Blood in Urine: Should You Be Worried?

Introduction to Haematuria (Blood in Urine)

Blood in urine, medically termed haematuria, can be an alarming symptom. Haematuria means red blood cells are present in the urine, which can be caused by various underlying health conditions—some mild, while others require urgent attention.

There are two main types of hematuria:

• Visible (Gross) Haematuria: Blood is visible to the naked eye, often giving urine a pink, red, or brown tint.
• Microscopic Haematuria: Blood cells are present in urine but can only be detected under a microscope.

Understanding haematuria and knowing its potential causes can help you make informed decisions about when to seek medical advice. This article will cover the causes, symptoms, when to worry, and diagnostic and treatment options for blood in urine.

What Causes Blood in Urine?

Common Triggers and Risk Factors

1. Exercise-Induced Haematuria
   • Intense exercise, particularly high-impact activities like long-distance running, can cause blood in the urine. Often, this type of haematuria is temporary and resolves within 24-48 hours post-exercise.
   • Tip: Moderating exercise intensity or staying well-hydrated before and after physical activities can help prevent this.
2. Dehydration
   • When you’re dehydrated, your urine becomes more concentrated, which can irritate the urinary tract and potentially lead to haematuria.
   • Recommendation: Make a habit of drinking sufficient water throughout the day to help maintain kidney and bladder health.

Infections

1. Urinary Tract Infections (UTIs)
   • UTIs, particularly common in women, often lead to haematuria. Symptoms include frequent urination, painful urination, and possibly fever.
   • UTIs irritate the bladder lining, which can cause bleeding.
   • Recommendation: Prompt antibiotic treatment and hydration can usually resolve the infection and stop the bleeding.
2. Bladder Infections (Cystitis)
   • Bladder infections, a common form of UTI, can cause haematuria, especially in women, due to the shorter urethra.
   • Prevention: Good hygiene practices, regular hydration, and urinating soon after intercourse can help reduce the risk of cystitis.

Kidney and Bladder Stones

1. Mechanism: Stones form when minerals crystallise in the kidney or bladder, causing irritation or even physical damage to the urinary tract.
2. Symptoms: Stones typically cause sharp pain in the side or back, nausea, or vomiting.
3. When to Worry: Persistent pain or inability to pass urine can indicate a stone blockage requiring urgent medical intervention.

Chronic Kidney Disease and Kidney Function

1. Connection
   • Haematuria can be an early symptom of kidney disease, which can progress to serious conditions if left untreated.
2. Risk Groups
   • Higher risk of kidney disease-related haematuria includes older adults, people with high blood pressure, or those with diabetes.
3. Diagnosis: Blood tests, urinalysis, and imaging of the kidneys help in diagnosing potential kidney disease.

Enlarged Prostate (Benign Prostatic Hyperplasia) in Men

1. How It Causes Haematuria: Prostate enlargement compresses the urethra, causing pressure on the bladder and possibly resulting in hematuria.
2. Symptoms: A weak urine stream, difficulty starting urination, and the feeling of incomplete bladder emptying are common.
3. Management Options: Treatments range from lifestyle changes to medications like alpha-blockers. Severe cases may require surgery.

Recognising When to Seek Medical Help

Symptoms That May Indicate Serious Conditions

1. Painful vs. Painless Haematuria
   • Blood in urine accompanied by pain often suggests an infection or kidney stones, while painless hematuria may indicate more serious conditions like bladder or kidney cancer.
2. Accompanying Symptoms
   • Blood in urine accompanied by fever, night sweats, weight loss, or persistent pain can be a sign of a more serious issue and requires immediate evaluation.
3. Visible (Gross) Haematuria
   • Gross haematuria (visible blood) is more concerning than microscopic haematuria, as it can signal more advanced underlying issues.

Warning Signs That Warrant Immediate Attention

1. Signs of Infection
   • Persistent pain, fever, or burning during urination, combined with haematuria, suggests a possible infection.
2. Kidney Disease Symptoms
   • Persistent haematuria accompanied by high blood pressure, hand or foot swelling, or fatigue can indicate chronic kidney disease.
3. Cancer Risk Factors
   • Recurrent, painless haematuria, particularly in smokers or older adults, is often a red flag for bladder or kidney cancer.

