Blood in Urine: Possible Causes and Next Steps

Q: Blood in Urine: Possible Causes and Next Steps

Hello： Generally, stones smaller than 0.5 centimeters or uric acid stones are not easily visible on X-rays. <br>The standard practice is to allow a few weeks for the stones to pass on their own. <br>If, after this time, no stones have been expelled or if hematuria is still presen

Continuation #147062 Hematuria

Hello Doctor: I later went for a follow-up appointment and had an X-ray taken.
The doctor there did not see any stones on the X-ray.
After returning home, I took Buscopan and did not have any hematuria the next day.
However, three days later, I noticed very light hematuria again, and at that moment, I felt a slight pulling sensation in the right groin area while urinating (although previous examinations indicated that the kidney stone was on the left side).
I would like to ask if it is possible that there are very small stones that were not visible on the X-ray? Can such small stones also cause hematuria? Or would it be necessary to conduct more detailed examinations if the hematuria is not caused by stones?

TT, 20~29 year old female. Ask Date: 2019/06/30

Dr. Du Shixi reply Urology

Hello: Generally, stones smaller than 0.5 centimeters or uric acid stones are not easily visible on X-rays.
The standard practice is to allow a few weeks for the stones to pass on their own.
If, after this time, no stones have been expelled or if hematuria is still present, further specialized X-ray examinations or endoscopic evaluations will be conducted.
At that point, if it is not a stone, it will be identified.
Since the chance of passing the stone is 80-90%, increasing fluid intake and waiting for passage is the standard approach.
Wishing you good health.

Reply Date: 2019/06/30

More Info

Understanding blood in urine, also known as hematuria, can be concerning and may arise from various underlying causes. In your case, the intermittent presence of blood in your urine, coupled with the sensation in your groin, warrants careful consideration and possibly further investigation.

Firstly, it is essential to understand that hematuria can be categorized into two types: gross hematuria, where blood is visible to the naked eye, and microscopic hematuria, where blood is only detectable under a microscope. The fact that you have observed blood in your urine, even if it is faint, indicates that there may be an issue that needs to be addressed.

Given your history of kidney stones, it is possible that you could be experiencing symptoms related to a small stone that may not be visible on standard X-rays. Some stones, particularly those made of uric acid, can be radiolucent, meaning they do not show up on X-rays. These small stones can still cause irritation to the urinary tract, leading to bleeding. The sensation you described in your groin could be related to the movement of urine through the ureter, especially if a stone is present.

However, hematuria can also result from other causes unrelated to kidney stones. These may include urinary tract infections (UTIs), bladder or kidney infections, trauma to the urinary tract, or even more serious conditions such as tumors in the urinary system. Given that you have had a previous diagnosis of kidney stones, it is crucial to rule out these other potential causes.

In terms of next steps, if the blood in your urine persists or if you experience additional symptoms such as pain, changes in urination frequency, or fever, it is advisable to seek further evaluation. A urologist can perform additional imaging studies, such as a CT scan, which is more sensitive in detecting small stones and other abnormalities in the urinary tract. Additionally, a urinalysis can help identify any signs of infection or other abnormalities.

If the imaging studies do not reveal any stones or other issues, your healthcare provider may consider other potential causes of hematuria. This could include cystoscopy, a procedure that allows direct visualization of the bladder and urethra, to check for any abnormalities.

In summary, while it is possible that a small kidney stone could be causing your symptoms, it is essential to consider other potential causes of hematuria. Given your history and current symptoms, further evaluation by a healthcare professional, particularly a urologist, is recommended to ensure an accurate diagnosis and appropriate management. Always prioritize your health and do not hesitate to seek medical attention if you have concerns about your symptoms.

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