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Page Title
Hematuria: Blood in the Urine
Overview Title
Overview
Definitions Title
Definitions
Definitions Intro
Hematuria is the medical term for blood in the urine and can be categorized in 2 ways.
Microscopic Hematuria Definition
Microscopic Hematuria or Microhematuria – the presence of blood in the urine that can only be detected on a urinalysis (urine test performed in the lab).
Gross Hematuria Definition
Gross Hematuria – the presence of visible blood in the urine
Diagnosis Title
Diagnosis
Diagnosis Content
Microscopic hematuria is diagnosed with a urine test called urinalysis. It is defined by having 3 or more red blood cells seen per high power field under a microscope. Hematuria can sometimes first be detected by a test called a urine dipstick which will report blood in the urine as “trace”, “small”, “moderate” or “large”. However, this requires confirmation with microscopic urinalysis, as dipstick testing can produce false-positive results for blood.
Gross hematuria is diagnosed by visualization of blood in the urine. Any visualization of blood in the urine should be evaluated. Blood in the urine can sometimes be confused with foods / medications that turn the urine pink or red such as beets or phenazopyridine (medication that helps with urinary pain that turns urine orange). It can also be mistaken for other causes of bleeding such as vaginal bleeding, rectal bleeding or genital bleeding. Regardless, any concern should be evaluated.
Causes Title
Causes
Causes Intro
Blood can enter the urine from any point along the urinary tract — the kidneys, ureters, bladder, prostate (in men), or urethra. Some causes are common and easily treated, while others require closer investigation.
Symptoms Title
Symptoms
Symptoms Intro
Microscopic hematuria produces no visible change in the urine and is found only on a urine test such as a urine dipstick or urinalysis.
Microscopic Hematuria Risk Intro
The American Urological Association categorizes the risk of microscopic blood in the urine based on several factors including
Microscopic Hematuria Risk Factors
Microscopic Hematuria Risk Outro
Depending on a person’s risk will help in determining the appropriate diagnostic workup.
Gross Hematuria Symptoms
Gross hematuria is its own symptom — you may see blood in the toilet bowl or notice that the urine has turned pink, red, brown or purple. Even a small amount of blood can change color dramatically, so even red urine may not indicate severe bleeding if it very thin and translucent. When blood stays still in the bladder, it can also form clots and these can cause difficulty urinating as the clots pass. Sometimes when the clots are very large, it leads to a complete inability to urinate. Examples of hematuria severity can be seen below.
Additional Symptom Notes
Hematuria itself may be the only finding, or it may occur alongside other symptoms that point toward a specific cause. Urinary tract infections may be accompanied by urination with increased frequency and urgency. Kidney stones can come with severe flank or lower abdomen. Regardless, since hematuria can appear without pain or other warning signs, it should never be dismissed even if it goes away on its own. A single episode of gross hematuria warrants medical evaluation.
Diagnostic Workup Title
Diagnostic Workup
Diagnostic Workup Intro
A thorough evaluation helps pinpoint the source of bleeding and rule out serious conditions. The workup typically includes several components.
Urinalysis and Urine Culture
Urinalysis and Urine Culture - A urinalysis examines the urine for red blood cells, white blood cells, protein, and bacteria. If infection is suspected, a urine culture identifies the specific organism so the right antibiotic can be chosen.
Imaging Studies Title
Imaging studies
Imaging Studies
Cystoscopy
Cystoscopy — A procedure where a thin, flexible camera is gently inserted through the urethra (the tube where the urine travels through and comes from), allowing visualization of the urethra, prostate and the bladder lining to look for tumors, inflammation, or other abnormalities. The procedure is performed in the office, typically takes only a few minutes, and is well-tolerated with local numbing gel. Despite imaging studies being performed for the hematuria workup, many tumors or lesions can only be seen through a cystoscopy.
Urine Cytology
Urine cytology — A urine sample is examined under a microscope by a pathologist looking for abnormal or cancerous cells shed from the lining of the urinary tract. Cytology is especially useful for detecting high-grade bladder cancers. Urine cytology can often miss cancer diagnoses, and therefore cystoscopy and imaging studies must still be performed for the hematuria workup.
Workup Outro
Your urologist will determine which combination of tests is right for you based on your age, symptoms, risk factors, and whether the hematuria is gross or microscopic.
Frequently Asked Questions Title
Frequently Asked Questions
Call to Action Title
Call to Action
Call to Action Content
Blood in the urine deserves a prompt, professional evaluation — whether you noticed it yourself or it was found on a routine lab test. Our urology team specializes in diagnosing and treating every condition that can cause hematuria, from common infections to complex cancers. Call our office today to schedule an appointment and get the answers you need. Early evaluation leads to peace of mind — and, when treatment is necessary, better outcomes.
