What can cause the appearance of blood in the urine

We understand hematuria as the presence of blood in urine, which may or may not be accompanied by clots. It is one of the most frequent problems that urologists encounter in the consultation room. In most cases, bleeding in the urine is due to benign processes, but, nevertheless, it should be consulted to rule out more worrying processes.

How is hematuria classified?

  • Gross hematuria: when blood can be seen directly, either alone or mixed with urine. Clots may appear.
  • Microscopic hematuria: when only through the microscope the red blood cells can be seen.

What is it due to?

It may be due to prostatic, bladder, ureteral and renal causes.

  • Causes of prostatic origin: due to prostatic congestion or enlargement of the prostate, there may be dilated, fragile veins on its surface, which, with the slightest effort, or simply the fact that urine, as it passes, rubs against these dilated veins, may cause bleeding, as when small veins in the nose break. They can be benign (benign hypertrophy) or malignant in nature.
  • Causes of bladder origin: may be due to tumors or the existence of lithiasis -stones- that rub against the internal wall -mucosa- of the bladder, or due to urine infections that cause inflammation of the small veins found on the internal surface of the bladder.
  • Ureteral origin: generally caused by tumors or stones -lithiasis- during their descent to the bladder that can erode the ureteral wall.
  • Renal origin: also most frequently caused by tumors or the presence of lithiasis. Occasionally, the rupture of cysts in the kidney can also cause bleeding in the urinary tract.
  • Exertional or athlete’s hematuria: as its name indicates, it appears in some people, especially professional athletes, after intense exercise. It has no pathological origin and therefore does not need to be treated.
  • Anticoagulant drugs: of the aspirin type (acetylsalicylic acid, Adiro), Clopidogrel, Sintrom, etc.
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How is the diagnosis of its causes reached?

Ultrasound is the best diagnostic method as an initial test, since it is completely harmless, quick and can be repeated at any time.

It will also be interesting to request a urine culture, in order to rule out the presence of germs that may be causing an infection.

If there is any diagnostic doubt, a CT scan can be requested, and even cystoscopy (in order to endoscopically evaluate the prostate and bladder).

How is it treated?

Specific treatment for the cause of the hematuria should be carried out: tumors, infections, lithiasis, etc.

In addition, we will increase fluid intake to clean the urinary tract and prevent the formation of clots that may hinder urination. This measure alone will often stop the bleeding.

Important to remember

  • All hematuria must be studied to rule out that it is not produced by tumor cells.
  • If hematuria occurs, the most important thing to do is to increase fluid intake and then consult your urologist.