Macrohematuria is the presence of blood in the urine that is macroscopic, that is, visible to the naked eye. This contrasts with microhematuria. In this, the blood can only be detected under a microscope, or further diagnostic procedures.
What is macrohematuria?
Schematic diagram showing the anatomy and structure of the urinary bladder in a man with bladder cancer. Click to enlarge. Hematuria refers to the presence of red blood cells, or blood in the urine, and macrohematuria refers to a red coloration of the urine that is visible to the naked eye. The bleeding may also be associated with pain, but it does not have to be. Nevertheless, in both cases a doctor should be consulted as soon as possible, as it is unusual and usually pathological. Inflammation, urinary stones, tumors, and mixing of menstrual blood may be possible causes. Hematuria is divided according to the source of bleeding and can be glomerular and postglomerular in origin. Macrohematuria is usually postglomerular hematuria; therefore, the red blood cells are less damaged in structure and shape.
Causes
Macrohematuria can have many causes. It can be caused by such things as menstrual blood, physical stress, sexual activity, viral illness, trauma, or infection. Infections, or kidney stones of the urinary tract, i.e. the renal pelvis, ureters, urinary bladder, and urethra often cause blood in the urine. Other serious causes of macrohematuria are tumors of the kidney, or bladder, and inflammation of the kidneys, urethra, bladder, or prostate in men. Genetic polycystic kidney disease can also be a determining factor. This is characterized by many grape-shaped, fluid-filled cysts that make kidneys larger over time and destroy kidney tissue. A blood clotting disorder, such as hemophilia, or sickle cell disease may also be the trigger for macrohematuria. Sickle cell disease is a hereditary disorder in which the red blood cells have an abnormal, crescent shape and are less able to carry oxygen to the tissues of the body. They often clog small blood vessels, disrupting healthy blood flow and causing bleeding.
Symptoms, complaints, and signs
Macrohematuria is primarily manifested by the visible red or brown coloration of the urine. Furthermore, blood residue or blood clots may be visible in the urine. The condition may occur painlessly, but in some cases it causes severe, usually burning pain when urinating. Affected individuals have to urinate excessively frequently. The degree to which these symptoms occur depends on the nature of the disease. Initial macrohematuria is manifested by noticing small blood inclusions in the urine, which usually only occur at the beginning of urination. In terminal macrohematuria, the blood residues appear at the end of micturition. Total macrohematuria is associated with visible blood admixtures in the urine that occur throughout urination. Symptoms are usually noted with each urination, but can vary widely. Externally, the disease cannot be detected except for the blood in the urine. However, an increasing feeling of illness may develop as the disease progresses, characterized by pallor and sweating. Accompanying gastrointestinal complaints such as nausea, vomiting, diarrhea, constipation and heartburn may occur. In addition, a low-grade fever may develop, often accompanied by chills and fatigue.
Diagnosis and course
Macrohematuria can be diagnosed with the help of many tests. In a urinalysis, a urine sample is tested. The urine sample is collected in a special container and sent to the hospital laboratory for analysis. The nurse, or nurse practitioner, can test in advance using a U-stick to see if it is indeed blood. The next step is to diagnose the cause of macrohematuria. To do this, the doctor first takes a proper medical history. If this suggests a cause, examinations must be performed accordingly. Infection, kidney diseases and tumors must be excluded. The presence of white blood cells signal a urinary tract infection.Malformed and clumped erythrocytes, as well as large amounts of proteins, also called proteinuria, may indicate kidney disease. Urine can also be tested for the presence of cancer cells. A blood test can detect the presence of high levels of creatinine. This is a normal waste product of muscle breakdown and may be an indication of kidney disease. A biopsy of kidney tissue may also be helpful. A pathologist then examines the removed tissue for disease. Cystoscopy is again used to check the urethra and urinary bladder for possible pathologic macroscopic tissue changes. Masses and cysts may also be seen with an ultrasound, or computed tomography scan. If the cause of macrohematuria is diagnosed, treatment methods must be initiated accordingly.
Complications
First and foremost, those affected by macrohematuria suffer from bloody urine. In many people, blood in the urine can lead to a panic attack or further sweating, thus significantly reducing the quality of life. As a rule, the further course of the disease strongly depends on the cause of the macrohematuria, so that a general prediction of this disease is usually not possible. In the case of bladder cancer, the patient’s life expectancy may also be reduced if the tumor has already spread to other regions of the body. Furthermore, an infection of the urinary tract may also be responsible for macrohematuria, although those affected may also suffer pain during urination. Not infrequently, the pain during urination leads to psychological discomfort or other depressive moods. In many cases, macrohematuria can be treated with antibiotics. Complications do not occur. If the treatment is successful, the life expectancy of the affected person is not limited. Furthermore, in the case of cancer, the cancer must be removed. Whether this results in a positive course of the disease or a reduction in life expectancy can generally not be predicted.
When should you go to the doctor?
