What Could Be The Cause For Blood In Urine?

Posted on Tue, 19 Nov 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 19 Nov 2013 Answered on

Wed, 18 Dec 2013 Last reviewed on

Question : I am a 53yr old female. I weigh 127 and am 5 ft 5 1/2 inches tall. I am a nonsmoker, with a history of SVT, and MVP. Today when I went to urinate I wiped and it was pink. I looked in the toilet and it was bloody. I called my family physician and they said to go to the ER. I did so, and they took a urine specimen and it came back moderate blood and a bit of bacteria. They put me on an antibiotic and said to take it for 7 days and then have it re-tested. I am at home now and still urinating blood. This is quite alarming to me because the dr didn't seem to think it was a urinary infection because he said there was just a trace of bacteria and a lot of blood. What else could it be? I am panicking atm and very afraid. Could you please tell me some other things or all things it could be and what I need to do. I hate to go to bed with something inside bleeding.

Answered by Dr. Rakesh Madhyastha (21 minutes later)

Brief Answer: Urinary tract infection Detailed Answer: Hello Thanks for the query From the query you have posted it looks like a urinary tract infection, it is common to have some red blood cells during the infection. However I need more info in order to rule out other causes for blood in urine 1. Do you have fever? Burning micturation? 2. Did you have a urine tract infection before this? 3. Any pain in the loins? 4. Could you please attach or type out the urine report? 5. Any other tests done apart from just a urine test? Like complete blood count, ultra sound scan, etc? Please get back to me, I am awaiting your reply Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (15 minutes later)

No fever I know of, no urinary tract infection prior to this that I am aware of, no pain in the loins. They didn't give me the report at the ER. They only said I had moderate blood and just a trace of bacteria. There is a lot of blood when I urinate and I have already had four bottles of water and it hasn't stopped at all. They didn't do any other test, only the urine specimen. I forgot to mention I have been having some shooting pains in the last two weeks in the left flank of my back. I mentioned it to my family dr when I was there last week for my three month checkup and nothing was ever said by her. The blood is getting brighter and I am really concerned. I have read where this can be a symptom of kidney cancer and that really scares me. What do I need to do? The ER dr didn't seemed concerned.

Answered by Dr. Rakesh Madhyastha (5 hours later)

Brief Answer: Further work up of hematuria required urgently Detailed Answer: Hello Thanks for the reply, I am sorry for the short delay in my reply I was on call at my hospital With history of left flank pain, hematuria (blood in urine) and bacteria I come to the conclusion that it is most likely to be a renal calculi (kidney stone) which is causing blood in urine. Here are my suggestions to you 1. Please do not delay the further work up of the hematuria. Please approach a physician for a Complete blood count, USG abdomen and pelivis to look for stones and urine culture 2. Continue drinking upto 8 glasses of water a day 3. Please continue taking the antibiotics prescribed to you It is hard to tell without an ultra sound abdomen whether or not it is renal carcinoma. The other differentials for the hematuria is 1. Renal calculi (most common) 2. Polycystic kidney disease 3. Pyelonephritis (infection of the kidney) 4. Cystitis (infection of the bladder) I hope I was of help, please get back to me if you have any further queries I wish you good health and a speedy recovery Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (6 hours later)

What is renal calculi that is most common you speak of? I called the specialist and they said to just stay on the medicine and would not even make me an appt. I would like to have this checked out thoroughly but seems impossible in the town I live in.

Answered by Dr. Rakesh Madhyastha (2 hours later)

Brief Answer: Kidney stone Detailed Answer: Hello Thanks for the reply Renal calculi is nothing but calcium stones in the kidney, which causes pain in the flank and also blood stained urine. It is easily treatable either by lithotripsy or surgery. Even I suggest you to get yourself checked however if your specialist is confident that it is just UTI then probably you should wait it out. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (2 hours later)

After sleeping last night, when I went to the bathroom this morning it was more brownish, and then pretty normal looking. Since I got up though and moving a bit it has turned back to bright red with some little clots in it. I am still worried. I don't have an appt. until the 10th of December. Could this be a tumor and when I move around it rubs and is bleeding? I am scared, I can't help it. I just don't have a good feeling about this. I don't feel like it is an UTI. The dr. yesterday didn't either because only a trace of bacteria but a lot of blood and no pain when I urinate.

