Article by Dr Manasa, B.A.M.S

What is Haematuria?

Haematuria is a medical condition wherein there is ‘blood in the urine’. Haematuria is not a disease by itself but indicates an underlying medical condition.

The causes for haematuria can range from infections, diseases of kidney, urinary bladder, prostate gland or any other diseases. Blood in the urine needs a proper evaluation for the causes to be treated effectively.

Types of haematuria

There are two main types of haematuria:

Gross haematuria – It is a condition where there is enough blood in the urine and urine looks pink or red and urine has visible spots of blood.

Microscopic haematuria – When the amount of blood in the urine is small and cannot be seen with the naked eyes and can be seen only under the microscope is termed as microscopic haematuria.

Causes of Haematuria

Causes of haematuria can be due to health issues related to kidney, urinary bladder, prostate gland or other underlying health conditions.

Few of the most common causes of haematuria include –

Infections of kidney and urinary tract – Infection to the parts of urinary tract forms the major causative factors of haematuria. Infection to the urinary tract is associated with pain, fever, chills, urinary urgency and there may be gross or microscopic haematuria.

Stones present in urinary bladder or kidneys – Yet another common cause of haematuria is stones in the bladder or kidney. Stones are crystals that are formed from the minerals present in the urine. These stones can be developed in the kidney or urinary bladder and if they are large enough to cause the blockage in the urinary tract it often results in haematuria and significant pain.

Certain kidney disorders of the kidney like glomerulonephritis – Inflammation of the kidney can cause haematuria. In children aged between 6 to 10 years, post streptococcal glomerulonephritis may cause haematuria. This condition generally develops 2 to 3 weeks after an improperly treated or untreated streptococcal infection. Haematuria because of this infection is rarely seen nowadays since the antibiotics given after early evaluation and treatment can take care of the underlying infection effectively.

Prostatic enlargement – Prostate is a gland situated beneath the urinary bladder and near the urethra. When the prostate gets enlarged, which is quite often seen in middle aged or older men, it puts a pressure on the urethra and compresses it. This tends to cause problems with urination and might prevent the bladder from emptying completely. As urine is not completely voided the more residual urine left back in the bladder harbours the growth of the bacteria and other pathogens leading to infection and subsequently leads to presence of blood in the urine.

Cancer of urinary bladder, kidney or prostate – Haematuria in cases of cancer of kidney, bladder or prostate can be seen in the advanced stages of the cancer.

Sexual activity – Recent sexual activity may cause irritation on the urinary tract and might cause haematuria.

Other causes

–         Inflammation of the bladder
–         Viral hepatitis
–         Endometriosis
–         Inherited diseases such as sickle cell anaemia and cystic kidney disease
–         Haemophilia
–         Polycystic kidney disease
–         An injury to the kidney from accidents or sports
–         Excessive and high intensity exercises|
–         Certain medications such as aspirin, heparin, penicillin, and cyclophosphamide

Signs and symptoms of haematuria

Along with blood in the urine, the other possible signs of haematuria are –

–         Fever
–         Chills
–         Burning sensation while voiding of urine
–         Painful micturitio
–         A strong urge to urinate
–         Nausea and vomiting
–         Weight loss
–         Complaints of pain in the lower abdomen, lower back, pelvis
–         High blood pressure
–         Swelling in the body including puffiness around the eyes

Who is more prone to develop haematuria?

There are certain things that make an individual more prone to develop haematuria. These risk factors include –

–         Family history of kidney disease
–         Suffering from urinary tract infection
–         Being middle aged or older
–         Few medications such as antibiotics, blood thinners, and painkillers.
–         People who are long distance runners or involved in contact sports

Diagnosis

Haematuria is a complaint and not a disease by itself. So, identification of the underlying cause forms an important protocol in the effective treatment of haematuria. Healthcare workers advice one or more of the following tests to come to a clear understanding of the causative factors for haematuria and these include –

–         Urine analysis
–         Urine culture and sensitivity
–         Complete blood count
–         Blood creatinine level
–         Tests for sickle cell, bleeding problems, and other bleeding disorders
–         Antinuclear antibody test for lupus

Other tests –

–         Abdominal scan
–         CT scan of the abdomen
–         Kidney biopsy
–         Cystoscopy

Treatment of haematuria

The common line of treatment for haematuria is as under –

Oral or intravenous administration of antibiotics
Procedure to remove or crush the stones of the urinary tract
Administration of medicines to shrink the enlarged prostate
Dialysis, medication, or surgery to treat the underlying kidney disease
Cancer treatment of the affected parts of the tract which includes medication, radiation and surgery.

