Hematuria (Blood in the Urine)

by Thomas J. Seary, MD | Commonwealth Urology

Blood in the urine, hematuria, can be an indication of a serious problem, or no problem at all. Studies have shown that between 9 and 18 percent of healthy individuals have some degree of hematuria. However, hematuria can be a marker for infection, stone disease or cancer, such as those listed below, requiring treatment. Risk factors for significant underlying disease include: smoking, radiation, overuse of some pain medicines and exposure to certain chemicals.

  • Bladder cancer
  • Kidney cancer
  • Prostate cancer
  • Ureteral cancer
  • Urethral cancer
  • Urinary stone disease
  • Urinary tract infection
  • Pyelonephritis (kidney infection)
  • Benign prostatic hypertrophy (enlarged prostate)
  • Renal (kidney) disease
  • Radiation or chemical induced cystitis (bladder irritation)
  • Injury to the urinary tract
  • Prostatitis (prostate infection)
  • Exercise hematuria

What is hermaturia?

Hermaturia, affects between 2.5 and 21 percent of the population, and is defined as the presence of red blood cells in the urine. It can originate anywhere in the urinary tract and often no specific cause is found. Hermaturia can be characterized as either "microscopic," usually found by a dipstick test at a routine check-up and visible only under a microscope, or "gross," which is visible to the naked eye, worrisome to the patient and could prompt a visit to the doctor. However, microscopic hermaturia can be as severe as gross hermaturia, but carries no symptoms.

What additional testing is needed?

Any patient with gross or significant microscopic hermaturia should have an exam which includes discussion of medical history, further evaluation of the urinary tract and laboratory analysis. First, a urinalysis is performed to determine if protein or a urinary tract infection is present. Then a laboratory examination of the blood cells may be done. The number and shape of red blood cells can help the physician determine where they are coming from. If there are white blood cells in the urine, the patient would have a urine culture to look for abnormal cells. A blood test may also be ordered to determine the functionality of the kidneys. If significant protein is in the urine, or abnormal blood cells are present, a patient should have a medical evaluation for the presence of kidney disease.

X-rays of the kidneys and ureters may also be necessary. Most urologists prefer a computerized tomography (CT) scan to evaluate kidney function. In patients with abnormal kidney function or an allergy to X-ray contrast material, magnetic resonance imaging (MRI) is used. Because these imaging studies cannot evaluate the bladder, a cystoscopic evaluation may also be required to examine the inner lining of the bladder and urethra for abnormalities.

What if no abnormality is found?

In most cases, a specific cause of blood in the urine is not found. However, most physicians will recommend follow-up at six, 12, 24 and 36 months. This may include both urinalysis and urine cytology. Immediate re-evaluation should be preformed if there is gross hematuria, an abnormal urinary cytology or irritating urinary symptoms, such as pain with urination or increased frequency of urination. If none of these symptoms occur within three years, no further urologic testing is needed.

How will hermaturia be treated?

Treatment will be based on the cause of the hermaturia and a physician's evaluation of the patient's condition, symptoms and medical history.