Greater Boston Urology Blog

What Does Blood in the Urine Indicate? Understanding Hematuria

Seeing blood in your urine can be distressing, but it's important not to panic. Hematuria, which is the medical name for blood in the urine, can have many causes, some more serious than others.

We invited Dr. Bijan Salari to discuss hematuria in more detail, but keep in mind that this is far from an exhaustive article. And like all content on our blog, what follows is meant to be educational in nature, not medical advice. Always talk to your doctor about your specific situation.

What is hematuria?

DR. SALARI: Hematuria means there is blood in the urine. You may visibly notice red, orange, amber, or dark tea-colored urine, possibly indicating gross hematuria; however, hematuria may also be invisible to the naked eye and only detectable when examining the urine using a microscope. When blood in the urine is significant, it can form "clots" which may appear as string or jelly-like solid blood that appears in the urine.

What's the difference between gross hematuria and microscopic hematuria?

DR. SALARI: Gross hematuria means you can see the blood in the urine or in the toilet. Sometimes, if significant, you will also see blood clots in the urine, which appear as a string or jelly-like solid blood that is passed into the toilet.

Microscopic hematuria means you cannot see any change in the color of the urine, but there are at least three red blood cells that have been detected in your urine under the microscope per high-powered field.

A urine dipstick test, which is often done at home or in a physician's office, can sometimes indicate that there is blood in the urine. If this is true, it is important to see a urologist to tease out what is truly blood in the urine that requires work-up vs "false positive" or obvious benign causes that can result from vigorous exercise, recent instrumentation, viruses, or medications. It is best to get a clean, mid-stream collection of urine for your test where you discard the first 10 mL of urine.

What are some common causes of hematuria?

DR. SALARI: Hematuria is never considered normal, which is why it is important to determine the etiology or cause of the hematuria. If you do have either microscopic or gross hematuria, the most common causes include urinary tract infection (UTI), recent instrumentation such as a recent Foley catheter or urologic procedure, kidney or bladder stones, BPH or enlarged prostate in men, vaginal or uterine tissue breakdown in post-menopausal women, and bladder cancer. Importantly, being on a blood-thinning medication, such as aspirin or warfarin, does not cause hematuria.

How is the specific cause of hematuria diagnosed?

DR. SALARI: Because we know hematuria comes from the urine tract, we focus our work-up to include all of its different parts: kidneys, ureters, bladder, urethra, prostate in men, and vagina in women. Often this will start with an in-office urine test where we look for red blood cells under the microscope. We may send the urine sample for a urine culture to ensure no UTI.

If you have visible blood in the urine, and in some patients with microscopic hematuria, we usually recommend cystoscopy, often done in-office, which involves using a flexible camera to directly visualize the inside of the urethra and bladder. We will also examine the prostate in men and perform a pelvic exam in women at the same time. To examine the kidneys and ureters, we typically recommend imaging tests such as a kidney ultrasound or a CT scan.

What treatment options exist for the various causes of hematuria?

DR. SALARI: In anybody who has hematuria, the most important task at hand is determining why you have hematuria, as the "why" ultimately dictates the treatment options. For simpler causes of hematuria such as infection, we would prescribe antibiotics. For more serious causes of hematuria, such as bladder cancer, we will often perform a bladder biopsy or removal of the bladder tumor in the operating room. By getting the proper workup, we can help guide you through the best treatment options.

Is there any way to prevent hematuria?

DR. SALARI: If you smoke or use tobacco, I would strongly recommend quitting. Tobacco use is heavily linked to bladder cancer, which can cause hematuria, and you can prevent the progression of cancer if you quit. Staying well-hydrated is important in reducing the severity of the hematuria as well. You should not stop blood-thinning medications if you have hematuria unless a physician instructs you to do so.

If there's one big takeaway that you want people to understand about hematuria, what would it be?

DR. SALARI: Hematuria is not normal and should not be ignored in any situation, regardless of your sex, race, or medical history. Determining the cause or etiology of the hematuria is our job. While we often give patients good news that the cause is benign or easily treatable, catching a more serious diagnosis like bladder cancer earlier can be life-saving and well worth the trip to the urologist. We are here to help you through this.

Bottom line: If you see blood in your urine, call your doctor!

If you need a urologist, consider making an appointment with one of our board-certified urologists at Greater Boston Urology. We have multiple locations throughout Eastern Massachusetts. You are not alone. Let us help.

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