Answered by Dr. Rakesh Madhyastha (5 hours later)

Brief Answer: Hello Detailed Answer: Renal carcinoma cannot be ruled out with just history. Patient usually presents with history of hematuria and weight loss, he will have raised Blood pressure on examination, fever and he will be anemic. I suggest you go to the ER and ask them to evaluate you further as the hematuria is persisting. The brown colored urine might have been clotted blood in the bladder. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (3 hours later)

I am going to try and get an appt. tomorrow with my family dr and see if he will do some testing. I don't see how it can be an UTI when it doesn't hurt when I urinate. Also, it seems to start getting brighter when I am up and moving around a bit. To me, it doesn't make sense unless it is a tumor or something that is rubbing on something and starts to bleed. I am just guessing here, but very frightened and worried.

Answered by Dr. Rakesh Madhyastha (9 hours later)

Brief Answer: Hello Detailed Answer: It is not true that only tumours bleed. Infection also bleeds, because of the inflammation there will be erosion of the epithelium which will cause the bleeding. Also stones tend to cause bleeding as well. You could always go back to the ER and tell them that the bleeding has not come down. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (10 hours later)

Today when I got up, my urine was again brownish like yesterday with a bit of small blood clots. Then it turned pretty normal looking eventually. Now it is getting a bit pink again. I tried to make an appt. with my family physician but they said I couldn't get in until next Tuesday. I am at wits end here. I have had blood in my urine before in a urine test, but not visible to the naked eye. I have had that several times over the years, but no dr. has ever been alarmed. When that would happen, there would be no bacteria either. I can't help but fear the worst. I also feel a bit nauseated today. I wish there were dr's here that cared. I feel like something is going on inside me that an ultra sound or CT could show up.

Answered by Dr. Rakesh Madhyastha (40 minutes later)

Brief Answer: Nothing that ultrasound and Ct wont show Detailed Answer: Hello I understand your anxiety, ultrasound and CT have wonderful diagnostic abilities. There is nothing that these both will miss if there is a structural abnormality like a tumour. If the CT is normal and the urine shows hematuria then the next step would be to do a renal biopsy. But all this is a far thought. I advice you to be calm and continue taking antibiotics till your appointment, however like I said earlier there is always an option of going back to the ER. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (25 hours later)

I ended up going to the ER last night and they did another urine specimen. I requested to see a DR. instead of an assistant. They contacted the urology specialist and he wanted a CT scan with and without contrast done. He also wanted to see me today. The CT scan showed a kidney stone on the right side and my pain is on the left flank and lower back. I know that with kidney stones, you don't have pain in the lower back. I am also concerned about the radiation from the CT scan. I know that they show a lot, but I also know from what I hear on the TV and from reading, that CT's have a lot of radiation, and is bad for you. I wish they had done an ultrasound and MRI, but because of Insurance, and all the other stuff, they don't. The specialist did a scope on my bladder today to look around and since I was seeing blood this morning when I woke up, he said that way he would be able to see for sure where the blood was coming from. But, after I got there and gave a urine specimen, there wasn't any blood to the naked eye. So, when he did the scope, he said he couldn't see any blood. He said everything looked ok in my bladder, and hoped it was coming from the stone. If everything looked ok in my bladder, is there anything at all in there that could be wrong and him not see it? Also, is there anything that wouldn't have shown up on the CT that would be wrong with my kidney and maybe it isn't the kidney stone? I am also scared of the procedure he is doing. I don't like to be put to sleep and he said he is going to blast it and put a stint in. He said it could be possible that the kidney might bleed and would have to be removed. He said it was slight, but still scary. Is this the safest way to take care of a kidney stone? He said it wasn't in the kidney anymore, but in the tube or right at the tube.

Answered by Dr. Rakesh Madhyastha (7 hours later)

Brief Answer: Happy you went to ER Detailed Answer: Hello Thanks for letting me know about the advances you have had. I will try and answer all your questions one by one 1. Looks like we were right about the cause of the hemarturia being a kidney stone. Since you are symptomatic in the form of lower back ache and hemarturia it has to be removed/ blasted 2. Renal stones does cause lower back ache 3. what you have read about ct scan and it's radiation is correct but one ct scan will not harm you. There is a minimum radiation one has to be exposed to in order to suffer harms of it 4. Blasting of the kidney is relatively safe. Your other option would be to undergo lithotripsy ( using ultra sound to blast kidneys). You could discuss this with your urologist 5. Cect has fantastic diagnostic capabilities. It wouldn't miss any structural abnormalities 6. Hematuria not visible to the naked eye is called microscopic Hematuria, it can happen when blood gets dissolved in the urine I hope I was of help regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (5 hours later)

When I went yesterday they didn't test my urine to see if there was blood in it. I find that strange. Being I have a history of this being seen by microscopically, I wish they had. Will they have to do more x-rays the day of the procedure to see where the kidney stone is to blast it? He said they would have to get it back in the kidney first. I wonder how they will do this.... If I just leave it, is there any way it will pass on it's on or dissolve? I am not having any pain or blood or anything now. It is also very expensive to do, and I am not rich. I have read many things about these herbal supplements or vegetable tablets you can take that will dissolve them and are money back guaranteed.

