Is Blood in Urine Always a Sign of Cystitis?

Q: Is Blood in Urine Always a Sign of Cystitis?

Hello： I have been experiencing lower back pain (on the right side) for about a month, and then one day I suddenly had severe pain in my lower abdomen. <br>A few days later, I noticed visible blood in my urine. <br>The doctor suggested it might be cystitis, but I don't experience

The presence of blood in the urine is it a sign of cystitis?

Hello Doctor: I have been experiencing lower back pain (on the right side) for about a month, and then one day I suddenly had severe pain in my lower abdomen.
A few days later, I noticed visible blood in my urine.
The doctor suggested it might be cystitis, but I don't experience pain when urinating; I only occasionally feel a slight stinging sensation in my bladder and a warm feeling during urination, but there is no pain.
So, is it possible to have cystitis without pain during urination? After taking antibiotics for a week, I had another urine test, which showed no hematuria (and my back pain has also resolved), but both RBC and WBC counts were slightly above normal, and there were bacteria present (the day before, I went hiking, which was not high intensity but was a long-awaited exercise that made me sweat; could this be related?).
Does this mean I still have hematuria? The next day, feeling uneasy, I had another check-up, and the report showed normal results.
However, I realized that I had consumed a large amount of water at that time, and I would like to know if this could lead to inaccurate results.
I read online that drinking water can affect specific gravity but is less likely to impact RBC and WBC results, is that correct? Now, when I lie flat, I occasionally feel a slight heaviness in my lower back, but otherwise, there are no significant issues.
Based on the doctor's assessment, do you think I have cystitis? I am very concerned that it could be a more serious condition (the possibility of kidney stones has been ruled out with relevant tests).

Nǚz, 20~29 year old female. Ask Date: 2021/09/04

Dr. Du Shixi reply Urology

Hello: I have been experiencing lower back pain (on the right side) for about a month, and then one day I suddenly had severe pain in my lower abdomen.
A few days later, I noticed visible blood in my urine.
The doctor suggested it might be cystitis, but I don't experience pain while urinating; I only occasionally feel a slight stinging sensation in my bladder and a warm feeling during urination, but there is no pain.
So, is it possible to have cystitis without painful urination? -- Yes, it is possible.
However, a urinalysis can increase diagnostic accuracy, as it can confirm inflammation and the presence of hematuria.
After taking antibiotics for a week, I had another urinalysis, which showed no hematuria (and my back pain has resolved), but both RBC and WBC counts were slightly above normal, and there were bacteria present.
I went hiking the day before, which wasn't high intensity but was a long-awaited sweating exercise; could this be related? Does this still indicate the presence of hematuria? The next day, because I was still concerned, I had another test, and the results were normal.
However, I realized that I had consumed a large amount of water at that time.
Could this affect the accuracy of the results? -- Urinalysis can be influenced by water intake; some minor issues may be overlooked due to excessive hydration.
I read that drinking water can lead to inaccurate specific gravity readings, but it typically does not affect RBC and WBC results, correct? -- That depends on how much water you drink.
Consuming around 2000 cc per day is not considered excessive.
Now, when I lie flat, I occasionally feel a slight heaviness in my lower back, but there are no other abnormalities.
Based on the doctor's assessment, do you think I have cystitis? I'm very worried it could be a more serious condition (the possibility of kidney stones has been ruled out through relevant tests).
-- It is important to stay hydrated, avoid holding in urine, maintain a light diet, and have regular follow-ups.
Wishing you good health.

Reply Date: 2021/09/04

More Info

Blood in urine, or hematuria, can indeed be a concerning symptom, but it is not always indicative of cystitis (bladder inflammation). Your situation presents a few important points to consider.

Firstly, cystitis typically presents with symptoms such as frequent urination, urgency, and dysuria (painful urination). However, it is possible to have cystitis without experiencing significant pain during urination. In your case, the absence of severe pain during urination, coupled with the presence of blood, suggests that while cystitis could be a possibility, it may not be the sole explanation for your symptoms.
The fact that you experienced sudden lower abdominal pain followed by visible blood in your urine is noteworthy. This could indicate a more complex issue, such as a urinary tract infection (UTI) or even a kidney-related problem, especially given your history of back pain. The presence of red blood cells (RBCs) and white blood cells (WBCs) in your urine, even if slightly elevated, suggests some form of irritation or infection in the urinary tract.
You mentioned that after a week of antibiotics, your urine tests showed no signs of blood, which is a positive sign. However, the presence of bacteria in your urine indicates that there may still be an underlying infection or inflammation. Engaging in physical activities, such as hiking, can sometimes lead to dehydration or minor injuries that may exacerbate urinary symptoms, but it is unlikely to be the sole cause of hematuria.

Regarding your concerns about hydration affecting urine test results, drinking a large amount of water before a urine test can dilute the urine, potentially affecting the concentration of certain substances, including bacteria. However, it typically does not significantly alter the presence of RBCs or WBCs. If your urine was diluted, it might lead to a lower concentration of bacteria, but the presence of blood cells would still be detectable if they were present.

Given your symptoms and the results of your tests, it is essential to follow up with your healthcare provider. They may recommend further tests, such as a urine culture, imaging studies, or even a cystoscopy, to rule out other potential causes of hematuria, such as kidney stones, tumors, or other urinary tract abnormalities.

In summary, while cystitis is a possibility, your symptoms and test results suggest that further investigation is warranted to ensure that no more serious conditions are present. It is crucial to maintain open communication with your healthcare provider about your symptoms and any changes you experience. Regular follow-up and monitoring will help ensure that any underlying issues are addressed promptly.

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