Hematuria: Causes, Symptoms, Treatment and Cost

Hematuria is a condition in which blood is present in the urine. It can be either gross, meaning it is visible to the naked eye, or microscopic, meaning it can only be seen under a microscope. It can occur due to injury or a medical condition like kidney infection or bladder cancer.

• Gross Hematuria: Also known as macroscopic hematuria, this is when a person with hematuria has red or dark coloured urine visible to the naked eye due to the presence of large amounts of red blood cells in it.
• Microscopic Hematuria: Also called microscopic hematuria, this is when a person has small amounts of red blood cells in their urine which can only be seen under microscopic examination by a doctor.

Common causes include:

• Urinary tract infections (UTIs)
• Enlarged prostate,
• Kidney or bladder stones.
• Benign prostatic hyperplasia (BPH),
• Cancer of the bladder or kidneys.
• An injury to the urinary tract such as from an accident or vigorous exercise.
• Long-term use of medications such as aspirin and certain chemotherapy drugs.
• Less common causes include:
• Certain inherited conditions like sickle cell uropathy or cyclic hematuria (when blood intermittently appears in the urine).
• Systemic disorders like lupus, multiple myeloma and rhabdomyolysis.

• Presence of blood in the urine, which may appear red, pink or cola-coloured.
• Pain or burning sensation while urinating.
• Urgent feeling to urinate and increased frequency in urination.
• Colour and odour changes in the urine, with accompanying cramps or abdominal pain sometimes seen with severe cases of hematuria.

• Avoid taking medications that can lead to blood in the urine.
• Drink plenty of fluids.
• Exercise regularly and maintain a healthy weight.
• Follow a nutritious diet, with an emphasis on limiting high fat and salty processed foods.
• Visit your doctor for annual check-ups.
• Avoid contact sports or exercise activities that may be traumatic to the bladder.
• Limit alcohol consumption.
• Stop smoking.

• Urinalysis:Urine tests can detect red blood cells (RBCs), white blood cells (WBCs), casts, and other materials that may be present in the urine. Your doctor may also use a microscope to check for RBCs when examining your urine.
• Renal ultrasound:A renal ultrasound is a procedure used to check the size, shape, and location of your kidneys as well as other structures in the area such as the bladder, uterus, and prostate gland.
• CT Scan:A CT scan is a test that uses X-rays to create detailed pictures of the internal organs and structures. It can be used to detect if there is any blockage or abnormal growths within the urinary tract or other organs such as the bladder or kidneys that can cause hematuria.
• Cystoscopy:This procedure involves inserting a thin tube into the urethra with a camera attached so that it can view inside the urinary tract directly. This test allows doctors to detect abnormalities such as tumours or stones more easily than they would with imaging tests like an X-ray or CT scan.
• MRI scan:An MRI scan is a test that uses strong magnetic radiations and radio waves that create detailed images of structures within the body without radiation exposure such as in X-rays or CT scans.
• Complete Blood Count (CBC):This is one of the most important diagnostic tests for determining if there is underlying disease causing hematuria because it analyses all aspects of a person’s blood including counts of red cells, white cells and platelets as well as levels of haemoglobin and hematocrit – two important components related to red cell production.

• Risk of damage of the kidney can increase.
• Urinary tract infections
• Infertility
• Risk of bladder cancer
• High blood pressure.

• Take equal parts of haritaki and shilajit and make a fine powder. Consume one teaspoon of this powder with warm water, twice daily for 15 days to cure hematuria.
• Consume 2-3 glasses of tender coconut water daily to flush out toxins from the body.
• Boil matsyakshi mixed with buttermilk or rice wash and drink it twice daily to reduce hematuria symptoms such as pain in the kidneys, etc.
• Boil mild pippali powder in a glass of cow’s milk until one-fourth quantity remains, sieve the concoction and drink it twice daily for around 15 days to get rid of hematuria problem naturally.
• Make a paste by adding honey and powdered shilajit in equal amounts; apply this paste on your lower abdomen every night before going to bed for at least 15 days continuously to eradicate hematuria issue naturally at home without any side effects.

• To help reduce the symptoms of hematuria, it is important to eat a nutritious, balanced diet that contains a variety of wholesome foods and drinks.
• Include plenty of fruits and vegetables as they are good sources of water and fibre to help flush out toxins from the body.
• Choose lean proteins such as fish, poultry, beans, nuts and seeds which will provide amino acids needed for healing.
• Healthy fats such as olive oil, avocado, fatty fish and flaxseed can also help keep your kidney function in check and reduce inflammation.
• Drink plenty of water throughout the day to keep yourself hydrated which will help promote healthy tissue repair and discourage the formation of clots in the urinary tract leading to hematuria episodes.

