Blood in urine: A cause for concern?

A red, pink, dark orange, or even brown colour might indicate various traces of blood in urine. But such changes  may not be due to the presence of blood. For example, certain foods and medications can affect your urine colour. If you have recently eaten a lot of beetroot or have started taking a new medicine, this could be the reason your urine has changed colour. If there really is blood in the urine, the medical term for this phenomenon is haematuria. When the urine has red, reddish, pink or brownish tones, it is called gross haematuria. But even if the urine is red in colour, this doesn’t necessarily mean it contains a large amount of blood – it only takes a little blood to make urine red. However, sometimes there can be blood in urine without it being visible to the naked eye. When the concentration of red blood cells in the urine is so low that it can only be detected by testing in a laboratory, it is called microhaematuria.

If your urine is red, and the discoloration is not likely due to certain foods, menstruation or medication, you should always consult a doctor. The doctor will analyse a urine sample to verify if there are red blood cells in the urine. The analysis can also, for example, show whether there are signs of inflammation, or if levels of protein in the urine are enhanced. All of these aspects can point the way to further diagnosis. Often, it is not possible to make a clear diagnosis by only examining the urine. In this case the doctor will order further examinations, such as a medical ultrasound of the kidneys or bladder.

• Urinary tract infections. If bacteria enter the urinary tract, the cause of bloody urine can be an infection of the lower urinary tract. Sometimes, the infection can spread further up to the kidney(s). Other symptoms, for example, can be pain and burning when urinating, dull pain in the kidney, strong-smelling urine, fever or fatigue. Symptoms will get worse if the bacteria spread further up to the upper urinary tract. 
• Bladder or kidney stones. Mechanical irritation from foreign bodies in the urinary tract can cause blood in the urine. For example, certain urinary components – which usually crystallize and are frequently flushed out – can sometimes form crystals, which over time become small bladder or kidney stones. If they become too big, they stick in the ureter or bladder and can often cause reddish urine and severe pain.
• Tumours of the bladder, urethra or kidneys (both benign and malignant) could also cause blood in urine. They sometimes lead to increased urination or spasmodic pain in the bladder.
• Diverticula. When part of the bladder wall or urethra wall is weak for some reason and thereby forms an unwanted pocket that can become infected. One of the symptoms can be bleeding when urinating. 
• Kidney injury. Traumas of the kidneys or urinary tract (due to falls, blows or other injuries) can cause visible blood in the urine.
• Extreme physical exertion, such as in a marathon race, can also cause blood in the urine.
• Side effects of medications or radiation therapy are also sometimes the cause of blood in urine in both men and women.

Blood in women´s urine during menstruation is nothing unusual. For men, blood in the urine can be caused by an infection of the prostate or benign enlargement of the prostate. In prostate cancer, however, blood in the urine is at least not one of the first or the main symptoms. Early stages of prostate cancer usually show no symptoms or signs, which is why active monitoring of prostate health is important.

If blood is detected in your urine, the potential treatment depends on the cause of the bleeding. For example, if the bleeding is caused by a urinary tract infection, it would usually be treated with antibiotics. However, if the bleeding is caused by foreign bodies or stones in the kidneys or bladder, the foreign bodies or stones will often need to be removed – this also applies to tumours. Stones can also be removed using ultrasound, which breaks the stones into small pieces and then flushes them from the bladder.

As already mentioned, blood in men’s urine can be explained by problems with an enlarged prostate. In benign prostate enlargement or having a prostate inflammation, bloody urine is not the most common symptom –other typical symptoms include a constant urge to urinate, or such a strong urge that you can’t make it to the toilet in time.

These symptoms are not uncommon. If you have urine leakage, contact a professional who can help discover the cause and recommend the right treatment. For extra support, there are also discreet and easy to use incontinence products available that prevent leakage on clothes and remove unwanted odours.

TENA absorbent products are designed to prevent  social isolation. Depending on the level of incontinence, there are different product types designed to suit different life situations. For light incontinence, for example, TENA Lady Discreet Mini liners and pads offer a perfect blend of discretion and protection. Their asymmetrical shape ensures a tight fit and guarantees discretion and comfort. The absorbent core safely absorbs urine and prevents moisture or odours. You can find  more TENA products here.

Audited by Josefine Grandin, District nurse, urotherapist, 2020-02-26

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