There’s Blood When I Go…How Serious is it?

Seeing blood in your urine is a scary thing for anyone. Unfortunately, many people let it go when they should see a physician right away. If you’ve seen blood in your urine and you’re unsure how serious it is, you’re not alone. We asked Dr. Larry Tetsotti, urologist, to help us out.

What is it called when you see blood in the urine, and what does it mean?
In medicine, hematuria, or haematuria, is the presence of red blood cells (erythrocytes) in the urine. It can be a sign that there’s a kidney stone or a tumor in the urinary tract (i.e., kidneys, urinary bladder, prostate, and urethra), ranging from trivial to lethal. If white blood cells are found in addition to red blood cells, most likely you have a urinarytract infection.

What is it called when you see blood in the urine, and what does it mean?
In medicine, hematuria, or haematuria, is the presence of red blood cells (erythrocytes) in the urine. It can be a sign that there’s a kidney stone or a tumor in the urinary tract (i.e., kidneys, urinary bladder, prostate, and urethra), ranging from trivial to lethal. If white blood cells are found in addition to red blood cells, most likely you have a urinarytract infection.
Occasionally, blood in the urine is seen without testing. In that case, we’re dealing with so called “macrohematuria.” If blood is found in a microscopic exam, this is microhematuria. Depending on the complaints and origin of pain, we can narrow our findings to more closely determine which it is.
For example, if a patient is complaining of pain and some bleeding at the very beginning of urination, we know it might be early hematuria, and most likely the urinary tract is affected. 
If, on the other hand, the symptoms of pain and blood discharge occur at the end of urination, it is a sure sign of ultimate hematuria, when cystitis or even kidney stones could be a factor. 

What if a patient complains of a scary experience when there is all blood or heavy blood urination?
If the patient sees all blood during urination, we call it “total hematuria,” which means that the source of the bleeding could be found in any section of the urinary system. It’s usually accompanied by back pain, a burning sensation during the process of urination, and lower abdominal pain. The causes range from cystitis to degenerative kidney disorder. 
Painless blood clots in urine make doctors suspect bladder cancer and renal pelvic tumor, where further testing is required. Slow and frequent urination among male patients could be a sign of a prostate gland disorder. 

Occasionally urine might look bloody-red, but there’s no blood present. Is this also a symptom of a urinary tract or kidney malfunction? 
Not necessarily. Sometimes, a dark, intense urine color in women patients occurs during the final days of a period cycle, when discharge is mixed with urine. Reddish urine could be caused by certain foods, such as beet roots or artificial food coloring. Medications can also affect urine color. For example, Rifampicin, an antibiotic used to treat tuberculosis, can cause certain bodily fluids, such as urine, to become orange-red in color—a benign but sometimes frightening side-effect. 
The doctor needs to determine, first of all, whether or not a patient is suffering from hematuria. (Occasionally, the term "hemoglobinuria" is used synonymously, but it refers only to hemoglobin in the urine. It’s mostly observed in cases of syphilis, chemical poisoning, anemia, or an adverse effect to a blood transfusion, where blood groups were not properly matched.) 

So it’s not the” blood in urine” that needs to be treated, but the underlying disease, correct? 
I can’t emphasize enough how important it is for everyone to have regular exams at the urologist’s office. Kidney tumors and stones, pyelonephritis, and cystitis are all accompanied by hematuria. It could also be found in cases of poor blood coagulation among patients with liver and blood problems. Neglecting the symptoms could be dangerous and costly, especially if we’re talking about tumors—the kidneys and renal pelvis suffer the most. I urge smokers, particularly, to consider the risks. Smoking is proven to be directly connected with kidney cancers. 

Is it possible to catch a tumor in the early stages?
The only way to protect yourself is to have exams twice a year. If the disease is caught in time, the chances of a positive outcome are very promising. Remember, blood in the urine is a symptom, not the diagnosis. The sooner you get it checked out, the better the outcome. 

What does a urology check-up entail? 
We start with a cytology test, followed by DNA testing for potential cancer. Then we could go for a cytoscopy procedure of the bladder. We may also do an ultrasound and a CAT scan alongside with radiography if the need arises. Only after such detailed testing can we conclude the exam and be sure about the diagnosis and treatment strategy. 

All this is performed at your office? 
Everything except the CAT scan, and we refer our patients to a CAT-scan professional center, which helps us coordinate the results of the tests. I urge everyone who has ever had or may be having concerns right now: Timing is important. Call our office, make an appointment, and get your check-up. Hematuria is not on your side, but we are!

Dr. Larry TETSOTI
1009 Brighton Beach Ave., Floor 4
Brooklyn, NY 11235
(718) 336-6166
107-21 Queens Blvd, Suite 6
Forest Hills, NY 11375
(718) 261-2992