Bleeding in Urine-Blood Urine

What is hematuria?

Blood and blood cells can be seen in the urine visually or under the microscope “hematuria”or “bloody urine” is named. This may be visible (gross) or on urinalysis (microscopic). In both cases it is important to identify the cause of the bleeding. The sight of blood in the urine is a cause for concern and although in most cases the cause is harmless, blood in the urine (hematuria); It can be a symptom of a serious disease such as bladder cancer, kidney and prostate cancer, kidney and urinary tract stones.

When urine is mixed with a very small amount of blood, it can be seen in colors ranging from pink to dark red depending on the amount of blood. Bleeding in the urine is usually painless, if blood clots in the urine are due to obstruction or accompanied by infection, pain may occur. Even microscopic hematuria may be present, even without symptoms, and may persist for years without the patient noticing. In case of blood in the urine, which is a symptom of many serious diseases, a doctor should be consulted. Some constipation remedies and drugs containing dyes such as azo, which dyes urine red, and some foods (beet, strawberry, raspberry, blackberry, etc.) can dye urine red without blood in the urine. Again, after heavy exercises (especially in long-distance runners), blood may be seen in the urine, and the urine returns to normal within a few days. Other risk factors for hematuria include age and certain inherited diseases.

Causes of Hematuria

The maximum number of blood cells (erythrocytes) seen in the urine when viewed under a microscope is around 1-2 in men and 3-4 in women. Bleeding in the urine can originate from any area from the kidneys to the urinary ducts (ureters), bladder, prostate and urinary tract (urethra) where urine is excreted from the external environment. Kidney and urinary tract stones, infections and cancers are the most common serious causes of bleeding in the urine. .

1-Kidney and Urinary tract infections: In the case of microbial infections of the kidneys and urinary tract (cystitis, pyelonephritis, urethritis, etc.), there may be bleeding in the urine, but the bleeding is usually accompanied by difficulty, burning, painful and frequent urination. Apart from these, urgent need to urinate and bad-smelling urine can be seen. If the infection is in the kidney, it may be accompanied by fever and flank pain. In prostate infections, urinary difficulty and the need to urinate frequently come to the fore, apart from bleeding.

2- Urinary tract stone disease: Kidney and urinary tract stones, which do not obstruct the urinary tract, can only give symptoms with bleeding in the urine, if it is obstructed, bleeding and severe colic pain accompanies. If this is accompanied by an infection, the picture becomes more complex.

3-Prostate enlargement:In prostate enlargement, which is mostly seen in men over the age of 40, besides the main complaint of the patient, bleeding in the urine can be detected. It may come out and cause bleeding in the urine.

4- Kidney diseases: Hematuria can be observed in some medical diseases such as glomerulonephritis of the non-microbial and filtration units of the kidney, which can be a symptom of kidney failure, leading to transplantation (kidney transplant). In diseases called nephritis that occur in the filter system of the kidney, bleeding occurs in the urine. Again, blood in the urine can be seen as an additional finding in some systemic diseases such as diabetes (diabetes).

5-Urological Cancers:Urological cancers may be the most important and serious cause of visible or microscopic blood in the urine with or without clots. One of the most important symptoms of prostate and other urological cancers, especially bladder and kidney cancer, is bleeding in the urine. In fact, men over 40 years of age who smoke, who have painless blood clots in the urine, are considered bladder cancer until proven otherwise. The common denominator accompanying bleeding is smoking. While continuous bleeding in the urine is observed in the first and long term in bladder cancer, it is more common in advanced stages of prostate and kidney cancer.

6-Other reasons: Inherited genetic diseases such as sickle cell anemia and Alport syndrome, kidney and urinary tract traumas, and some medications may cause bleeding in the urine. Anticancer drugs such as cyclophosphamide, radiotherapy, blood thinners such as aspirin, and penicillin-type antibiotics can cause serious bleeding in the urine.


1- History and physical examinationIt is the first step in the investigation of hematuria.

2-Simple urine test: Even if there is visible bleeding, a simple urine test is necessary to determine if there is any additional finding. Again, urine taken in a transparent container should be examined visually. If there are signs and symptoms suggestive of infection, a urine culture is taken.

3-Basic routine blood analysisIt should definitely be requested from the patient with the complaint of hematuria.

4-Imaging tests: Ultrasonographic imaging, which is easily accessible and feasible at first, is the basic examination method in patients with bleeding in the urine. In addition, when necessary, computed tomography (CT) and magnetic resonance (MR) imaging may be requested.

5-Cystoscopy: If a result cannot be obtained with other methods, cystoscopic (endoscopic) examination may be required. Cystoscopy is a diagnostic method that allows examination of the bladder and urinary canal (urethra) using a light-camera endoscope called a cystoscope, which is used for some other clinical conditions (stone, tumor, prostate, etc.), especially for bladder cancer.

6- Sometimes the cause of bleeding in the urine cannot be found.In this case, he or she may recommend regular follow-up, especially if there are risk factors for bladder cancer such as smoking, exposure to environmental toxins, or a history of radiation therapy.


The treatment of blood in the urine is possible by eliminating the main cause of bleeding. Bleeding is not a disease but a symptom of an existing disease. When the disease causing bleeding is treated, hematuria is also cured.

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