Blood in Urine: Causes, Concerns, and When to Seek Help

Identifying the source of hematuria?

My father recently experienced hematuria, and despite family urging him to seek medical attention, he has been unwilling to do so, which has made us very upset.
He described his hematuria as being a deep red color and stated that it was consistently blood in his urine, but the next day the urine returned to normal color, so he believes it is not serious.
He insists that he is "fine" and wants us not to worry.
He has two points: 1.
He used a cleaning agent (commercial/over-the-counter) that had a strong odor, which he believes caused a sort of poisoning that led to the hematuria.
2.
He worked harder than usual that day, which may have caused mild rhabdomyolysis.
Are these two points potentially serious enough to cause such severe hematuria? If he were to seek medical care, should he see a urologist, a family medicine physician, or another specialist? What tests are typically performed for hematuria, and how long do they take? My father mentioned that the tests could take an entire day, and he doesn't have that much time, which is why he is reluctant to get checked.
Thank you for your response.

Mr. Chen, 20~29 year old female. Ask Date: 2023/01/17

Dr. Xiao Yongxun reply Family Medicine

1.
Poisoning or rhabdomyolysis can lead to dark or red-colored urine; however, the term hematuria specifically refers to the presence of red blood cells in the urine.
Gross hematuria is visible to the naked eye, while microscopic hematuria is detected under a microscope.

2.
There are many causes of hematuria, with common ones including urinary tract stones, urinary tract infections, side effects of medications, tumors, and other less common causes.
3.
It is essential to first determine whether the issue is hematuria or another factor causing the urine to appear red.
Initially, the physician will inquire about relevant symptoms, the course of the illness, and medical history, followed by a routine urinalysis or urine culture.
If necessary, ultrasound, contrast pyelography, computed tomography (CT) scans, or endoscopic examinations may be performed.
Please visit the urology outpatient department at a regional hospital for consultation, and feel free to register and wait for your appointment.
When it comes to health issues, please do not use lack of time as an excuse; do not let your convenience or negligence affect your family.

Reply Date: 2023/01/17

More Info

Blood in urine, or hematuria, is a concerning symptom that can arise from various underlying conditions. In your father's case, the fact that he experienced bright red blood in his urine, even if it resolved the next day, should not be taken lightly. While he may believe that his symptoms are not serious, it is essential to understand that hematuria can indicate a range of issues, some of which may require immediate medical attention.

Possible Causes of Blood in Urine
1. Urinary Tract Infections (UTIs): These are common causes of hematuria, particularly in older adults. UTIs can lead to inflammation and irritation of the bladder and urethra, resulting in blood in the urine.

2. Kidney Stones: The presence of stones in the urinary tract can cause significant pain and bleeding, leading to hematuria.

3. Trauma: Any injury to the kidneys or bladder can result in blood in the urine.

4. Glomerulonephritis: This is an inflammation of the kidney's filtering units, which can cause blood to appear in the urine.

5. Cancer: Tumors in the bladder, kidneys, or prostate can also lead to hematuria.

6. Medications: Certain medications, such as blood thinners, can increase the risk of bleeding.

7. Rhabdomyolysis: This condition, characterized by the breakdown of muscle tissue, can lead to myoglobinuria, which may cause dark urine but is not typically associated with bright red blood.

Addressing Your Father's Concerns
Regarding your father's belief that cleaning agents or muscle strain could cause his symptoms, while chemical exposure can irritate the urinary tract, it is less likely to cause significant hematuria. Similarly, while rhabdomyolysis can lead to dark urine, it typically presents with other symptoms, such as muscle pain and weakness, and is not commonly associated with bright red blood in urine.

When to Seek Medical Help
It is crucial for your father to seek medical attention, especially since he experienced a clear episode of hematuria. Even if the blood resolved quickly, it is important to investigate the underlying cause. Delaying medical evaluation could lead to worsening conditions if there is an underlying issue that requires treatment.

Which Specialist to See
For hematuria, the appropriate specialist to consult is a urologist. A urologist specializes in the urinary tract and male reproductive system and can conduct the necessary evaluations. While a family medicine doctor can also provide initial assessments, a urologist will have the expertise to investigate urinary issues more thoroughly.

Diagnostic Tests
When your father visits a urologist, the following tests may be conducted:
1. Urinalysis: This test checks for the presence of blood, protein, bacteria, and other substances in the urine.

2. Urine Culture: If a UTI is suspected, a urine culture can help identify the specific bacteria causing the infection.

3. Imaging Tests: Ultrasound, CT scans, or X-rays may be ordered to visualize the kidneys and urinary tract for stones, tumors, or other abnormalities.

4. Cystoscopy: In some cases, a urologist may perform a cystoscopy, where a thin tube with a camera is inserted into the bladder to directly visualize the urinary tract.

Duration of Tests
The time required for these tests can vary. A urinalysis can often be done quickly, while imaging studies may take longer, depending on the facility's schedule. It is understandable that your father may be concerned about time, but it is essential to prioritize health over convenience.

Conclusion
In summary, while your father may have his reasons for dismissing the seriousness of his symptoms, blood in urine is a significant sign that warrants medical evaluation. It is crucial to consult a urologist to determine the cause of the hematuria and to rule out any serious conditions. Encouraging him to seek medical attention is vital for his health and peace of mind.

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