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Hematuria, i.e. seeing blood in the urine can be alarming. Although in many cases the cause is harmless, blood in the urine (hematuria) may indicate a serious disorder.

Blood in the urine that you can see clearly when urinating is called hematuria. Urinary blood that can be seen only under a microscope (microscopic hematuria) is detected when your physician tests your urine In both cases, it is important to identify the cause of the bleeding.

Treatment options vary depending on the cause of the blood in the urine.

Causes of Hematuria

In hematuria, your kidneys (or another element of your urinary tract) allows blood cells to leak into urine A variety of problems may cause such a leakage, including:

  • Urinary tract infections: These infections occur when bacteria enter your body through the urethra and then multiply in your bladder. Symptoms can include a constant urge to urinate, pain and burning sensation with urination, and extremely strong-smelling urine.
  • Kidney infections (pyelonephritis): These infections may develop when bacteria enter your kidneys through your bloodstream or when they pass from your ureters to your kidneys. Signs and symptoms are often like those of bladder infections, however, kidney infections are more likely to cause a fever and flank pain.
  • A bladder or kidney stone: The minerals in concentrated urine sometimes form crystals on the walls of your kidneys or bladder. In the course of time, the crystals turn into, hard stones.

The stones are generally painless. Therefore, you probably will not be aware of their presence unless they cause a blockage. Bladder or kidney stones are also likely to cause both gross and microscopic bleeding.

  • Enlarged prostate: The prostate gland located just below the bladder surrounds the top part of the urethra. It often grows in size as men approach middle age. It then partially blocks urine flow by compressing the urethra. The signs and symptoms of an enlarged prostate (benign prostatic hyperplasia, or BPH) are difficulty in urination, an urgent or constant need to urinate, and visible or microscopic blood in the urine.  Infection of the prostate (prostatitis) is likely to cause the same signs and symptoms, as well.

Other Causes of Hematuria

  • Kidney disease: Microscopic urinary bleeding is the common symptom of glomerulonephritis, a renal disorder characterized by inflammation of the filtering system in the kidneys. Glomerulonephritis may be a part of a systemic disease, such as diabetes, or can develop spontaneously. Glomerulonephritis can be induced by viral or strep infections, blood vessel diseases such as vasculitis, and immune disorders such as IgA nephropathy, which affects the small capillaries in the kidneys (glomeruli) that filter blood.
  • Cancer: Visible urinary bleeding can also be a sign of advanced kidney, bladder, or prostate cancer. Unfortunately, these cancers may show no signs or symptoms in the early stages, when they are more treatable.
  • Inherited disorders: Sickle cell anemia, a hereditary disorder of hemoglobin in red blood cells, causes both visible and microscopic hematuria i.e. blood in the urine.
  • Kidney damage: A blow or other kinds of damage to your kidneys caused by an accident or contact can result in visible blood in your urine.
  • Medications: Cyclophosphamide, an anti-cancer drug, and penicillin can cause urinary bleeding. Visible urinary blood sometimes occurs in cases where you take an anticoagulant, such as aspirin and the blood thinner heparin, and where you have a condition causing bleeding in your bladder.
  • Strenuous exercise: Strenuous exercise rarely causes gross hematuria due to an unknown reason. It may be associated with trauma to the bladder, dehydration, or the breakdown of red blood cells caused by constant aerobic exercise.

In general, the cause of hematuria cannot be identified.

Risk factors

Almost all people including children and teenagers can have red blood cells in the urine. The factors that increase its probability include:

  • Age: Occasional hematuria due to an enlarged prostate gland is observed in most men older than 50 have occasional.
  • A new infection: Inflammatory kidney disorder after a viral or bacterial infection (glomerulonephritis) is one of the most common causes of visible blood in the urine in children.
  • Certain medications: Aspirin, nonsteroidal anti-inflammatory pain relievers, and antibiotics such as penicillin are the medications known to increase the risk of urinary bleeding.
  • Strenuous exercise: Long-distance runners, in particular, tend to experience exercise-induced urinary bleeding.


The tests and exams listed below play a key role in identifying the cause of blood in your urine:

  • Physical exam, which also includes a discussion of your medical history.
  • Urine tests: Even if the bleeding has been detected through a urine test (urinalysis), you may need to have another test to see whether your urine still contains red blood cells. A urine analysis can also check for the presence of any urinary tract infection or minerals that cause kidney stone formation.
  • Imaging tests: In most cases, an imaging test is required to identify the cause of hematuria. Your physician may recommend you to have a CT or MRI scan or an ultrasound exam.
  • Cystoscopy: Your physician inserts a thin tube equipped with a small camera into your bladder to examine your bladder and urethra for any signs of disease.

Sometimes, it cannot be possible to identify the cause of urinary bleeding. In such a case, your physician may recommend you to have regular follow-up tests, especially if you have certain risk factors for bladder cancer, such as smoking, exposure to environmental toxins, or a history of radiotherapy.


Depending on the condition that led to hematuria, treatment can involve the administration of antibiotics to clear a urinary tract infection, a prescription medication intended to shrink an enlarged prostate, or having shock wave therapy to crush stones in the bladder or kidney. In some cases, no treatment is needed.