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Clots in the Urine ( Hematuria ) - Causes, Symptoms, Diagnosis, and Treatment

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Clots in the Urine ( Hematuria ) - Causes, Symptoms, Diagnosis, and Treatment

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The typical color of urine ranges from pale yellow to deep amber, but peeing blood clots or red-colored urine signals severe health problems.

Medically reviewed by

Dr. Ankush Jairath

Published At September 20, 2021
Reviewed AtMay 7, 2024

What Is Hematuria?

Hematuria is a condition characterized by excessive blood in the urine. Hematuria is categorized into two types based on whether the blood in the urine is visible to the naked eye.

  • Microscopic Hematuria - On occasions, the presence of blood in urine may not be visually detectable. In cases of microscopic hematuria, the red blood cells can only be identified through laboratory testing.

  • Gross Hematuria - In this particular type, the presence of blood is apparent. Rather than its typical pale yellow hue, the urine may exhibit colors such as pink, red, brownish-red, or tea-colored.

What Are the Symptoms of Hematuria?

Gross hematuria produces red or pink-colored urine due to the presence of red blood cells (RBC). A little blood is enough to make the urine red, and bleeding is usually not painful, but passing blood clots in the urine can be painful. In some instances, blood in the urine will not produce any symptoms.

What Are the Causes of Hematuria?

Hematuria is when the kidneys or other parts of the urinary tract allow red blood cells to leak into urine. Some other problems that can cause this leakage are,

1. Urinary Tract Infections (UTI) - UTI occurs when bacteria enter the body through the urethra and multiply in the bladder.

Symptoms:

  • Persistent urge to urinate.
  • Pain during urination.
  • Burning sensation with urination.
  • Offensive odor in urine.

2. Enlarged Prostate - The prostate gland, which is just below the bladder and surrounding the top part of the urethra, is often enlarged in middle-aged men. It then compresses the urethra and partially blocks the urine flow.

Symptoms:

  • Difficulty in urinating.
  • Urgent or persistent need to urinate.
  • Visible or microscopic blood in the urine.

3. Kidney Infections (Pyelonephritis) - Pyelonephritis occurs when bacteria enter the kidneys from the bloodstream or move from the ureters to the kidneys.

Symptoms:

  • Fever.
  • Flank pain.
  • Frequent urge to urinate.
  • Pain during urination.
  • Burning sensation while urinating.
  • Unpleasant odor of urine.

4. Bladder or Kidney Stone - The minerals present in the concentrated urine sometimes form crystals on the kidney or bladder walls. After some time, these crystals become small and turn into hard stones.

Symptoms:

It is painless and does not produce pain until it causes blockage or is being passed. After, it starts to block the urine and it creates,

  • Excruciating pain.
  • Visible or microscopic blood in the urine.
  • Fever.
  • Vomiting.
  • Chills.
  • Nausea.

5. Inherited Disorders - Sickle cell anemia is a hereditary disorder of hemoglobin in red blood cells (RBC), which causes blood in the urine (both visible and microscopic hematuria).

6. Cancer- Visible blood in the urine may be a sign of advanced bladder, kidney, or prostate cancer.

7. Medications - Urinary bleeding can be caused by anti-cancer drugs such as:

  • Cyclophosphamide.
  • Penicillin.
  • Visible urinary bleeding sometimes occurs on taking an anticoagulant, such as:
  • Aspirin.
  • Blood thinner Heparin.

8. Kidney Injury - A blow or other injuries in the kidneys from contact sports or an accident can cause visible blood in the urine.

9. Strenuous Exercise - It is rare for strenuous exercises to cause gross hematuria, but the cause is unknown. It is linked to,

  • Trauma to the bladder.
  • Dehydration.
  • Breakdown of red blood cells.
  • Runners are most commonly affected; anyone can develop visible urinary bleeding after intense workouts.
  • Other reasons for having blood in the urine are:
  • Trauma.
  • Vigorous exercise.
  • The hepatitis virus causes inflammation of the liver and liver diseases.
  • Sexual activity.
  • Menstruation.
  • Endometriosis.
  • More serious causes for people to have hematuria are:
  • Bladder or kidney cancer.
  • Inflammation of the urethra, kidney, bladder, or prostate.
  • Blood clotting disorders, such as hemophilia.
  • Sickle cell disease (abnormally shaped red blood cells).
  • Polycystic kidney disease.

What Are the Risk Factors of Hematuria?

Blood in the urine can affect people of various ages, including children and teenagers. Several factors can increase the likelihood of this condition:

  • Age: Middle-aged and older men, especially those over 50, may have a higher risk due to conditions like an enlarged prostate gland or certain cancers.
  • Urinary Tract Infections: Common among children, UTIs are a leading cause of blood in the urine.
  • Family History: Individuals with a family history of kidney disease may have an increased risk.
  • Certain Medications: Blood thinners, pain relievers, and antibiotics can elevate the risk of hematuria.
  • Intense Physical Activity: Engaging in vigorous exercise, such as marathon running or contact sports, can also raise the risk of blood in the urine.

How Is Hematuria Diagnosed?

Hematuria and its cause can be diagnosed by the following:

1. Medical History:

Taking a medical history will help a doctor diagnose the cause of hematuria. It will include,

  • The patient's current and past medical history.

  • Review of symptoms.

  • List of prescription medicines.

  • Over-the-counter medicines.

2. Physical Examination:

During a physical examination, the doctor taps on the abdomen and back to check for pain or tenderness in the kidney or bladder area.

  • A digital rectal examination is done in men to look for any prostate problems.

  • A pelvic examination is done in women to look for red blood cells in the urine.

3. Urinalysis:

The doctor will test the urine using a dipstick or send it to a laboratory for analysis. Sometimes, the urine tests using a dipstick could be positive even though the patient does not have blood in the urine, resulting in a false-positive test. The test samples (urine) are diagnosed under a microscope before ordering other tests.

