Dr Alvin Ng
Senior Consultant Nephrologist
MBChB (Auckland), FRACP (Aus), FAMS (Renal Medicine)
What Exactly Is Hematuria?
Hematuria simply means there is blood in the urine. It is not a disease by itself but a symptom that can appear for many reasons related to the urinary system, which includes the kidneys, ureters, bladder, prostate, and urethra. The appearance of blood in the urine can vary widely from person to person. In some cases, the amount is so small that it can only be seen under a microscope, while in others, the colour of the urine changes visibly. These two forms are known as microscopic and gross hematuria.
● Microscopic Hematuria
Microscopic hematuria occurs when only a small number of red blood cells are present in the urine, not enough to change its colour. Because the blood is invisible to the naked eye, this type of hematuria is usually discovered during routine laboratory testing. The urine typically appears normal in colour, remaining clear or yellow, even though small traces of blood are present under microscopic examination.
● Gross Hematuria
Gross hematuria refers to blood in the urine that is visible without magnification. The urine may appear pink, red, or cola coloured depending on the amount of blood and how long it has been present. Although the sight of blood can be alarming, the intensity of the colour does not always reflect how serious the cause is. Nevertheless, because gross hematuria is noticeable, it often prompts people to seek medical evaluation more quickly than microscopic hematuria.
Common Causes of Blood in the Urine Among Women
Blood in the urine can occur for many reasons, ranging from mild, temporary issues to more serious medical conditions. Understanding the possible causes helps ensure early diagnosis, appropriate treatment, and peace of mind.
● Urinary Tract Infections (UTIs)
A UTI develops when bacteria enter and multiply within the urinary tract, leading to inflammation and irritation of its lining. This can result in small amounts of blood appearing in the urine. Other typical symptoms include a burning sensation during urination, an urgent or frequent need to urinate, and lower abdominal or pelvic discomfort.
● Kidney Infections (Pyelonephritis)
A kidney infection is a more serious type of UTI that affects one or both kidneys. It can cause blood in the urine along with fever, chills, nausea, and sharp pain in the back or side. Because kidney infections can lead to complications if untreated, prompt medical attention is crucial.
● Kidney Stones
Kidney stones are solid mineral or salt deposits that form inside the kidneys. As they move through the urinary tract, they can scrape against its delicate lining, causing pain and bleeding. The resulting hematuria may be visible, and the associated pain is often described as intense or cramping, sometimes radiating to the lower abdomen or groin.
● Vigorous Exercise
Intense physical activity, such as long-distance running, high-impact sports, or heavy weightlifting, can occasionally cause temporary bleeding in the urinary tract. This is known as exercise-induced hematuria. It typically resolves on its own within a few days but should still be evaluated to rule out other causes.
● Medications
Certain medications can contribute to blood in the urine by increasing the likelihood of bleeding. Common examples include aspirin, blood thinners, some antibiotics, and chemotherapy drugs. If medication-related bleeding is suspected, a healthcare provider can review the treatment plan and recommend appropriate adjustments.
● Cancer
In some cases, hematuria may be an early sign of more serious conditions such as bladder cancer, kidney cancer, or other urinary tract malignancies. Early medical evaluation is critical for accurate diagnosis and timely treatment. While cancer is a less common cause, it should always be considered when blood in the urine occurs without a clear explanation.
● Menstrual Blood Contamination
At times, what appears to be blood in the urine is actually menstrual blood that mixes with urine during urination. This can make it difficult to tell whether the bleeding is from the urinary tract or the reproductive system. Careful observation and, when necessary, a urine test can help confirm the true source.
Common Risk Factors for Hematuria in Women
Women are more likely to experience blood in the urine due to certain biological and hormonal factors. Understanding these helps in identifying potential causes early.
- Higher risk of UTIs: Women have a shorter urethra that sits closer to the anus. This makes it easier for bacteria to enter the urinary tract, increasing the risk of infection. UTIs are one of the most common causes of blood in the urine among women.
- Pregnancy: During pregnancy, the growing uterus puts pressure on the bladder and urinary tract. Hormonal changes can also make these areas more sensitive to irritation or infection. Together, these factors can lead to urinary discomfort or visible blood in the urine.
- Menopause: After menopause, lower oestrogen levels can thin the lining of the urinary tract and reduce its natural defences. This raises the risk of urinary tract infections and inflammation, both of which may cause blood to appear in the urine.
