Blood in the urine

Synonyms

Hematuria, erythruria, erythrocyturia

English: hematuria

introduction

Blood in the urine, called hematuria (häm = blood, ouron = urine), describes the pathologically increased occurrence of red blood cells (erythrocytes) in the urine. The cause of the blood in the urine is a source of bleeding in the body, which can originate from various tissues.

Epidemiology / frequency distribution

Is there a disease that causes the occurrence of Blood in the urine caused, it is most often - in about 50% of cases - an inflammation of the bladder or the urethra.

A benign enlargement of the prostate (see: benign prostatic hyperplasia, also Prostate adenoma called), which causes the blood in the urine.

The third most common cause of blood in the urine with around 8% is bladder tumors (bladder carcinoma).

Causes of blood in the urine

Causes of blood in the urine can be varied and mostly lie in the Kidneys or the urinary tract.
Common and harmless causes are, for example, menstrual blood in women, the consumption of beetroot, which can also color the urine red, or slight bleeding after an operation or an intervention on the pelvic floor or the urinary tract.

However, blood in the urine can also indicate serious illnesses and must therefore be checked by a doctor. It goes with colicky pain and fever hand in hand, are Kidney stones or Ureteral stones probably.
Occurs blood in the urine in connection with painful and frequent urination (please refer: Painful urination) hand in hand is a Inflammation of the urinary bladder and the urinary tract is mostly the cause.
Painless blood in the urine can indicate a malignant tumor, such as a Urinary tract tumor, indicate and must be examined by a doctor.
Other types of tumor that can lead to blood in the urine are renal cell carcinoma, a malignant one Kidney tumorwhich mainly affects older men, Prostate cancer or even gynecological tumors in women, like that Endometrial cancer, Cervical cancer or Fibroids.

Other causes of blood in the urine can also Bleeding disorders or rheumatic diseases. In any case, a doctor should be examined in the event of prolonged or heavy bleeding and accompanying symptoms such as pain and fever.

Blood in the urine during pregnancy

A relatively common cause of blood in the urine during pregnancy is cystitis, which is usually associated with painful and frequent urination and can be treated well with an antibiotic.
If a bladder infection has been ruled out, the bleeding may also be from the uterus. Often this is due to hormonal disorders or burst small veins in the cervix that is well supplied with blood.

It helps to take it easy in the first few months of pregnancy and to refrain from sport and sexual intercourse.
Magnesium intake can also help. However, if there is very heavy bleeding, which is accompanied by back or abdominal pain, it can also be a miscarriage or a premature birth, with early placenta detachment.
Pregnant patients with blood in their urine should definitely see their gynecologist.

Read more on the subject here: Cystitis in pregnancy

Symptoms

Blood in the urine in itself is a symptom of various diseases. The clinical picture depends on the underlying disease.
Generally speaking, it can be said that inflammation is usually associated with fever, Pain and increased Inflammation values (CRP value, White blood cells = Leukocytes) in the blood. The presence of a Tumor fever, night sweats and weight loss (B symptoms) Show.

The presence of stones often manifests itself in typical colic-like pain (interval-like, very strong, independent of movement).
If blood coagulation is disturbed, the patient may have an increased tendency to bleeding in addition to the blood in the urine (for example of the skin and mucous membranes, prolonged Menstruation).
Other symptoms that can occur with blood in the urine are loss of protein (proteinuria) and the existence of white blood cells (leukocytes).

Painful urination

Blood in the urine, in combination with painful urination, speaks primarily for one Urinary bladder infection and occurs mainly in women. When bacteria get into the urethra, they can rise up into the bladder and cause painful inflammation.
If the infection is not treated adequately, the bacteria can continue to rise and cause inflammation of the renal pelvis, which is also high fever, Flank pain and Exhaustion goes hand in hand.
Both clinical pictures should be treated with antibiotics.