If the formation of blood in the urine occurs after performing heavy physical work or intensive sports activities, it may be a one-time event. If the organism is overloaded, there is a possibility that blood vessels burst and leaked blood is excreted through the urine. If there is an improvement within a few hours, a doctor is not needed. A visit to the doctor must be made if the blood in the urine is noticed for several days or repeatedly when going to the toilet. If the amount of blood increases, there is also a need for action. If there is additional discomfort in the abdomen, swelling or a feeling of pressure near the bladder or bowel, a doctor should clarify the symptoms. Changes in the amount of urine excreted is another signal of an existing imbalance. If the amount of urine decreases despite constant fluid intake, a doctor is needed. The cause of the observation must be investigated and treated. If there is an elevated blood pressure, disturbances in the heart rhythm or burning pain during urination, a visit to the doctor should be made. Fatigue and chills are warning signs of the organism for an existing health impairment. If they occur in conjunction with vomiting, nausea or diarrhea, a doctor should be consulted. If the affected person suffers from a feeling of illness or a decrease in performance, he should consult a doctor.
Treatment and therapy
Macrohematuria is treated according to the diagnosed cause. If no serious disease causes it, no treatment is necessary. Hematuria caused by infection is cured with the help of an antibiotic. Urinalysis should be repeated after six weeks. Kidney stones are often excreted by urine on their own. In this case it is important to drink a lot so that they are flushed out. However, if they are too large, stone disintegration by shock waves must be used. The stage of a tumor determines how it is treated. Small and previous tumors of the bladder are removed with minor surgery. The procedure is performed through the urethra with an endoscope. The removed tissue is then sent to the pathology department for further microscopic examination.If the tumor is larger, the entire urinary bladder must be removed and a replacement of it must be made. Accordingly, macrohematuria has many treatment methods.
Prospect and prognosis
Since it is not a disease in its own right, relief depends on the curability of the primary disease. In some affected individuals, it is blood that naturally leaks during menstruation in women. Thus, a spontaneous cure can be expected as soon as the bleeding period is over. In addition, injuries to the vessels in the lower abdomen can occur during sexual activities. Here, too, spontaneous healing can be expected within a short time. However, if the bleeding is based on the presence of foreign bodies in the organism, medical care is needed. In the case of kidney stones, removal of the foreign bodies must be initiated for recovery to occur. In case of inflammation in the kidney area, medical care is also needed. Through the administration of medication, the pathogens are killed as well as prevented from multiplying. If the affected person suffers from a blood clotting disorder, a life-threatening condition can develop if the disease progresses unfavorably. Without medical care, a further increase in the symptoms is to be expected. Therefore, in principle, in the case of macrohematuria, clarification of the cause is important for the position of the prospect of a cure. In particular, persistent or increasing bleeding indicates an underlying disease that should be taken seriously.
Prevention
Macrohematuria is difficult to prevent. Because it has many different causes, only the appropriate causes can be prevented. Infection of the urinary tract, can be prevented with the help of adequate water intake and a balanced diet. The same applies to the formation of kidney stones. A bladder tumor cannot always be prevented. However, smoking nicotine is often a cause of the development of a tumor.
Aftercare
After the actual treatment of macrohematuria, those affected require ongoing care. In addition to regular medical examinations and seeking further therapies, aftercare also includes lifestyle changes. Those affected must now try to build up the quality of life to which they are accustomed. Sometimes it can help to go to a self-help group. Depending on the type of cancer, nutritionists, sports groups and other authorities may also need to be consulted. The aftercare plan is drawn up together with the doctor and is based on the symptoms, the general course of the disease and the prognosis. In the first phase, when patients are still coping with the consequences of the disease and treatment, aftercare is particularly important. It is crucial to support patients until remission is achieved. Macrohematuria can lead to various symptoms and complications if it is not treated properly or even in time. Many affected individuals also suffer from depression or other psychological upsets, which can have a very negative impact on the quality of life of the affected individual. They continue to suffer from severe fatigue and exhaustion and can no longer actively participate in everyday life. In this context, the further course of the disease depends very much on the exact time of diagnosis, so that no general prediction can be made about it.
What you can do yourself
Macrohematuria can have a wide variety of causes. Even if it can be diagnosed or at least suspected by the patient, self-therapy is strongly discouraged. Some causes of macrohematuria can be treated well under medical supervision and can also be cured, while others can have a life-threatening disease as their cause. A patient who detects or suspects macrohematuria in himself should therefore urgently consult a doctor. If there is a concrete diagnosis of the causes and the underlying disease, the doctor will prepare a treatment plan for the patient and discuss it with him. Now the patient can contribute a lot to his recovery by sticking to the established therapy plan and following the recommendations of his doctor. Depending on the diagnosed cause, different therapeutic approaches are necessary. Some therapies require surgery, while others require the patient to take pills on a regular basis. Diet plans or even a complete change in diet and lifestyle habits often follow as a second step.Every patient can make a major contribution to his or her own well-being here by understanding the therapy approach and making a consistent effort to comply. This also includes attending any follow-up examinations.
