Michael Hirsh, MD
Michael Hirsh, MD





Should I be concerned about Blood in My Urine?

Michael Hirsh, MD
Western Wisconsin Urology
Eau Claire

If you have ever urinated bright red blood, you were probably quite alarmed at the sight. Blood in the urine is also known as hematuria. Hematuria is classified as “gross” or “microscopic”. Gross hematuria is blood in the urine that you can see. Microscopic hematuria is not visible with the naked eye; it is usually diagnosed in the physician’s office through a microscopic examination of the urine. Hematuria may resolve with increased fluid intake and rest; however, it is important to determine the source for the hematuria, as many serious health conditions can cause hematuria.

The kidneys, ureters, bladder, urethra, and prostate (in men), make up the urinary tract. Gross or microscopic hematuria may originate in any of these parts of the body.

Causes for hematuria range from benign to serious conditions. Some causes include:

• Enlarged prostate
• Urinary tract/kidney/bladder infection
• Kidney stones
• Prostatitis
• Cancer: bladder, kidney(s), prostate, ureter(s), or urethra

Exercise is one of the most common causes of non-threatening hematuria and can be either microscopic or grossly visible blood. Hematuria has been described after a variety of forms of exercise, including the obvious contact sports such as football, wrestling and boxing. Also, non-contact sports can predispose a person to the development of hematuria. Sports, such as long-distance running, rowing and swimming have been implicated. Bike riding is a rare cause, even on a stationary bike. Roughly 20% of marathon runners after a race will have microscopic hematuria that lasts 3–7 days.

Both gross and microscopic hematuria should be evaluated by a physician. Once an individual has a diagnosis of hematuria, the urologist may order a number of tests to determine the cause of the hematuria.

  • A cystoscopy is an in-office procedure performed by the urologist. The physician looks into the patient’s bladder with a scope to identify any bladder defects or tumors that may be causing the hematuria.
  • The physician may collect the patient’s urine for cytology, which is a laboratory test that looks for malignant cells in the urine
  • The physician may order a CT scan to look for stones or tumors in the kidneys or ureters as a cause of hematuria.

If the cause is likely exercise induced hematuria, usually it is up to the discretion of one’s physician to repeat urine testing or continue on for a complete workup. The presence of hematuria in a patient on anti-coagulation therapy (ie., Coumadin, Plavix) may lead a clinician to underestimate urological pathology. In patients on anti-coagulation therapy it should not be assumed the anti-coagulant is the sole cause of hematuria. The differential diagnosis of hematuria should almost always include both benign and malignant etiologies. Thus a work-up is almost always warranted even in the presence of anti-coagulant status of the patient.

Sometimes testing does not determine a cause for hematuria. If that is the case, the physician will then consider a number of factors in recommending follow-up.

Follow-up factors include:

• Whether the hematuria is gross or microscopic
• History of hematuria recurrences
• Patient’s personal history (i.e., smoking history, personal medical history,
  including anti-coagulation therapy)

Follow-up may include repeating tests from the initial workup.

Hematuria is resolved through treatment of the cause. For example, if a kidney stone is the cause, then hematuria is resolved by removal of the stone. Hematuria is also common after urologic surgery; as the urinary tract heals, urine may appear dark or bright red and then turn to a pink color. This can occur for several weeks post-operatively and the individual may also pass blood clots through the urinary tract as part of the healing process.

Whatever the cause, hematuria is a condition that must be addressed. To learn more about hematuria and other urologic conditions and treatment options, visit the Western Wisconsin Urology website at www.eauclaireurology.com.


Dr. Hirsh – Western Wisconsin Urology
For information or to schedule an appointment:
715-835-6548  |  www.eauclaireurology.com
Dr. Hirsh sees patients in Eau Claire, Baldwin, Durand, Ladysmith, Neillsville, and Lake City, MN.