Does Blood in the Urine Necessarily Mean Something Wrong?

Man flushing toilet using thumb

Blood in the urine or hematuria can be common as we age. However, no matter how informed we are, blood in the urine can make it feel like a serious problem. Quite rightly, many patients are concerned and want to visit their primary care physician or urgent care to understand more. For the most part, male and female patients alike are diagnosed with urinary tract infections or UTIs. This is much more common in women than men. Because of the testing required to culture the urine and look for bacteria, some practitioners do not order follow-up tests, being quite confident that it is nothing more than a UTI. However, whenever it relates to the urinary tract, patients must advocate for themselves and speak to their urgent care or primary care physician for a referral to a qualified urologist.

What It Could Be – Benign

Most cases of blood in the urine are benign and may resolve with antibiotic therapy or no treatment at all. To be sure, the most common cause of hematuria is a UTI, and this is managed with antibiotic therapy. UTIs can begin just about anywhere in the urinary tract. Most occur in the bladder and tend to be less severe. This could be more problematic if the infection enters the kidneys. Often, urinary tract infections occur because of holding urine, whether knowingly or due to a disease or condition like BPH. As the bacteria proliferate, a burning sensation when urinating or blood in the urine often follows.

Surgery or Minimally Invasive Procedures

Some surgeries or minimally invasive procedures, especially those that access the urinary tract through the urethra, can cause blood in the urine for up to several days after the procedure. This is simply a result of the trauma of the procedure and will be explained in post-procedure instructions.

Kidney Stones

If you’ve ever had a kidney stone, you know how painful it can be. Even small kidney stones can cause excruciating pain. Most patients pass their kidney stones, but for those that can’t, we have excellent treatment options, both noninvasive and surgical. However, there are times when a kidney stone cannot be retrieved, at least not for a while. These kidney stones, although rare, can create bacteria that lead to a UTI.

Lastly, Malignancy

One of the reasons why you shouldn’t simply ignore blood in the urine is a phenomenon that Dr. Natale is acutely aware of – the uncommon but very unfortunate possible misdiagnosis of bladder cancer that results from a medical practitioner assuming that a urinary tract infection exists without doing testing to confirm this diagnosis. It most certainly doesn’t happen often, but it is possible, mainly when a urine culture or PCR test is not performed; typically, when a patient visits us with symptoms of a UTI, we prescribe antibiotic medication to get them started. We either continue them through the course of therapy or ask them to stop once we get the results of the urine culture, which could be anywhere from a day to three days after the visit. Without the test, we are guessing.

Not All Blood in the Urine Is Visible

There are two kinds of blood in the urine. Gross hematuria is blood you can see. This usually tints the urine pinkish red and is obvious in the toilet bowl. On the other hand, occult hematuria involves microscopic or trace amounts of blood in the urine. It can only be caught during a urinalysis, which every patient should have during their annual physical. Either way, blood in the urine is rarely an emergency, but it does require a call to your trusted urologist to get a proper diagnosis and learn more.

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