Blood in Urine (Hematuria) – Flexible Cystoscopy

Seeing blood in your urine can be alarming. While in many instances the cause is harmless, blood in urine (hematuria) can indicate a serious disorder.
Blood that you can see is called gross hematuria. Urinary blood that’s visible only under a microscope (microscopic hematuria) is found when your doctor tests your urine. Either way, it’s important to determine the reason for the bleeding.

Gross hematuria produces pink, red or cola-colored urine due to the presence of red blood cells. It takes little blood to produce red urine, and the bleeding usually isn’t painful. Passing blood clots in your urine, however, can be painful. Bloody urine often occurs without other signs or symptoms.

Make an appointment to see your doctor anytime you notice blood in your urine.

Various problems can cause hematuria, including:
1. Urinary tract infections
2. Kidney infections (pyelonephritis)
3. A bladder or kidney stone
4. Enlarged prostate
5. Kidney disease ( Viral or strep infections, blood vessel diseases and immune problems such as IgA nephropathy)
6. Cancer ( Visible urinary bleeding may be a sign of advanced kidney, bladder or prostate cancer)
7. Inherited disorders (Sickle cell anemia, Alport syndrome)
8. Kidney injury (A blow or other injury to your kidneys from an accident or contact sports can cause visible blood in your urine)
9. Medications (The anti-cancer drug cyclophosphamide and penicillin can cause urinary bleeding. Visible urinary blood sometimes occurs if you take an anticoagulant, such as aspirin and the blood thinner heparin, and you also have a condition that causes your bladder to bleed)
Often the cause of hematuria can’t be identified.

The following tests and exams play a key role in finding a cause for blood in your urine:
1. Physical exam, which includes a discussion of your medical history.
2. Urine tests. Even if your bleeding was discovered through urine testing (urinalysis), you’re likely to have another test to see if your urine still contains red blood cells. A urinalysis can also check for a urinary tract infection or the presence of minerals that cause kidney stones.
3. Imaging tests. Often, an imaging test is required to find the cause of hematuria. Your doctor might recommend a CT or MRI scan or an ultrasound exam.
4. Cystoscopy. Your doctor threads a narrow tube fitted with a tiny camera into your bladder to examine the bladder and urethra for signs of disease.
Sometimes, the cause of urinary bleeding can’t be found. In that case, your doctor might recommend regular follow-up tests, especially if you have risk factors for bladder cancer, such as smoking, exposure to environmental toxins or a history of radiation therapy.

Depending on the condition causing your hematuria, treatment might involve taking antibiotics to clear a urinary tract infection, trying a prescription medication to shrink an enlarged prostate or having shock wave therapy to break up bladder or kidney stones. In some cases, no treatment is necessary.