Blood in urine

Dear Dr. Mo: What is Heamturia and if I would have it, what could be causing it?

Dear reader: Hematuria is a medical term, which we use to describe presence of blood (or red blood cells) in urine and it always warrants further medical

Any blood in urine is a serious symptom

Any blood in urine is a serious symptom

investigation and evaluation.

Blood should not be found in urine in any amount under normal circumstances.

If it is there it may be visually undetectable – this condition is called micro-hematuria – and only urine lab tests can establish blood’s presence.
If you can visually notice blood in urine this condition is referred to as gross (macro) hematuria.

Just because blood in urine cannot (yet) be seen with a naked eye doesn’t mean a condition is any less serious. Also, painless conditions in which you detect hematuria are at times even more alarming than painful ones.

Now, many different conditions and situations may lead to blood in urine (true hematuria) or an apparent reddish color of urine which may seem like blood but actually isn’t, or it is blood but not coming from a urinary system (pseudo hematuria). Never attempt to make that distinction yourself and always consult with your doctor – hematuria is not a symptom to be ignored or missed.

Let me list a few important categories and reasons for hematuria to occur.

First of all as I’ve briefly mentioned, there are true and pseudo hematurias.

Pseudo hematurias appear as blood in urine but are actually not blood at all or not blood coming from or through the urinary system.

One of the usual suspects in women is their period (the menstrual bleeding). This usually happens if a woman is collecting her urine sample for lab tests immediately after her period has ended (and sometimes even during the period). This of course gives a false result – to avoid this, women should wait a few days if possible after the menstrual bleeding had ended before taking a urine sample.

Other reasons include some dyes (in candy and juices), certain foods (beets), medication (rifampin, phenytoin, phenolphthalein etc), and a few others, which I will skip here to avoid dry medical language.

True hematurias are really blood in urine and these we divide by location of origin:

  • before kidney (pre-renal)
  • in kidney (renal) and
  • after kidney (post-renal)

Again, to save you from technicalities let’s just grossly classify common urologic causes of hematuria as:

Trauma, Infection, Neoplasms (cancers) and Stones.
Chances are that in most cases a reason will be found among these common causes.

In conclusion, I wish to underline two important pieces of advice regarding any blood (or suspected blood) in urine – remember those well:

  1. If you are 40 years or older and have blood in your urine – Investigate it with cystoscopy as a first order of business to rule out bladder tumor.
  2. Gross painless hematuria (visible blood – macro-hematuria) is bladder cancer until proven otherwise.

Most hematurias will be a symptom of infection or stones or perhaps an injury (and will usually be accompanied by pain) but some (especially painless ones) could signal even more serious conditions.

Never ignore this symptom and always ask your doctor to get to the bottom of it fully.

Yours in health,

Dr. Mo

  • Jennifer

    I have gross hematuria frequently, have had urine tested twice with no blood showing up. Blown off by the doc. I have no pain with this. I am 53 yrs old and have no uterus. This blood is not coming from another source, but it is intermittent. What should I do? I made an appt with a female urogynecologist, but I’m afraid it will not show up in the testing then either.

  • Donna Tvares

    I have had blood in my urine for two years I have had a full hysterectomy and my GP thought it might be due to menopause, I’ve been to a urologist who also detected blood seems my kidneys are fine. I’m 57 years old. Urologist advises having that test in the hospital. I urinate quite often seems to be getting worse. Should I have the procedure done. I am a long time smoker and have cancer on both side os my family.