Diagnosing Blood in Urine

Physical Examination and Patient History

1. Detailed Medical History
   • Doctors will ask about your diet, exercise, fluid intake, and any family history of urinary or kidney issues.
   • Existing conditions, such as diabetes or hypertension, may increase the risk of haematuria.
2. Lifestyle Factors
   • Your doctor may also ask about lifestyle habits, such as a high-sodium diet, dehydration, and certain medications, as these can contribute to haematuria.

Laboratory Tests and Imaging

1. Urinalysis
   • A standard urinalysis detects signs of infection, blood cells, and protein levels, which can indicate kidney disease.
2. Urine Culture
   • This test identifies bacteria in the urine, which is essential if an infection is suspected.
3. Blood Tests
   • Blood work assesses kidney function, blood sugar, and infection markers.
4. Bladder Diary
   • Keeping a record of the frequency, volume, and timing of urination can help identify patterns and triggers.
5. Imaging
   • Ultrasound is a non-invasive method to detect stones, masses, or structural abnormalities.
   • CT Scan provides detailed images of the kidneys, bladder, and ureters, helping diagnose more complex issues.

Management and Treatment Options

Lifestyle and Behavioural Adjustments

1. Hydration
   • Consistent hydration throughout the day and avoiding late-night fluids help dilute urine and reduce urinary tract irritation.
   • Tip: Minimise caffeine and alcohol intake, as they can dehydrate and irritate the bladder.
2. Dietary Changes
   • Reducing high-sodium foods helps prevent fluid retention and bladder strain.
   • Avoid spicy foods and caffeinated drinks to reduce bladder irritation.
3. Adjusting Exercise Routines
   • Modifying exercise intensity can prevent exercise-induced hematuria.

Medications

1. Antibiotics
   • For UTIs or bladder infections, antibiotics are prescribed. Completing the full course prevents recurrence.
2. Medications for Enlarged Prostate
   • Alpha-blockers relax bladder neck muscles, while 5-alpha-reductase inhibitors can shrink the prostate.
3. Diuretics
   • When taken early in the day, diuretics manage fluid balance in cases of recurrent hematuria.

Surgical Interventions (For Severe Cases)

1. Kidney and Bladder Stones
   • Treatments for stones include shockwave therapy to break up the stones or surgery for large stones.
2. Treatment for Enlarged Prostate
   • Transurethral Resection of the Prostate (TURP) is often performed when symptoms are persistent or severe.

Potential Complications if Left Untreated

Long-term Health Effects

1. Chronic Kidney Disease
   • Untreated kidney conditions leading to haematuria can progress to chronic kidney disease (CKD), which requires ongoing management.
2. Insomnia and Sleep Disruptions
   • Frequent nighttime urination can interrupt sleep, affecting both mental and physical health.
3. Increased Risk of Urinary Incontinence
   • Persistent hematuria can weaken bladder muscles, increasing the risk of incontinence over time.

Impact on Quality of Life

1. Physical and Mental Health
   • The anxiety related to recurrent haematuria can negatively impact overall well-being.
2. Prevention and Regular Check-ups
   • Early diagnosis, lifestyle adjustments, and regular health checks are essential for reducing complications and maintaining quality of life.

Preventive Strategies for Bladder Health

Practising Good Bladder Hygiene

1. Daily Habits
   • Regular urination and avoiding holding urine for extended periods help maintain bladder health.
   • Avoid harsh soaps and scented products that can irritate the urinary tract.
2. Fluid Management
   • Steady hydration throughout the day, with limited fluid intake in the evening, helps maintain healthy bladder function.

Monitoring and Managing Health Conditions

1. Regular Check-ups
   • Patients with high blood pressure, diabetes, or kidney disease should have regular health checks to avoid complications.
2. Blood Sugar Control
   • Managing diabetes effectively reduces the risk of kidney issues that could lead to haematuria.

Conclusion

Blood in urine should never be ignored, even if it’s not always a cause for alarm. An early evaluation can often prevent more serious complications. Lifestyle adjustments like proper hydration, regular check-ups, and addressing underlying health conditions are key steps in managing and preventing haematuria.

Seeking professional advice for persistent haematuria can help ensure that your bladder and kidney health remains in check, allowing for peace of mind and better overall health.

Further Resources:

https://www.baus.org.uk/patients/conditions/2/blood_in_the_urine_haematuria

Author: Mr Neil A Haldar MBBS MD FRCS

Consultant Urological Surgeon

The Pelvic Specialists