Blood in Urine

Blood in Urine overview and Definition

 It is also know as haematuria, means passage of blood in the urine.

Structure of Blood in Urine

Haematuria is classified into:

Visible Haematuria:

Macroscopic or gross haematuria. Blood is visible in the urine, colouring it pink, red, or dark brown.

Non visible haematuria:

 Initially microscopic and dipstick positive. Blood is present in the urine in the urinanalysis but not visible. This can be further categorized into:

Symptomatic non visible haematuria:

Haematuria presents with associated symptoms such as suprapubic pain or renal colic.


Haematuria confirmed with no symptoms.



  • Injury to the blood vessels in the situation such as internal bleeding might result in passage of urine with blood. Structural disruption in the integrity of the glomerular basement membrane
  • Disruption of the renal tubules
  • Mechanical erosion of the mucosal surfaces of the genitourinary tract.

 It occurs when the normal anatomic and physiologic function of the excretory systems gets interrupted. Incontinence usually occurs from the multiple factors and it is not concerned to the single factor. The internal anal sphincter function is to cause the pressure during the resting phase and also it enhances the action of external sphincter , the anal mucosal folds, and the anal endovascular cushions. Disruption of the external sphincter results in urge related disorder or urine related disorder. Damage to the endovascular cushions results in dysfunction of the anal seal and sampling reflex. The ability of the rectum to perceive the presence of urine leads to the rectoanal contractile reflex response, an essential mechanism for maintaining continence.Pudendal  neuropathy can diminish rectal sensation and lead to excessive accumulation of urine, causing  urine impaction, mega-rectum, and fecal overflow. The puborectalis muscle plays an integral role in maintaining the anorectal angle. Its  nerve supply is independent of the sphincter, and its precise role in maintaining continence needs to be defined. Obstetric trauma, the most common cause of anal sphincter disruption, may involve the EAS, the IAS, and the pudendal nerves singly or in combination.  These leads to the inflammatory actions and dilatation of the blood vessels surrounding the area and might cause blood in urines.

Clinical signs & symptoms

passing red coloured urine

passing blood clots

burning sesation to pass the urine

frequent urge to pass the urine

Often internal bleeding can become notice

Abdominal pain



 Difficulty breathing, 



 Fainting, and 

Weight loss depending on the cause, location, length, and severity of the bleeding.

Differential Diagnosis

The doctor might see and evaluate the causes of bleeding.The doctor might help to evaluate the sight of bleeding. A black, tarry urine indicate the presence of renal tract infection.  Bright red colour indicated any dysfunction or abnormalities in the renal tract.

After certain conclusion from the physical examination the doctor might advice for the following investigation techniques:

Renal function test:

To check for the proteins

To check foe globulin albumin ratio.

Flexible cystoscopy :

It is the gold standard investigation for assessing the lower urinary tract and should be performed in all cases that meet the criteria for further investigation where feasible (Fig. 3). This is often performed under local anaesthetic at a one-stop haematuria clinic.

Whilst more commonly used in follow-up of patients with proven malignancy, some centres will also send urine cytology in the intial assessment for haematuria as a further adjunct assessment.

Upper urinary tract imaging is also warranted in cases of haematuria:

US KUB imaging is a cheap and non-invasive method, and is typically employed for cases of non-visible haematuria

CT Urogram is more definitive imaging, albeit with a higher radiation exposure, and is typically used for cases of visible haematuria

Barium X-ray: A procedure that uses the barium and the barium is inserted into the digestive tract and several investigations are made. The barium must be either inserted through the rectum are swallowed.

Radionuclide scanning:

It involves injecting the radioactive material into the vein and camera is focused in it to see the images in the urinary tract to detect where the bleeding is happening.

A procedure that involves injecting a special dye into a vein that makes blood vessels visible on an X-ray or computerized tomography (CT) scan. The procedure detects bleeding as dye leaks out of blood vessels at the bleeding site.

Laboratory tests:

Ordered laboratory tests must be based on the history and clinical examination findings. Main tests:

  • Urine dipstick: one of the most useful and sensitive tools in detecting hematuria, but with low specifity as it also give positive results when myglobinurea and hemoglobinurea are present.
  • Urine sidement : confirms hematuria under microscopy, more than 3 RBCs per high power field is generally considered abnormal.
  • Urine culture: peroformed in case urinary tract infection is suspected, it distinguishes the causative organism.
  • Electrolytes, serum creatinine, nitrogen levels; performed
  • Coagulation studies; performed in case coagulopathy or drug intoxication are suspected.


The prognosis depends upon the caustive factor of the disease. The causes such as urinary tract infection, glomerulonephritis, medications and strenous exercise can be deteriorated and haematuria can be stopped by starting the treatment earlier.

When the haematuria depends upon the cancer, then the symptoms revival depends upons the stages.


Intake  lots of water and other fluids.

Stay hydrated.

If initial symptoms arises, seek for the medical help as soon as possible.

Intaking of lots of fibers rich diet or wholesome grains might leads to easy digestion and passage of stool through the anal canal and this might prevents the anal stiffness and reduces the difficulties of passage of urine.

Intaking  lots of water and staying hydrated prevents loss of tear of anal tissue.