Morning Hematuria: Causes and Concerns for Patients

Q: Morning Hematuria: Causes and Concerns for Patients

Hello： For individuals over 45 years old, the presence of visible hematuria requires thorough examination, as it may indicate potential issues. <br>X-rays and cystoscopy are essential, as we need to rule out the possibility of malignancy, even though it may not necessarily be can

Morning hematuria?

Hello Dr.
Du,
I woke up this morning at 6 AM with a feeling of heaviness in my lower abdomen.
I went out for a brisk walk and ran for about 50 minutes.
After returning home, the sensation of heaviness and swelling in my lower abdomen and genital area became more pronounced.
When I went to the bathroom to urinate, I was shocked to see that my urine was completely red, bright red blood.
There was a feeling of pressure in my urethra as the urine came out.
Aside from the heaviness and pressure, there was no pain like that associated with kidney stones.
After six minutes, I forced myself to urinate again, and it was still bright red.
I drank more water, and by around 9 AM, when I went to the bathroom again, the color was not as bright red, more of a light brown.
After 11 AM, my urine was light yellow, and the red color was no longer visible.
After dinner, it was clear and transparent.
In the evening, I had a urinalysis, which confirmed the presence of red blood cells, but no white blood cells were detected.
I had two experiences with kidney stones over a decade ago, one of which I felt the stone passing along with bright red blood.
I have slight prostate enlargement.
I have been taking aspirin for two years and have been on anticoagulants (Baoshantong) for 1 year and 10 months, which I stopped in mid-October of this year.
In the past two years, my health check-ups showed red blood cell counts of 2-5.
I am very anxious; I am unsure if the blood in my urine this morning is due to passing a kidney stone or if, as mentioned online, it could be painless hematuria, possibly indicating bladder cancer.
I understand that visible blood in urine could suggest advanced stages...
Dr.
Du, I am truly frightened and would greatly appreciate your insights.
Thank you very much.

Du Mi, 50~59 year old female. Ask Date: 2019/12/17

Dr. Du Shixi reply Urology

Hello: For individuals over 45 years old, the presence of visible hematuria requires thorough examination, as it may indicate potential issues.
X-rays and cystoscopy are essential, as we need to rule out the possibility of malignancy, even though it may not necessarily be cancerous.
Additionally, conditions such as aspirin use, vascular proliferation due to benign prostatic hyperplasia, and kidney stones can also lead to bleeding tendencies.
There is no need to be afraid; undergoing examinations does not automatically mean a cancer diagnosis.
Regarding the media's mention of painless hematuria potentially being a sign of bladder cancer, it is important to remain vigilant, but it does not necessarily indicate advanced disease, so there is no need to panic.
Simply seek out a hospital for evaluation; neglecting various symptoms and avoiding medical attention can lead to delays in treatment.
Wishing you good health.

Reply Date: 2019/12/17

More Info

Morning hematuria, or the presence of blood in urine upon waking, can be a concerning symptom for many patients. Understanding the potential causes and implications of this condition is crucial for addressing any underlying health issues and alleviating anxiety.

Possible Causes of Morning Hematuria
1. Urinary Tract Infections (UTIs): UTIs can cause inflammation and irritation in the urinary tract, leading to blood in the urine. Symptoms may include a burning sensation during urination, frequent urges to urinate, and cloudy urine.

2. Kidney Stones: Given your history of kidney stones, it is possible that you may be experiencing another episode. Stones can cause bleeding as they move through the urinary tract, leading to hematuria. The absence of severe pain does not rule out this possibility, as some stones can cause minimal discomfort.

3. Prostate Issues: You mentioned having slight prostate enlargement. Conditions such as benign prostatic hyperplasia (BPH) can lead to hematuria, especially in older men. Inflammation or irritation of the prostate can cause blood to appear in the urine.

4. Bladder or Kidney Conditions: More serious conditions, such as bladder cancer or kidney disease, can also present with hematuria. While the presence of blood can be alarming, it is essential to remember that not all cases of hematuria indicate cancer, especially in the absence of other symptoms.

5. Medications: You noted that you have been taking aspirin and anticoagulants. These medications can increase the risk of bleeding, including in the urinary tract. If you have recently stopped taking anticoagulants, it is essential to monitor for any changes in bleeding patterns.

Immediate Steps to Take
1. Stay Calm: While it is natural to feel anxious about blood in your urine, try to remain calm. Many causes of hematuria are treatable and not life-threatening.

2. Hydration: Continue to drink plenty of fluids, as this can help flush out your urinary system and may reduce the concentration of blood in your urine.

3. Seek Medical Attention: It is crucial to consult with a healthcare provider, especially given your history of kidney stones and the recent occurrence of hematuria. A urologist can perform tests, such as urinalysis, imaging studies (like an ultrasound or CT scan), and possibly cystoscopy, to determine the cause of the bleeding.

4. Document Symptoms: Keep a record of your symptoms, including the timing, color, and any associated sensations (like pressure or pain). This information can be helpful for your healthcare provider in diagnosing the issue.

Understanding the Risks
While the presence of blood in urine can be alarming, it is essential to approach the situation with a clear mind. Not all cases of hematuria are indicative of severe conditions like cancer. Many benign causes can lead to blood in the urine, and early intervention can often lead to successful management of the underlying issue.

Conclusion
In summary, morning hematuria can arise from various causes, including urinary tract infections, kidney stones, prostate issues, and more serious conditions. Given your medical history and the recent occurrence of blood in your urine, it is advisable to seek medical evaluation promptly. Early diagnosis and treatment are key to managing any potential health issues effectively. Remember to stay hydrated and document your symptoms to provide your healthcare provider with the necessary information for a thorough assessment.

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