• Avoid caffeine, as it is a diuretic and increases urine production, which can worsen hematuria symptoms.
• Consume less salt and processed foods, since they increase the risk of dehydration and could aggravate symptoms.
• Limit animal proteins such as red meat, eggs, and dairy products that are high in purines and can increase the presence of uric acid in your urine.
• Avoid spicy foods like curries or other dishes that are heavily spiced as they can irritate the bladder lining, potentially leading to increased pain when passing urine with hematuria symptoms present.
• Limit your intake of alcohol to reduce inflammation or infection in your urinary tract which could worsen hematuria symptoms.

• Fluids:Keeping the patient hydrated and replenishing electrolytes are important aspects of managing hematuria. Oral rehydration salts, along with lots of water, can help to reduce the levels of hematuria.
• Medications:Medications used to treat hematuria depend on the underlying cause and may include antibiotics, anti-inflammatory medications, etc.
• Transurethral resection of the bladder (TURB):This procedure involves the resection of any abnormal tissue in the bladder that is suspected to cause bleeding and can be done using a scope through the urethra.
• Robot-assisted laparoscopic radical cystectomy:This involves removal of all or most of the cancerous bladder, with lymph nodes and surrounding tissue, using surgical tools controlled by a computer system.
• Kidney and Bladder Surgery:Procedures may include reconstruction of ureteroneocystostomy (UNC), partial nephrectomy, radical nephroureterectomy, endoscopic removal stones from the bladder or ureter, and ablation for tumours or polyps in the bladder wall.
• Ureteral Stent Placement:During this procedure, a stent is placed in an affected ureter to restore normal urine flow and reduce bleeding from an enlarged prostate or tumours related to hematuria.

It is always recommended to consult a urologist or nephrologist with experience in diagnosing and managing hematuria if you notice any symptoms of it.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications are used to treat inflammation and reduce pain, but they can also help reduce hematuria in certain cases. Examples include ibuprofen (Motrin), naproxen (Aleve), and celecoxib (Celebrex).
• Alpha-blockers: These drugs relax the bladder neck muscles to help passing urine easier. They also relax blood vessels, which prevents bleeding in some cases. Examples of alpha-blockers used to treat hematuria include terazosin (Hytrin) and doxazosin (Cardura).
• Antibiotics: If a bacterial infection causes your hematuria, your doctor will likely prescribe an antibiotic such as trimethoprim/sulfamethoxazole (Bactrim DS) or amoxicillin/clavulanate potassium (Augmentin).
• Diuretics: Also known as water pills, diuretics help rid the body of excess fluid and can help manage high blood pressure caused by hematuria in some cases. Examples include spironolactone (Aldactone) and furosemide (Lasix).
• Immunosuppressants: Immunosuppressants are medications that suppress or weaken the immune system. They may be used to reduce inflammation in the urinary system, as well as to prevent and reduce kidney damage caused by certain substances or conditions. Examples of immunosuppressants used to treat hematuria include cyclophosphamide, azathioprine and mycophenolate mofetil.

Generally speaking, most people who have mild hematuria recover within 1–2 weeks with appropriate treatment. If it is determined that surgery is necessary for the underlying condition, then recovery times can range from several weeks to several months.

The results of treatment for hematuria vary depending on the underlying cause or condition.

In some cases, the hematuria can be cured, while in others the condition may recur or require ongoing management.

If a person has been successfully treated for an infection or another cause of their hematuria, they should experience a permanent and long-term improvement.

• Rest and relax:After treatment, it is important to rest and relax as much as possible. This step is especially important in cases of Hematuria where bleeding needs to be reduced and healing needs to be facilitated.
• Avoid straining:Avoid activities that cause straining such as lifting heavy objects, high-impact exercises and even frequent coughing or sneezing. Taking short walks or low-impact exercises may be allowed if deemed safe by your healthcare team.
• Manage pain:Pain medications should be taken according to the prescribed dosage and regularly monitored by healthcare providers for any unwanted reactions or side effects.
• Follow doctor's instruction:After being released from the hospital, it is important to follow up with doctor’s instructions regarding the management of the condition, including taking medications as needed or attending any follow up appointments for monitoring progress and checking for signs of complications such as infection or anaemia.

The cost of Hematuria treatment in India depends on the underlying cause and can range from anything around Rs. 5,000 to Rs. 1 Lakh and above. The cost may also involve lab tests, medicines, and patient care charges. Depending on the severity of the case, some more costs may be incurred as well.

Common side effects of treatment for hematuria include:

• Dizziness
• Fatigue
• Changes in urination
• Frequent urination
• Abdominal or back pain.
• More serious side effects may include:
• Seizures
• Anxiety or depression
• Difficulty breathing
• Allergic reactions
• Kidney failure.

In some cases of hematuria treatments, there is an increased risk of developing blood clots or heart problems such as arrhythmia.

Medications used to treat hematuria can also have side effects related to the specific drug used including nausea, vomiting and diarrhoea.

If you are going through any of the complications related to hematuria then do consult a doctor nearby as they can cause complications like 'urinary tract infections, infertility, risk of bladder cancer' if not detected and treated on time in which treatment courses can vary from a few months to years depending on the severity of the situation.