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

What Is Hematuria?

Hematuria is a condition characterized by the presence of excessive blood in the urine. There are two types of hematuria, they are,

• Microscopic Hematuria - When the blood in the urine is not visible to the naked eye, and can be detected only through laboratory examination, it is known as microscopic hematuria.

• Macroscopic Hematuria - When the blood in the urine is visible to the naked eye, it is called macroscopic hematuria.

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, the presence of blood in the urine will not produce any symptoms.

What Are the Causes of Hematuria?

Hematuria is a condition in which 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 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, and anyone can develop visible urinary bleeding after intense workouts.

Other reasons for having blood in the urine are,

1. Trauma.

2. Vigorous exercise.

3. Hepatitis virus causing inflammation of the liver and liver diseases.

4. Sexual activity.

5. Menstruation.

6. Endometriosis.

More serious causes for people to have hematuria are,

1. Bladder or kidney cancer.

2. Inflammation of the urethra, kidney, bladder, or prostate.

3. Blood-clotting disorders, such as hemophilia.

4. Sickle cell disease (abnormal shaped red blood cells).

5. Polycystic kidney disease.

What Are the Risk Factors of Hematuria?

Anyone can have red blood cells in the urine, including children and teens. The following are the risk factors of hematuria,

1. Men above 50 years of age have occasional hematuria due to an enlarged prostate gland.

2. The viral or bacterial infection leads to inflammation of the kidneys (post-infectious glomerulonephritis), which can cause visible urinary blood in children.

3. Family history of kidney stones or disease has increased risk of blood in the urine.

4. Aspirin, nonsteroidal anti-inflammatory drugs, and antibiotics such as Penicillin increase the risk of urinary bleeding.

5. Exercise-induced urinary bleeding occurs in long-distance runners, but anyone who does an intense workout can develop these symptoms. The condition is sometimes called jogger's hematuria.

How Is Hematuria Diagnosed?

Hematuria and its cause can be diagnosed with,

1. Medical history.

2. Physical examination.

3. Urinalysis.

4. Additional testing.

1. Medical History:

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

• 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.

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

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

3. Urinalysis:

The doctor will ask you to test the urine in the office 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.

If you are a woman, before obtaining a urine sample, you will be asked when you last menstruated. Sometimes blood from the menstrual period can get into the urine sample and result in a false-positive test for hematuria. After you stop menstruating, the test will be repeated.

The health care 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).

How Is Hematuria Treated?

Treatment of hematuria involves treating the underlying cause. If it is not caused by a serious condition, then the person typically does not need treatment. Depending on the causative factor of hematuria, treatment includes,

• Antibiotics for urinary tract infections.

• Prescription medicine to shrink an enlarged prostate.

• Shock wave therapy to break the bladder or kidney stones.

There is no information about diet and nutrition playing a role in the cause or prevention of hematuria. Make sure to follow up with the doctor after the treatment to determine there is no presence of blood in the urine.