Answered by Dr. Rakesh Madhyastha (17 hours later)

Brief Answer: Hello Detailed Answer: Thanks for the reply Repeated urine examinations are not required. You can repeat one after 3 weeks. A repeat ct scan will be required post surgery to see if the stones are gone I do not know about herbal treatment however I don't think it's a good idea to go for alternate medicine in such acute situations. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (10 hours later)

I am not hurting today and no bleeding. I don't want subjected to another CT scan. I have already had one with contrast and without, so that would really be two. I have been reading about the radiation, and it says they are very bad for you. Another thing I have been experiencing is a strong ammonia smell in my nose after walking 2 miles either outside or inside. I have asked the dr. about it, but they just dismiss it. I know it can have something to do with kidney failure. Do I need anymore tests run to find out if I do have kidney failure or would by blood work and scan have shown something? What else should I be concerned about with this smell. Only after exercise and doesn't last that long. I don't smell it on my skin, only when I am breathing like an ammonia stick is up my nose. Is there anything at all that could have made me see blood in my urine when he looked in my bladder and didn't see anything because the bleeding stopped when he was looking around? Is there anything else being the CT scan showed my kidneys looked ok? Are there any other tests that need to be done to check out my kidneys? It is just weird because I never did really hurt, except my low back some, but not bad. And now there is no pain and no blood.

Answered by Dr. Rakesh Madhyastha (5 hours later)

Brief Answer: Blood tests Detailed Answer: Hello Thanks for the query Ammonia smell is unlikely to arise from kidney failure, what would be possible is smell of uremia, which is like the smell of urine. I understand your concern of radiation, ultimately it is the patient's decision to undergo a treatment or not. Hematuria is most likely because of the kidney stone, that is why the bladder was normal. I dont think there would be anything else that could have caused the bleeding, please furnish me your urine routine so that I can see and rule out glomerular diseases The other tests that are usually done by us to rule out kidney issues are, s creatinine ( indicates kidney failure), blood urea nitrogen, uric acid and 24 hour urine protein. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (1 hour later)

I don't have anything from the dr on the urine tests. What is glomerular disease? When u say urine routine, do you mean my urine results and if so, can I request them from the hospital?

Answered by Dr. Rakesh Madhyastha (2 hours later)

Brief Answer: Inflammation of the glomerulus Detailed Answer: Hello Glomerulonephritis are a group of disorders which cause inflammation of the glomerulus and blood vessels withing the kidney. These set of patients also have hematuria but apart from that they will epithelial casts and a proteins as well. When I said urine routine I meant the normal urine analysis which is done as a routine when someone complaints of urinary tract related problems. Please request for the urine routine from the hospital Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (23 hours later)

I will pick up the report from the hospital and send it to you. I have been debating on what to do about the procedure on Wednesday, so I went walking on the treadmill. After walking on the treadmill now I am urinating blood again but no pain. Why does it bleed when I walk and why is there no pain? What else could it be? From all the people I talk to that have had them, they have pain, and I am not even having low back pain or pain when I urinate. I just don't know what to do. Also, I keep having shooting pains in the flank of my left back. It is also tender in the flank of my left back where the kidney is. Could this be where the blood is coming from?

Answered by Dr. Rakesh Madhyastha (20 hours later)

Brief Answer: Left flank pain Detailed Answer: Hello The pain in the left flank region is most likely to be a muscle catch, it might not be from the kidneys as the ct did not reveal any kidney stone on the left. This left flank pain is not the reason behind your Hematuria. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (37 minutes later)

I already know the blood isn't from the pain in the flank on my left side, I just mentioned it because I have been having it for a while and wondering what it also might be. My question was before that one. I copy and pasted it so here it is.I will pick up the report from the hospital and send it to you. I have been debating on what to do about the procedure on Wednesday, so I went walking on the treadmill. After walking on the treadmill now I am urinating blood again but no pain. Why does it bleed when I walk and why is there no pain? What else could it be? From all the people I talk to that have had them, they have pain, and I am not even having low back pain or pain when I urinate. I just don't know what to do.

Answered by Dr. Rakesh Madhyastha (36 hours later)

Brief Answer: Nothing more to pen Detailed Answer: Hello Thanks for reply I am extremely sorry for the delayed reply I have given my suggestions and there is nothing more I can add here. For further more detailed help regarding the procedure and techniques I suggest you re post a query to a urologist. Urologists can be of better help. regards

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar