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Bleeding in Urine, Bloody Urination (Hematuria)

The presence of blood and blood cells in the urine visually or under the microscope is called "hematuria" or "bloody urine". This can be visible (gross) or on urinalysis (microscopic). In both cases it is important to identify the cause of the bleeding. The sight of blood in the urine is a cause for concern, and although the cause is harmless in most cases, blood in the urine (hematuria) can indicate a serious disorder. When urine is mixed with a very small amount of blood, it can be seen in colors ranging from pink to dark red depending on the amount of blood. Bleeding in the urine is usually painless, if blood clots in the urine are due to obstruction or accompanied by infection, pain may occur. Even microscopic hematuria may be present, even without symptoms, and may persist for years without the patient noticing. In case of blood in the urine, which is a symptom of many serious diseases, a doctor should be consulted. Some constipation remedies and drugs containing dyes such as azo, which dyes the urine red, and some foods (beet, strawberry, raspberry, blackberry, etc.) can dye the urine red without blood in the urine. Again, after heavy exercises (especially in long-distance runners), blood may be seen in the urine, and the urine returns to normal within a few days. Other risk factors for hematuria include age and certain inherited diseases.

Causes of Hematuria

The maximum number of blood cells (erythrocyte) seen in the urine when viewed under a microscope is around 1-2 in men and 3-4 in women. Bleeding in the urine can originate from any area from the kidneys to the urinary ducts (ureters), bladder, prostate, and the urinary tract (urethra) where urine is excreted from the external environment. Kidney and urinary tract stones, infections and cancers are the most common serious causes of bleeding in the urine. .

1-Kidney and Urinary tract infections: In the case of microbial infections of the kidneys and urinary tract (cystitis, pyelonephritis, urethritis, etc.), there may be bleeding in the urine, but the bleeding is usually accompanied by difficulty in urination, burning, painful and frequent urination. Apart from these, urgent need to urinate and bad-smelling urine can be seen. If the infection is in the kidney, it may be accompanied by fever and flank pain. In prostate infections, besides bleeding, urinary difficulty and the need to urinate frequently come to the fore.

2- Urinary tract stone disease: Kidney and urinary tract stones that do not obstruct the urinary tract can only show symptoms with bleeding in the urine, if it is obstructed, bleeding and severe colic pain accompany. If this is accompanied by an infection, the picture becomes more complex.

3-Prostate enlargement: In prostate enlargement, which is mostly seen in men over 40 years old, besides the main complaint of the patient, bleeding in the urine can be detected. It may come out and cause bleeding in the urine.

4- Kidney diseases: Hematuria can be observed in some medical diseases such as glomerulonephritis of non-microbial and filtration units of the kidney, these can be a symptom of kidney failure to the point of transplantation (kidney transplantation). In diseases called nephritis that occur in the filter system of the kidney, bleeding occurs in the urine. Again, blood in the urine can be seen as an additional finding in some systemic diseases such as diabetes (diabetes).

5-Urological Cancers: Urological cancers may be the most important and serious cause of visible or microscopic blood in the urine with clots or clots. One of the most important symptoms of prostate and other urological cancers, especially bladder and kidney cancer, is bleeding in the urine. In fact, men over the age of 40 who smoke, who have painless blood clots in the urine, are considered bladder cancer until proven otherwise. The common denominator accompanying bleeding is smoking. While continuous bleeding in the urine is observed in the first and long term in bladder cancer, it is more common in advanced stages of prostate and kidney cancer.

6-Other reasons: Inherited genetic diseases such as sickle cell anemia and Alport syndrome, kidney and urinary tract traumas, bleeding in the urine can be seen in some drugs. Anticancer drugs such as cyclophosphamide, radiotherapy, blood thinners and penicillin-type antibiotics can cause serious bleeding in the urine.


1- History and physical examination are the first steps in the investigation of hematuria.

2-Simple urine test: Even if there is visible bleeding, a simple urine test is required to detect whether there is any additional finding. Again, urine taken in a transparent container should be visually examined. If there are signs and symptoms suggestive of infection, a urine culture is taken.

3-Basic routine blood analyzes should definitely be requested from the patient with hematuria.

4- Imaging tests: Ultrasonographic imaging, which is easily accessible and feasible at first, is the basic examination in patients with bleeding in the urine.

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