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Hematuria means blood in the urine. It is not a disease but can be a sign of a disease. The structure of the urinary tract in the male & in the female is shown in the diagram below. Blood can originate form any of these organs. Hematuria is described as gross if the urine is red or brown & microscopic if the urine appears clear; but when examined under a microscope, shows presence of Red Blood Cells (RBC). Hematuria can come & go, even when it is caused by a serious disease. This is why should consult your doctor immediately.

There are many causes of Hematuria & in about 25% of the patients, the cause may be a serious disease. Some of the common causes are

Urinary Stone Disease - Usually this is associated with pain in the abdomen, back or in the urinary passage.

Urinary Tract Infection (UTI) - Though usually associated with frequency, pain & burning while urinating, sometimes infection can produce Hematuria. In general, infections, especially cystitis, are more common in women. Sometimes, Hematuria may follow sexual intercourse.

Urinary Tract Cancer - Cancer anywhere in the urinary tract can cause Hematuria. In fact this is one of the commonest symptoms of such cancers.

Enlarged Prostate - Though a rare cause, in some older men, inflammation & rarely cancer of prostate can produce Hematuria.

Injury - fall from a height, injury to the back or rigorous exercises or running can also lead to Hematuria.

Other Causes - Rarely underlying medical problems such as nephritis, ingestion of medications such as aspirin, some anti cancer medicines & food allergies can produce Hematuria.

The cause of Hematuria can vary depending on the patient's age. Though it is a rare condition in small babies, in young children it may indicate inflammation of kidneys or stone disease. In young adults, urinary tract stone is the commonest cause though infection (especially in young women) & rarely cancer can also be seen in this age group. Above the age of 40, both in men & women, urinary tract cancer is the most common serious cause of gross Hematuria followed by stones & infection. Smokers & people exposed to certain chemicals (because of their occupation) may be more prone to developing such cancers. In men, above the age of 60, in addition to the above causes, prostate gland enlargement may be responsible for Hematuria.

If you suffer from Hematuria, most important thing is to get yourself seen by an expert. He will first examine you & then carry out some simple investigations, which may give a clue about the possible cause of Hematuria. Following investigations should be done in every case of Hematuria.

Urine Examination Including Urine Culture Test - this will confirm the presence of blood in the urine & may give some additional information regarding its cause.

Sonography - this is one of the simplest tests, whereby ultrasound waves are used to scan the urinary tract. Majority of common causes of Hematuria can be diagnosed on sonography.

Special Tests - depending on the results of the above, some patients are advised to undergo following tests

Urine cytology - in this test, a urine sample is checked for presence of cancerous cells.

IVU - This is a special form of X-ray where an intravenous dye is used to make the kidneys visible on an X-ray. This gives very useful information both about the function & anatomy of the urinary tract.

Cystoscopy - Here a telescope is inserted through the external urinary passage & urinary bladder is inspected. This is the only test, which gives complete information about the urinary passage & the urinary bladder.

C.T. Scan / MRI scan - These highly sophisticated investigations are advised in some cases of urinary tract cancer, especially prior to planning major operative treatment. Rarely, these tests are carried out when the cause of Hematuria remains obscure, in spite of the above investigations.

Treatment of Hematuria

Treatment of Hematuria depends on its cause. However, drinking plenty of liquids can help in diluting the urine. Since Hematuria is not a disease in itself, treatment can be given once the cause of Hematuria is detected. E.g. UTI is treated with antibiotics, urinary tract stones are treated by appropriate non-invasive or minimally invasive treatment modalities depending on their size & location. Urinary tract cancer especially if in the urinary bladder, can often be treated endoscopically.

Even though Hematuria may be intermittent, the patient must get himself/herself thoroughly investigated to prevent it from developing into a serious problem.