How Is Hematuria Diagnosed
When blood appears in the urine, identifying its cause begins with a detailed evaluation. Your doctor will start by reviewing your symptoms and medical history, followed by a series of tests to determine the source of the bleeding and assess overall urinary health.
- Urinalysis: A urinalysis is often the first test performed. It examines the appearance and composition of your urine, checking for red blood cells, protein, and other substances that can indicate infection or kidney problems.
- Urine Culture: This test helps detect bacterial infections in the urinary tract, one of the most common causes of blood in the urine.
- Blood Tests: Blood samples might be taken to look for infection, measure kidney function, and rule out other systemic conditions that could cause hematuria.
- Imaging Studies: Scans such as ultrasound or CT provide a clear view of the kidneys, bladder, and ureters. These imaging tests help identify stones, tumours, or structural abnormalities that may be responsible for the bleeding.
- Cystoscopy: In this procedure, a thin, flexible tube with a small camera is inserted through the urethra into the bladder. It allows the doctor to examine the urinary tract lining directly and identify any abnormalities or potential sources of bleeding.
Hematuria Treatment Options
Treatment for hematuria depends on the underlying cause. Once the source of bleeding has been identified, your doctor will recommend the most appropriate approach to relieve symptoms, address the root problem, and prevent recurrence.
- Antibiotics: If the bleeding is due to a urinary tract infection (UTI) or prostatitis, antibiotics are prescribed to clear the infection. Treating the infection usually resolves the hematuria and reduces the risk of future episodes.
- Medication Management: When hematuria is linked to kidney inflammation (such as glomerulonephritis) or autoimmune conditions, medications that control blood pressure, reduce inflammation, or suppress the immune response may be recommended.
- Pain Management and Hydration: If small kidney stones are responsible for the bleeding, conservative management such as increased fluid intake and pain relief may help the stones pass naturally without surgical intervention.
- Lithotripsy or Ureteroscopy: For larger or persistent stones, these minimally invasive procedures can help break down or remove stones that cause irritation and bleeding in the urinary tract.
- Surgery: In cases where hematuria stems from tumours, structural abnormalities, or severe trauma, surgery may be necessary to remove the source of bleeding and restore normal urinary function.
- Ongoing Monitoring: Even after the cause is treated, regular follow-up with your doctor ensures that hematuria does not return and that any underlying conditions remain well-controlled.
Hematuria Prevention Tips for Women
Adopting healthy daily habits can significantly lower the risk of hematuria and other urinary tract problems. While not all causes of blood in the urine can be prevented, maintaining good urinary and reproductive health helps reduce many common risk factors.
- Stay Hydrated: Drink plenty of water throughout the day to keep your urinary tract functioning properly. Staying hydrated helps dilute the urine, flush out bacteria, and reduce the risk of kidney stones and infections.
- Practise Good Hygiene: Proper genital hygiene is essential for preventing urinary tract infections. Always wipe from front to back after using the toilet and choose breathable underwear to reduce moisture and irritation.
- Urinate Regularly: Avoid holding in urine for long periods. Regular urination helps remove bacteria from the bladder before they have a chance to multiply, lowering the risk of infection.
- Use Blood-Thinning Medications with Care: Take blood-thinning medications only as prescribed and under medical supervision. Overuse or unsupervised use can increase the risk of bleeding, including in the urinary tract.
- Urinate After Intercourse: Passing urine soon after sexual activity helps flush out bacteria that may have entered the urethra, reducing the likelihood of urinary tract infections.
- Manage Menstrual Health: Track your menstrual cycles and note any changes in bleeding patterns. This can help you differentiate between menstrual bleeding and blood in the urine, ensuring you seek medical advice when needed.
When to See a Doctor for Blood in the Urine
Blood in the urine should never be ignored. Even if it appears only once or causes no pain, it can be an early sign of an underlying condition that requires medical attention. The sooner the cause is identified, the easier it is to treat and prevent complications.
At The Kidney Health Care Clinic, we comprehensive testing and personalised treatment for women experiencing hematuria or other kidney-related conditions. Using advanced diagnostic tools and evidence-based care, Dr Alvin Ng, our kidney specialist, works to determine the exact cause of bleeding and develop a treatment plan that supports lasting urinary and kidney health.
If you have noticed blood in your urine, schedule an appointment with our clinic today to receive expert evaluation, accurate diagnosis, and compassionate care from our dedicated specialists.