Another cause of painful urination and blood in the urine is kidney and ureteral stones. If the sharp stones move through the urinary tract, severe pain and tissue damage can occur over and over again, which can lead to a leakage of blood.
With small urinary stones one can walk away spontaneously, with painkillers and antispasmodics (e.g. Buscopan®), wait and see.
Larger stones can be sent by Shock wave lithotripsy (ESWL) or removed under a ureter mirror. Sufficient exercise, plenty of drinking (approx. 2.5 liters), as well as avoiding animal fats and a diet high in protein.

diagnosis

First, if blood appears in the urine, an anamnesis (inquiring about the medical history) is taken and then the patient is physically examined. Particular attention is paid to the examination of the kidney bearings or flanks, the bladder region and the genitals.
In addition, basic diagnostics are carried out, which include the following examinations:

• Ultrasound of the kidneys, the filled bladder and the prostate (sonography)
• Excretory urography (urogram): radiological representation of the kidneys and parts of the lower urinary tract after administration of contrast medium
• Computed tomography of the abdomen (CT abdomen) as an alternative to excretory urography
• Cystoscopy (Cystoscopy)
• Laboratory with urine laboratory and urine stix (urine test)

The general laboratory test includes values ​​relating to kidneys, blood clotting and anemia (anemia). The urine laboratory includes, among other things, the detection of various cells including their morphology and protein.
If an excretory urography or a computed tomogram cannot be performed, for example due to a contrast agent allergy, an alternative is magnetic resonance imaging of the abdomen (MRI abdomen).

Read more on this topic at: MRI of the abdomen and allergy to contrast media.
Further diagnostic examinations can be arranged for specific questions about the cause of the bloody urine. This includes examining the cells in the urine (Urine cytology), radiological imaging of the ureter using a contrast medium (retrograde pyelography), a ureteroscopy (Ureterorenoscopy), a vessel representation (Angiography) and a kidney sample with subsequent microscopic tissue examination (kidney biopsy).
A pelvic exam should also be performed to determine the cause of the blood in the urine.

Read more about this topic under Gynecological examination

Read more about angiography here

Differentiation between man and woman

The most common causes of blood in the urine in women are Menstrual blood or Cystitis. But also Cysts, Polyps or Genital organ tumors can lead to bloody urine. Some rheumatic diseases that occur much more often in women than in men, such as systemic Lupus erythematosus, can also lead to blood in the urine if the kidneys are involved.

In men, common causes are kidney and ureter stones, inflammation of the prostate, prostate cancer, or tumors of the kidney and urinary tract. In particular, tumors of the urinary tract, urothelial carcinoma, are associated with painless macrohematuria (visible, bloody discoloration of the urine) and should definitely be examined by a doctor.

therapy

If blood appears in the urine, the underlying condition needs treatment.
Cancer is treated with surgery, chemotherapy or radiation, depending on the stage and tissue of origin.
In the event of inflammation or infection, the patient receives depending on the pathogen Antibiotics, sometimes in combination with, for example, pain relieving medication.
Stones causing the blood in the urine are crushed (Lithotripsy) or surgically removed, blood coagulation disorders are treated in severe forms by substituting the missing or defective blood components (coagulation factors, platelets, etc.). Drugs that cause the bloody urine are stopped.

forecast

The prognosis depends on the underlying disease.

Summary

"Blood in the urine" means the occurrence of red blood cells (erythrocytes) in the urine, which is a symptom of various diseases. Depending on whether the urine is visibly reddish in color, a distinction is made between micro and macro hematuria (see causes of blood in urine). In the former, such a color cannot be seen with the naked eye. Diseases that cause blood in the urine affect the kidneys, the lower urinary tract (ureters, urethra), the urinary bladder or the prostate, with inflammation, stones or tumors in these structures usually causing the bloody urine. Non-pathological reasons for the red color of the urine can be the female menstruation, certain foods (beetroot) or medication.
In addition to anamnesis and physical examination, the diagnosis is mainly based on blood diagnostics including urine diagnostics, imaging procedures (ultrasound, excretory urography, CT) and cystoscopy (Cystoscopy). The underlying disease, which also determines the prognosis, is treated with blood in the urine.

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