Highlighting Hematuria: What to Look Out For Leave a comment

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Hematuria, or blood in the urine, can be frightening. The cause very well could be harmless, but it could also be a sign of something more serious.

There are two types of hematuria. If you can visibly see the blood in your urine, it’s called gross hematuria. If you can’t see blood in the urine, it’s called microscopic hematuria, and can only be seen under a microscope when the urine is being tested by a lab.

Uwais Zaid, MD, is a Urologist with OSF HealthCare and Urology of St. Louis.

“Whenever there’s any blood in the urine, it’s something we take very seriously,” Dr. Zaid says.

Dr. Zaid says the first goal when treating a patient with hematuria is seeing what they’re dealing with, then deciding a course of action.

“If somebody has a tumor in the bladder, the next step is surgery to scrape that tumor off and see what we’re dealing with. Is it a bladder cancer, is it an inflammatory lesion? If someone has a kidney stone, we could potentially watch it, we could treat it surgically or watch it,” Dr. Zaid says.

The National Institute of Diabetes and Digestive and Kidney Diseases says gross hematuria makes your urine look pink, red, or brown. Usually gross hematuria is not painful. If you are having pain in your bladder or back, it’s possible there are blood clots in your urine. Microscopic hematuria does not change the color of your urine and normally doesn’t have symptoms.

Dr. Zaid says hematuria is about as commonly seen as urinary tract infections (UTI) in his clinics. He adds that sometimes hematuria and a UTI co-exist. He says the medical response to blood in the urine has become more serious in recent years, and he doesn’t want to just write the symptoms off as a UTI.

“Scary bladder things, like bladder cancers, were more common in men. Because historically, men had a higher risk of smoking. As we saw the gender gap decrease in smoking, you start to see these cancers increase in women,” Dr. Zaid says.  

For women, Dr. Zaid says there are ways to know if the blood in the urine is something completely separate from menstrual bleeding.

“If it’s outside of the cycle setting, if there’s any pain associated with it, or if it’s when you’re passing urine and you see clots coming out of the urethra channel, then you get worried it may not just be the menstrual cycle,” Dr. Zaid says. “When it comes to menstrual cycles, if you have irregular cycles, breakthrough bleeding, or someone is post-menopausal and they start having bleeding, that’s not normal either.”

Treatment of hematuria can vary just as much as the cause. Dr. Zaid says if someone is at a higher risk, which includes those who are older, male, and have a smoking history or chemical exposure, the treatment could be more thorough.

“We recommend looking at the kidneys with the CT scan. It is a CT scan with contrast dye. We also recommend looking at the bladder with the camera,” Dr Zaid says.

For lower risk patients, doctors can still do a kidney ultrasound and look at the bladder.

“At the end of the day, the evaluation does involve looking at all the urinary organs. Kidneys, ureters, bladder and urethra. That involves pictures of the kidneys and ureters, whether that’s an ultrasound or a CT scan with contrast dye. Then we look directly inside the bladder with a camera, called a cystoscopy,” says Dr. Zaid who adds the cystoscopy helps because CT scans don’t always give you the anatomical detail you need to get the full picture.

“The bladder has all sorts of folds in it. So if there was a small and scary tumor, it may hide out in one of those folds. That’s why we always recommend looking inside the bladder with the camera,” Dr. Zaid says.

The cystoscopy is something OSF HealthCare providers can perform in their urology clinics without too much special preparation ahead of time.

If you have any concerns about hematuria, OSF HealthCare has multiple Urology clinics. You can find the locations here.