Before obtaining a urine sample, women will be asked for the last menstrual date. Sometimes, blood from the menstrual period can get into the urine sample and result in a false-positive test for hematuria. Once the menstruation stops, the test will be repeated.

The healthcare professional will confirm the presence of any red blood cells by examining the collected urine under a microscope before ordering other tests.

4. Additional Testing:

When the urine samples detect too many red blood cells (RBCs), then the doctor will order additional tests. They are,

  • Blood test.

  • Computed tomography (CT) scan.

  • Cystoscopy.

  • Kidney biopsy.

  • Magnetic resonance imaging (MRI).

What Are the Potential Complications Associated With Hematuria?

The treatments for hematuria, which encompass medications and procedures, may entail distinct side effects depending on the specific treatment modality. Nevertheless, neglecting hematuria could escalate into more significant issues, particularly if the underlying cause is more serious than physical exertion. A healthcare provider must address any condition precipitating blood in the urine. In cases where the cause involves conditions such as cancer or kidney disease, timely identification facilitates early intervention, which in turn enhances prognosis and outcomes.

Conclusion

Blood in urine, known as hematuria, can arise from various causes, including infections, kidney stones, or more serious conditions like kidney disease or cancer. Prompt medical evaluation is crucial for accurate diagnosis and timely intervention. Whether visible to the naked eye or detected only through laboratory testing, hematuria warrants attention to ensure proper management and potential resolution.

Frequently Asked Questions

1.

Whether Blood Clots in the Urine Serious?

Some causes of hematuria (blood in the urine) can be severe, and others can be harmless and may require no treatment. However, it is necessary to consult a healthcare professional. Gross hematuria often occurs without many symptoms, but heavier bleeding with blood clots is an emergency that can be painful and block bladder outlets leading to urine blockage.

2.

What Cancer Is Associated With Blood in the Urine?

Kidney and bladder cancers are usually associated with blood in the urine. The symptoms will be passing rust-colored urine or clots, tissues, or blood in the urine. Around ten percent of patients with hematuria have kidney or bladder cancer.

3.

Why Do People Experience Hematuria Without Any Infection?

Hematuria can occur without any infections, and it has multiple causes. Sometimes, other red substances (pigments) in the urine, like eating excessive beets, food dyes, or certain medications such as Phenazopyridine, can produce red color in the urine.

4.

What Are the Common Causes of Blood in the Urine?

Hematuria has various causes, including:
 - Urinary tract infections.
 - Bladder or kidney stone.
 - Kidney infections.
 - Enlarged prostate.
 - Kidney, bladder, or prostate cancer.
 - Kidney injuries.
 - Certain medications like Cyclophosphamide and Penicillin.
 - Excess exercise.

5.

Can Dehydration Result in Hematuria?

 
Severe or continuous dehydration can cause blood in the urine. Lack of water required amount of fluid can exacerbate underlying kidney conditions contributing to kidney disorders like kidney stone, which causes hematuria.

6.

Does Hematuria Go Away on Its Own?

A number of different conditions can cause hematuria. But most of the time, it may not be due to severe causes and will get cured soon. However, treatment might be required, which may involve taking antibiotics or other prescription medication.

7.

Is Hematuria Caused Due to Stress?

Stress is not directly related to blood in the urine. But excessive stress can cause weaker urine retention and incontinence (lack of control over urination); however, it cannot result in hematuria. Hematuria usually occurs due to underlying diseases, such as UTI (urinary tract infection), sickle cell disease, kidney cancer, and others that may cause urinary bleeding.

8.

Which Organ Is Involved in Causing hematuria?

 
Hematuria usually occurs with kidney or urinary tract diseases, disorders, or injuries. There are various causes for blood in the urine, such as urinary tract infections, kidney stones, kidney or bladder cancer, etc. It is necessary to consult a doctor to rule out the cause and aid in treatment.

9.

What Quantity of Blood Is Considered Hematuria?

When there is the presence of at least five red blood cells/HPF in three of three consecutive centrifuged specimens collected at least seven days apart is considered hematuria. It can be asymptomatic or symptomatic and may have other urinary tract abnormalities.

10.

What Causes Painless Hematuria?

Painless haematuria can usually occur due to underlying malignancies, whereas pain-associated hematuria is commonly seen with UTIs and kidney stones. Also, blood at the start of the urinary stream may be due to lower urinary tract malignancy.

11.

What Is the Prognosis for Blood in the Urine?

The prognosis for hematuria varies depending on the underlying cause. In the case of mild to moderate infection, the prognosis is good. If hematuria is accompanied by proteinuria, it indicates significant kidney disease; in such cases, there is a poor prognosis. Also, hypertension and abnormal renal function have a poor prognosis.

12.

Is Hematuria a Temporary Condition?

Hematuria can last till it eliminates the causative disease or condition. For infections, antibiotics therapy will help to treat the cause and cease hematuria as well. For people with long-term medications such as blood thinners or chronic illnesses, hematuria may last long.

13.

When to Consult a Doctor for Hematuria?

Most cases of blood in the urine are not very serious. Since some of the causes of hematuria are serious, it is necessary to seek medical attention immediately after seeing blood in the urine. Also, immediate medical attention is needed if hematuria is associated with nausea, vomiting, pain in the sides, back, or abdomen, fever, and chills.

14.

Does a Urologist Provide Treatment for Hematuria?

A general physician or urologist provides the treatment for hematuria. Hematuria occurs when blood enters the urine. The urine color will be red, orange, pink, or cola-colored. Urologists use various diagnostic tests to detect hematuria.
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Dr. Ankush Jairath
Dr. Ankush Jairath

Urology

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