Prevention of haematuria

Prevention of the haematuria is aimed at preventing the underlying causes:
Drinking plenty of water daily, voiding after sexual intercourse and a good hygienic practice
Avoiding excess salt and over consumption of certain foods like spinach and rhubarb helps in preventing the formation of stones
Limiting the exposure to chemicals, refraining from smoking and drinking enough water helps to prevent bladder cancer to a certain extent.

How serious is observing blood in the urine?

Most cases of haematuria are related to infection and these can be managed quite effectively with the help of antibiotics and intravenous medications. Other serious underlying causes like stones in the kidney or bladder or injury to urinary tract or cancer of organs of urinary tract are to be treated based on the signs and symptoms and cause.

Observing blood in the urine even for one time or occasionally should be taken seriously. Evaluation of the underlying cause of haematuria is the first step towards proper management. One should approach the healthcare professional when he or she experiences frequent micturition, pain during voiding, abdominal pain or pain in the flanks. Individuals who are experiencing one or more of the following symptoms with or without the presence of blood in the urine should seek medical advice as early as possible.

The symptoms are as follows –

–         Fever
–         Chills
–         Not able to urinate
–         Nausea and vomiting
–         Weight loss which is unexplained
–         Mild to severe abdominal pain
–         Pain in the back or flanks which range from mild to severe intensity
–         Experiencing pain during sexual intercourse or heavy menstrual bleeding
–         Experiencing dribbling of urine, nocturnal urination, or difficulty in starting to urinate

Ayurveda Understanding

Haematuria may be compared to a condition called ‘Rakta Meha’ explained in Ayurveda in the context of Prameha Nidana.

Rakta Meha is one among the six types of Pittaja Meha or Pittaja Prameha.

It is a urinary disorder in which the person passes red coloured urine which appears like ‘blood mixed urine’ and hence the name.

Symptoms of Rakta Meha

विस्रमुष्णं सलवणं रक्ताभं रक्तमेहतः।वा.नि.१०।
visramuṣṇaṃ salavaṇaṃ raktābhaṃ raktamehataḥ|vā.ni.10|

In this condition, the person voids urine which has the below mentioned characteristic features –

–         Visram – foul smelling
–         Ushnam – hot on touch
–         Lavanam – salty in taste
–         Raktabham – having red coloured – resembling blood

Master Charaka has mentioned Lohita Meha and Master Sushruta has mentioned Shonita Meha. Both these conditions are similar to Rakta Meha vis-à-vis Haematuria. Lohita and Shonita are synonyms of Rakta – blood.

Treatment

Rakta Meha is treated on the lines of –

–         General line of treatment of Prameha
–         Line of treatment of Pittaja Prameha

We need to use the same principles for treating Haematuria also.

Other consideration

There is yet another condition called Raktapitta explained in Ayurveda. This term includes in it the description of all kinds of bleeding disorders. This is a condition wherein rakta and pitta are contaminated due to the consumption of their own etiological factors. Later they contaminate each other and cause raktapitta. In this condition bleeding may occur from the orifices from upper or lower parts of the body and even from the skin.

In adhogata raktapitta bleeding occurs from the lower orifices / passages which includes urinary passages. Even in this condition the urine may appear bloody red in colour due to the contaminated blood passing through the urine.

In this condition the physician needs to differentiate between raktapitta and rakta meha before administering the treatment. The line of treatment for raktapitta is different from that of rakta meha.

Related Reading – Difference between Raktapitta and Rakta Meha