Synonyms
Haematuria, erythruria, erythrocyturia English: hematuria
Introduction
Blood in the urine, called haematuria (haem = blood, ouron = urine), refers to the pathologically increased occurrence of red blood cells (erythrocytes) in the urine. The blood in urine is caused by a source of bleeding in the body, which can originate from various tissues.
Epidemiology/frequency distribution
If there is a disease that causes blood to appear in the urine, the most common – in about 50% of cases – is an inflammation of the bladder or urethra. This is followed by benign enlargement of the prostate gland (see also: benign prostatic hyperplasia, also known as prostate adenoma), which causes the blood in the urine. The third most common cause of blood in the urine with about 8% is bladder tumours (bladder carcinoma).
Causes of blood in urine
Causes of blood in the urine can be diverse and are usually in the kidneys or the draining urinary tract. Common and harmless causes are, for example, menstrual blood in women, the consumption of beetroot, which can also colour the urine red, or slight bleeding after an operation or surgery on the pelvic floor or the urinary tract. However, blood in the urine can also indicate serious illness and must therefore be clarified by a doctor.
If it is accompanied by colicky pain and fever, kidney stones or ureteral stones are likely. If blood in the urine is accompanied by painful and frequent urination (see: Pain when urinating), an inflammation of the bladder and urinary tract is usually the cause. Painless blood in the urine can indicate a malignant tumour, such as a tumour of the urinary tract, and must be examined by a doctor.
Other types of tumours that can lead to blood in the urine are renal cell carcinoma, a malignant tumour of the kidneys, which mainly affects men in old age, prostate cancer or gynaecological tumours in women, such as endometrial carcinoma, cervical carcinoma or myomas. Other causes of blood in urine can also be blood coagulation disorders or rheumatic diseases. In any case, a medical clarification should be made in case of prolonged or heavy bleeding and accompanying symptoms such as pain and fever.
A relatively common cause of blood in urine during pregnancy is cystitis, which is usually accompanied by painful and frequent urination and can be treated well with an antibiotic. If cystitis has been ruled out, the bleeding can also come from the uterus. This is often caused by hormonal disorders or burst small veins in the cervix, which is well supplied with blood.
Here it helps to take it easy on the body in the first months of pregnancy and to avoid sports and sexual intercourse. Taking magnesium can also help. However, if there is very heavy bleeding, which is accompanied by back or abdominal pain, it can also be a case of miscarriage or premature birth, in the case of early placental abruption.
Pregnant patients with blood in their urine should always consult their gynaecologist. Blood in the urine itself is a symptom of various diseases. The clinical picture depends on the underlying disease.
In general, it can be stated that an inflammation is usually accompanied by fever, pain and increased inflammation values (CRP value, white blood cells = leukocytes) in the blood. The presence of a tumour can be indicated by fever, night sweats and weight loss (B symptoms). Stone deposits often manifest themselves in typical colicky pain (interval-like, very strong, independent of movement).
If blood clotting is disturbed, the patient may have an increased tendency to bleed in addition to the blood in the urine (e.g. of the skin and mucous membranes, prolonged menstruation). Other symptoms that can occur together with blood in the urine are protein loss (proteinuria) and the existence of white blood cells (leukocytes). Blood in the urine, in combination with pain when urinating, indicates above all an inflammation of the urinary bladder and occurs mainly in women.
When bacteria enter the urethra, they can rise up into the bladder and cause a painful inflammation there. If the infection is not treated sufficiently, the bacteria can continue to rise and cause an inflammation of the renal pelvis, which is also accompanied by high fever, flank pain and fatigue. Both clinical pictures should be treated with antibiotics.
Another reason for pain when urinating and blood in the urine are kidney stones and ureteral stones. When the pointed stones move through the urinary tract, there can always be severe pain and tissue injury, which can lead to blood loss. In the case of small urinary calculi, a spontaneous discharge can be awaited under painkillers and spasmolytics (e.g. Buscopan®).
Larger stones can be removed by shock wave lithotripsy (ESWL) or under ureteral mirroring. Adequate exercise, plenty of drinking (approx. 2.5 litres), as well as avoiding animal fats and a high-protein diet have a preventive effect.
If blood is found in the urine, an anamnesis is first taken (asking for the patient’s medical history) and then the patient is physically examined. Particular attention is paid to the examination of the kidney position or flanks, the bladder region and the genitals. In addition, a basic diagnosis is carried out, which includes the following examinations: The general laboratory examination includes values regarding the kidneys, blood clotting and anaemia.
The urine laboratory includes the detection of various cells including their morphology and protein. If an excretory urography or a computer tomogram cannot be performed, for example due to a contrast medium allergy, an alternative is a magnetic resonance tomography of the abdomen (MRI abdomen). and contrast medium allergy.
Further diagnostic examinations can be arranged for certain questions regarding the cause of the bloody urine. These include an examination of the cells in the urine (urinary cytology), radiological imaging of the ureter using a contrast medium (retrograde pyelography), ureteroscopy (ureterorenoscopy), vascular imaging (angiography) and kidney sampling with subsequent microscopic tissue examination (kidney biopsy). In addition, a gynaecological examination should be carried out to find the reason for the blood in the urine.
- Ultrasound of the kidneys, the filled bladder and the prostate (sonography)
- Excretory urography (urogram): radiological imaging of the kidneys and parts of the urinary tract after administration of contrast medium
- Computer tomography of the abdomen (CT abdomen) as an alternative to excretory urography
- Bladder examination (cystoscopy)
- Laboratory with urine laboratory and urine stix (urine analysis)
The most common causes of blood in urine in women are menstrual blood or cystitis. But cysts, polyps or tumours of the genital organs can also lead to bloody urine. Some rheumatic diseases, which occur significantly more frequently in women than in men, such as systemic lupus erythematosus, can also lead to blood in the urine in the case of kidney involvement.
Common causes in men are kidney and ureteral stones, inflammation of the prostate, prostate cancer or tumours of the kidney and the urinary tract. Above all, tumours of the urinary tract, urothelial carcinoma, are accompanied by painless macrohaematuria (a visible, bloody discolouration of the urine) and should definitely be clarified by a doctor. If blood appears in the urine, the underlying disease must be treated.
Cancer is treated by surgery, chemotherapy or radiation, depending on its stage and the tissue of origin. In the case of inflammation or infection, the patient is given antibiotics depending on the pathogen, sometimes in combination with painkillers, for example. Stones as the cause of the blood in the urine are crushed (lithotripsy) or removed surgically, blood coagulation disorders are treated in severe forms by substitution of the missing or defective blood components (coagulation factors, blood platelets, etc.). Drugs that cause bloody urine are discontinued.
