Don’t Take a “Wait and See” Attitude with Blood in the Urine
Causes, diagnosis, and treatment of urinary tract infections
By Robert A. Hesson, M.D., F.A.C.P.
Did you know that your kidneys require 20 percent of your total blood flow
to function effectively? They are part of the urinary tract and they perform a
number of crucial functions. The kidneys act as a filter to eliminate toxic
waste from the blood, control the body’s acid-alkaline balance, regulate your
blood pressure, and produce a number of important hormones. In fact, the only
organs that use and circulate more blood are your heart,
lungs, and brain.
One of the ways in which our kidneys indicate a problem is by the appearance
of blood in the urine. And while blood in the urine is a relatively common
occurrence, it is always an indication that something is wrong. If you notice
blood, make an appointment to see your doctor because this is not one of those
instances where a “wait and see” attitude is the right approach. There may be
significant pathology, including infections that require medical intervention.
Those problems always need to be ruled out before a period of observation is
What are the common causes of blood in the urine?
Among women, the most common cause of blood in the urine is a urinary tract
infection (UTI). In men, the most common causes are an enlarged prostate (the
gland that surrounds the neck of the bladder and the urethra) and prostate
Other causes range from insignificant to serious. Some families, for example,
have a genetic condition known as benign familial hematuria where there is a
natural tendency to put blood into the urine, and it is of no consequence. On
the other hand, blood can indicate very serious conditions like bladder cancer
or a primary kidney disease that has inflamed the kidney. Sometimes blood in
the urine indicates other underlying problems like infected heart valves or
autoimmune diseases, such as lupus.
Someone who has been hit hard in a contact sport may have suffered a bruised
kidney which can put blood in the urine temporarily. Even then you should be
checked out by a doctor because there may well be an underlying condition that
caused you to bleed under contact. Whenever there is blood in the urine it is
very important to your health and well-being to determine why it is there.
How are these problems diagnosed?
The earliest portion of the medical evaluation may be done by your primary
care physician to either treat or rule out UTI, which is a commonplace problem
that generally responds well to appropriate antibiotics. If the blood is not a
result of UTI, you may need to see a urologist to rule
out anatomic problems like kidney stones or cancer of the bladder, kidney, or
At this stage, evaluation of these problems often includes radiologic
imaging of the kidneys, using a dye and x-ray, CT scan, MRI scan, or
ultrasound. Your doctor may recommend a cystoscopy, which is a diagnostic
procedure that allows the doctor to look directly into the bladder. If she or
he sees no sign of pathology, you may be referred to a nephrologist to look for
kidney disease or other serious problems that produce blood in the urine. The
ultimate goal is to identify the underlying cause so it can be treated.
Sometimes blood in the urine produces symptoms that feel just like a UTI.
Often people are thought to have had multiple UTIs, when in fact the symptoms
they have been suffering came from the existence of blood in the urine but were
not, in fact, caused by a UTI. If you believe you have had multiple UTIs, you
may require a catheterized urine sample to end the confusion and to avoid
contaminating the urine sample with other normally occurring bacteria on your
Dr. Hesson is board certified in internal medicine and nephrology and
serves on the medical staff at Cayuga
His practice is located in the professional building adjacent to the Medical Center.