Bleeding in Urine, Bloody Urination (Hematuria)

The presence of blood and blood cells in the urine visually or under the microscope is called “hematuria” or “bloody urine”. This is visible (gross) or urine output. It can be seen on examination (microscopic). In both cases, the cause of the bleeding It is important to determine. Blood in the urine is a cause for concern and most In this case, although the cause is harmless, blood in the urine (hematuria) indicates a serious disorder. can. When urine is mixed with a very small amount of blood, it is pink to dark according to the amount of blood. It can be seen with the naked eye in colors ranging from red. Bleeding in the urine is usually painless, if there are blood clots in the urine due to obstruction or accompanied by infection pain may occur. Even without any symptoms, microscopic Although there may be hematuria, it may last for years without the patient noticing. Many serious diseases In case of blood in the urine, which is a symptom of blood, a doctor should be consulted. Some medicines containing dyes such as azo, which relieve constipation and dye the urine red, and some foods (beet, strawberry, raspberry, blackberry etc.) urine without blood in the urine can dye it red. Again, heavy exercises (especially long distance runners) then blood may be seen in the urine, within a few days the urine will return to normal. hematuria Other risk factors include age and certain inherited diseases.

Causes of Hematuria

The maximum number of blood cells (erythrocyte) 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 in urination, 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 that 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 non-microbial and filtration units of the kidney, these can be a symptom of kidney failure to the point of transplantation (kidney transplantation). 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 clots or 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, bleeding in the urine can be seen in some drugs. Anticancer drugs such as cyclophosphamide, radiotherapy, blood thinners and penicillin-type antibiotics can cause serious bleeding in the urine.


1- History and physical examination are the first steps in the investigation of hematuria. 2-Simple urine test: Even if there is visible bleeding, a simple urine test is required to detect 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 analyzes should definitely be requested from the patient with 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 so-called cystoscope, which is used for some other clinical conditions (stone, tumor, prostate, etc.), especially bladder cancer.

It is the basic diagnosis/diagnosis method that allows the examination of the bladder and urinary canal (urethra) using a light-camera endoscope.

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. TREATMENT

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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