries (auto accident, hit in kidney, groin or abdominal region)?
- Do you have a history of kidney stones?
- Do you have a frequent urge to urinate?
- Do you have fever or chills, nausea or vomiting?
- Are you taking any medications, including herbal supplements or banned drugs?
If your doctor needs further tests, the following may be considered:
- Blood tests to check your blood count and kidney function.
- An ultrasound to look for kidney or prostate enlargement, as well as blockages from a stone.
- Intravenous pyelogram (IVP) to check for a tumor or stone that may block the path of urine.
- Cystoscopy, a method to take pictures inside the bladder and urethra, that helps doctors see a tumor or bladder stone.
- CT scan, often used when looking for kidney or urinary tract stones. Doctors tend to prefer to use this method instead of an IVP in people with kidney disease.
Summing up, not all cases of hematuria are bad. However, anyone over the age of 40 should have a thorough evaluation in order to make sure no cancer is present in the urinary system. Men over the age of 50 who experience hematuria should be checked for prostate cancer. Finally, all cases of hematuria should prompt an appointment to visit your health-care professional.
