Haematuria, commonly referred to as blood in the urine, is a condition that can signal a range of health issues, from minor infections to serious kidney disorders. This condition is relatively common and may affect individuals of all ages, including children, adults and older individuals.
In some cases, haematuria may appear suddenly and without pain, while in others it may occur alongside symptoms such as discomfort during urination, frequent urination or lower abdominal pain. The appearance of blood in urine can be alarming for many people, and it is important to understand the potential causes in order for individuals to recognise when medical assessment is necessary. Early detection and timely treatment can help prevent complications, support kidney health and contribute to the management of underlying conditions.
The Most Common Types of Haematuria
Haematuria primarily comes in two main forms based on how the blood is detected in the urine. These include:
Microscopic Haematuria:
Microscopic haematuria occurs when blood cells are present in the urine but are not visible to the naked eye. This type is often discovered during routine urine tests or health screenings for unrelated conditions. While microscopic haematuria may not cause immediate concern, it still warrants medical evaluation to rule out underlying problems.
Gross Haematuria (Visible Haematuria):
Gross haematuria, also known as macroscopic haematuria, is when blood in the urine can be seen without any special equipment. The urine may appear pink, red, brown or even cola-coloured, depending on the amount of blood present. In some cases, small or large blood clots may also be visible.
What Causes Haematuria?
There are multiple potential causes of each type of haematuria. This condition is further classified according to the underlying causes linked to the presence of blood.
Infective Haematuria:
Urinary tract infections (UTIs), bladder infections (cystitis), kidney infections (pyelonephritis) and urethritis can all inflame and irritate the lining of the urinary tract, leading to bleeding. These infections often present with additional symptoms such as frequent urination, burning sensation during urination, cloudy or foul-smelling urine and sometimes fever.
Stone-related Haematuria:
Kidney or bladder stones can cause bleeding as they move through the urinary tract. The sharp edges of these stones can scratch the delicate lining of the urinary system, resulting in blood in the urine. This is often accompanied by severe pain in the back, side or lower abdomen.
Trauma-related Haematuria:
Physical injury to the kidneys, bladder or other parts of the urinary tract can cause blood in the urine. This may result from pelvic trauma, direct injury to the kidneys or the presence of foreign bodies in the urinary tract. Medical procedures involving the urinary system can also occasionally cause temporary haematuria.
Renal Haematuria:
Renal haematuria originates from the kidneys themselves. Conditions such as glomerulonephritis (inflammation of the kidney's filtering units) and other renal disorders can lead to bleeding. This type may be accompanied by symptoms such as swelling in the hands or feet, high blood pressure and fatigue.
Iatrogenic Haematuria:
Iatrogenic haematuria refers to blood in the urine resulting from medical interventions or medications. Recent endoscopic procedures, catheterisation, kidney biopsies or the presence of ureteric stents can cause temporary bleeding. In addition, certain medications, particularly blood thinners, can increase the risk of bleeding in the urinary tract.
Benign Haematuria:
Benign causes of haematuria include non-cancerous conditions such as benign prostatic hyperplasia (BPH) in men, where an enlarged prostate gland compresses the urethra and can cause blood in the urine. Urethral strictures and certain benign kidney masses can also result in haematuria.
Malignant Haematuria:
In some cases, haematuria may indicate cancer of the bladder, kidney or prostate. While this is less common, it is one of the reasons why persistent or unexplained haematuria should always be investigated thoroughly, especially in older adults or those with risk factors like smoking.
When Should I See a Doctor for Haematuria?
- Blood in the urine accompanied by pain or burning during urination
- Frequent or urgent need to urinate that is accompanied by haematuria
- Blood clots in your urine
- Persistent or recurrent haematuria
- Difficulty starting urination, weak stream or feeling of incomplete bladder emptying
- Fever, chills, nausea or vomiting accompanying haematuria
- Severe pain in your back, side or lower abdomen
Seeking Specialist Care for Haematuria
Although haematuria can sometimes be caused by temporary or minor conditions, it should never be ignored. Blood in the urine may be the first sign of an underlying issue, and identifying the cause early allows doctors to determine the severity of the condition. Timely assessment can make a major difference in treatment outcomes and resolving the source of your discomfort.
