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Q: " ... I was wondering if you could help me. I am a 17 year old male and just yesterday I noticed a little bit of blood after I urinated and it was a bit painful. Could you give me some information about this and shoud I see a doctor?... "

Dr. Keti:
7 October, 2002

Blood in urine: Hematuria
Hematuria is the presence of red blood cells (RBCs) in the urine. Some believe that hematuria occurs in up to 10% of the general population. If the urine appears normal to the naked eye, but examination under a microscope shows a high number of RBCs, than it's called microscopic hematuria; when the urine is red or of dark red- brownish colour, it's referred to as gross hematuria.
Several conditions can cause hematuria. The number of potential causes for hematuria are many. Most of the causes do not represent serious or life threatening disease. Some of the common, less serious reasons for hematuria include kidney stones and urinary tract infections.
The most common reason for hematuria in a man 50 years of age or older is benign prostate enlargement. A small percentage of the population normally has microscopic hemuturia with no apparent cause.
Note: Trauma, and excessive exercise ("jogger's hematuria") may also cause blood in the urine.
Sometimes the urine may appear red coloured but the colouring is not blood related. If this is the case than it's called pseudohematuria (false hematuria). This occurs in excessive consumption of beets, berries, or rhubarb; food coloring; and certain laxatives and pain medications; all of which can produce pink or reddish coloured urine.(3)

More serious reasons for hematuria include bladder tumors, kidney tumors, and kidney obstruction. It is reasons like these which make it necessary to properly and thoroughly evaluate all hematuria. The proper treatment for hematuria is dependent upon the cause.(2)

Because hematuria may be the result of a serious problem, you must consult a doctor immediately. (1)

Your doctor may order a series of tests, including urinalysis, blood tests, intravenous pyelogram, and cystoscopic examination.


Causes:
Normally the urine is sterile and it is free of bacteria, viruses, and fungi. An infection occurs when microorganisms, usually bacteria from the digestive tract, get into the urethra( part of the urinary tract). Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally lives in the colon. Microorganisms called Chlamydia and Mycoplasma may also cause Urinary Tract Infections (UTI) in both men and women.

Unlike E. coli, Chlamydia and Mycoplasma may be sexually transmitted. The disease affects all age groups, but is most prevalent among U.S. teenagers. (5)

Symptoms may occur 1 to 3 weeks after exposure to chlamydia. If symptoms do occur, they're often mild and transient. As a result, you may overlook them. Signs and symptoms of chlamydia infection may include: painful urination, lower abdominal pain, vaginal discharge in women or discharge from the penis in men. (5)

Some people are more prone to getting a UTI than others.
Also, any abnormality of the urinary tract that obstructs the flow of urine (a kidney stone, or an enlarged prostate gland for example) sets the stage for an infection.
Another common source of infection is catheters, or tubes, placed in the bladder.

Any disorder, such as diabetes or HIV, that suppresses or changes the immune system raises the risk of a urinary infection.
UTIs may occur in infants who are born with abnormalities of the urinary tract, which sometimes need to be corrected with surgery.
Other abnormalities that could occur and are common in children with urinary infections include the following:

    Vesico-ureteral reflux: Urine normally flows from the kidneys down the ureters to the bladder in one direction. With reflux, when the bladder fills, the urine may flow backward from the bladder up the ureters.
    Urinary obstruction: Blockages to urinary flow may occur at many sites in the urinary tract. Blockages usually occur if the ureter or urethra is too narrow or a kidney stone stops the urinary flow from leaving the body. UTIs are rarely seen in boys and young men. (4)

Signs and Symptoms: In many cases of hematuria, blood in the urine (gross or microscopic) is the only sign of a disorder. Many other common symptoms may be experienced by the patients:

    Abdominal pain
    Decreased urinary force, hesitance, incomplete voiding
    Fever
    Frequent urination (polyuria)
    Pain during urination (dysuria)
    Pain in the flank or side
    Urinary urgency (6)

Diagnosis and EVALUATION
The evaluation consists of taking a history and doing a physical exam of the individual and an analysis of the urine under a microscope. To find out whether you have a UTI, your doctor will test a sample of urine for pus and bacteria. Your doctor will ask many questions about your urinary tract, including urination habits, stone disease, infections and injuries, etc. In addition,other questions about recent illnesses, family history, drugs used in the recent past, prior operations, social habits such as drinking and smoking, and work related exposures should be asked. Usually two diagnostic tests are necessary to enable a doctor to look at the entire urinary tract. Thse are the intravenous pyelogram (IVP) and cystoscopy.

Treatment
The proper treatment for hematuria is dependent upon the cause.
Urinary Tract Infections (UTIs) for example, are treated with antibacterial drugs. The choice of drug and length of treatment depend on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug. The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin. (7)


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