Four Common Causes of Hematuria (Blood in The Urine)

Hematuria is a condition in which red blood cells are found in the urine. Hematuria can be macroscopic (also called gross hematuria), where blood is visible with the naked eye, or it can be microscopic, only visible when examined under a microscope.

Here are four of the most common causes of this condition.

1. Urinary Tract Infections

Urinary tract infections (UTIs) are the most common cause of hematuria. Since the urinary tract is composed of the bladder, ureters and kidneys, a UTI refers to an infection anywhere in that system. A bladder infection is called cystitis, and a kidney infection is called pyelonephritis.

UTIs are typically caused when bacteria on the skin of the perineum (the space between the rectum and genitals) tracks in through the urethra and then into the bladder. If a bladder infection goes undetected or untreated, the infection can continue to spread upward through the ureters and into the kidneys. 

Since women’s urethras are five times shorter than men’s on average, women are much more prone to UTIs than men.

In addition to hematuria, common UTI symptoms include burning with urination, urinary frequency and urinary urgency. Patients with pyelonephritis can also experience flank or back pain, a fever and vomiting.

Anyone with UTI symptoms should seek medical attention, as antibiotics are required to treat the infection and reduce the risk of serious complications, like a kidney infection.

2. Urinary Tract Tumors

Any patient with hematuria requires a medical workup to look for the source of the problem, because in some cases, hematuria is a sign of a tumor in the urinary tract. 

The most common urinary tract tumor is bladder cancer, which is more common in adults ages 65 and older, and more common in men than women. Cigarette smoking is another major risk factor for bladder cancer, responsible for as many as 60% of cases.

While patients with urinary tract tumors often fare well if diagnosed and treated early, if these tumors go undetected or untreated, they can be fatal. Therefore, any patient with hematuria should seek prompt medical attention to determine the source of the blood.

3. Kidney Stones

Kidney stones, called urolithiasis, are another common cause of hematuria. Kidney stones lead to more than half a million E.R. visits in the U.S. each year. It’s estimated that 1 in 10 people in the U.S. will experience a kidney stone in their lifetime.

In addition to macroscopic or microscopic hematuria, kidney stones can also cause vomiting and severe, one-sided flank pain that comes in waves (called colicky pain).

Kidney stones are diagnosed on imaging -- typically either ultrasound or CT scan. Stones that are less than 6 millimeters (approximately ¼”) in diameter usually pass on their own, while larger stones often require a surgical procedure to break them into smaller pieces so the patient can pass them.

I.V. fluids and medication to alleviate vomiting and pain are often indicated for patients who are experiencing a kidney stone.

4. Prostatitis

The prostate is a walnut-sized gland that sits between a man’s rectum and bladder and surrounds the top of the urethra. When the prostate becomes infected or inflamed (a condition called prostatitis), it can cause hematuria.

Other symptoms of prostatitis include frequent urination, urinary retention, fevers and pain in the back, lower abdomen or pelvis. Prostatitis is often treated with antibiotics, and with medication that decreases prostate inflammation.

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