What causes urine with blood in males

Hematuria in Brief

Hematuria is the presence of blood in the urine, usually resulting from bleeding within the urinary tract. Hematuria can fall into two categories:

• Microscopic hematuria is when blood in the urine is only visible when using a microscope;
• Gross hematuria is when blood is visible to the naked eye. Depending on the number of red blood cells, the colour of urine can be bright red or even pinkish. There may even be clots present.

Under normal circumstances, hematuria is not a serious condition and will disappear in time. In other cases, the colour of urine may change due to certain foods or medications.

As a precaution, hematuria could be a sign of an underlying condition that needs treatment. A medical checkup will be an advisable course of action to take to put any concerns to rest. If there is pain during urination, you should have it checked immediately.

There are some reasons why hematuria could occur:

Physical Injury

Any kind of physical injury to the urinary tract, whether directly or not, can potentially cause blood in the urine. This can happen whether you or your loved one may have been in a minor vehicle accident or had a bad fall, for example.

Exercise-induced Hematuria

While a rare occurrence, exercise-induced hematuria can occur. This generally affects those who frequently undertake regularly strenuous physical activity; runners are the most commonly affected, but others are still able to show signs of hematuria. The exact cause is unknown, but some probable factors include:

• Trauma or injury to the bladder (or another part of the urinary tract)
• Breakdown of red blood cells due to sustained aerobic exercise
• Dehydration

On the subject of lifestyle habits, the consumption of certain foods (like berries and beets) and medications (such as blood thinners) are also known to have an effect on the colour of urine. It may also be the breakdown products of red blood cells and muscles that cause this change of colour.

Benign Prostatic Hyperplasia (BPH)

BPH is non-cancerous, abnormal cell growth in the prostate gland, which causes it to become enlarged. It is also known as prostate gland enlargement. It is also the most common prostate problem in men.

The prostate is a walnut-shaped organ that surrounds the urethra, and is responsible for producing fluid for the semen that enables sperm to “swim’. The prostate can continue to grow over time in most men, but having an enlarged prostate gland can lead to a number of health complications.

For one, an enlarged prostate can end up blocking off the urethra, preventing urine from being excreted. Symptoms may include:

• Blood in the urine (though quite rare)
• A need to frequently urinate
• Difficulty emptying the bladder
• Weak/intermittent streams of urine
• Pain after urination

Active surveillance is the usual treatment method, as some instances of BPH will go away on their own after some time. Medications like alpha-blockers and 5-alpha reductase inhibitors may be prescribed if symptoms persist. These help to shrink, reduce the size or prevent further growth of the prostate. Minimally invasive surgery methods may also be considered for severe cases. Surgery usually involves removing excess tissue in the prostate, or reducing/shrinking its size, to open up the blockage to the urethra.

Kidney/Bladder Stones

Also known as kidney, or bladder, calculi, these are hard deposits made of minerals and salts that form in the kidneys or bladder. These stones normally form in the kidneys but can happen anywhere in the urinary tract. BPH may be one cause of stone buildup, as its enlargement blocks the urethra and causes urine to remain in the kidneys or bladder for longer than it should.

Stones are generally formed due to any of the four following minerals built up in the urinary tract: calcium (which is the most common type of stone formed), uric acid, struvite (found in those with urinary tract infections, or UTIs) and cysteine (acid in the kidneys that somehow leaks into the urine).

Kidney stones generally do not cause any symptoms and are usually passed out of the body rather easily. However, there is still the possibility a stone can get lodged anywhere along the urinary tract, which can lead to symptoms including:

• Blood in urine
• Difficulty/pain when urinating
• Nausea
• Vomiting
• Cloudy or foul-smelling urine
• Severe, sharp pains

For mild cases, treatment involves waiting for the stone to be passed naturally while taking pain medications if there is any pain while urinating. Treatment may also depend on the location of the stones. Surgery may be required to remove huge stones that cannot be passed normally. One such surgical procedure is tunnel surgery, or percutaneous nephrolithotomy, which is a minimally invasive surgical method. A small incision is made in the back or side, allowing a special nephroscope to be inserted into the kidney to remove the stones.

There is also shock wave lithotripsy (SWL), which uses directed shock waves to break stones into much smaller pieces. It does come with the risk of causing discomfort or other side effects post-treatment, so the medical team may only consider it under specific circumstances.

Blood/Bleeding Disorders

Possible blood, or bleeding, the disorder could also be the cause of blood in the urine. This may be due to conditions such as haemophilia, where blood clotting takes longer than usual, or some other complication such as platelet defects, specific deficiencies or even sickle cell anaemia.

When a sufficient amount of blood is in the urine, a blood clot can form. The clot could potentially cause a blockage and lead to pain during urination, as well as the inability to pass any urine. If you notice oddly shaped clots being passed in the urine, it could mean there is bleeding in the urethra or prostate.

The cause of the blood or bleeding disorder must be ascertained first before treatment can start. If, for example, there is bleeding in the urethra, surgery may be needed to repair the damage. If it is haemophilia, treatment involves replacing a missing clotting factor in the blood intravenously.

Urinary Tract Infections (UTI)

UTIs occur due to bacterial infection that affects any part of your urinary tract. The bacteria often originates from either the skin or rectum, which then enters the urethra and infects the urinary tract. The urinary system does have the means to protect the body from such infections, but there may be times when it fails to do so effectively. Statistically, 1 in 10 men will develop a UTI in their lifetime.

Because it shares symptoms with other urinary tract conditions, UTIs can be mistaken for other medical complications. Some symptoms include:

• Burning sensation when urinating
• A strong urge to urinate, even on an empty bladder
• Pain in the lower back
• Blood in urine
• Fever
• Tiredness

Specific UTIs can also exhibit additional symptoms. For example, pyelonephritis (bacterial infection of the kidneys) can cause nausea, vomiting and even chills.

As bacteria is the main cause of UTIs, antibiotics and regular water intake are prescribed as a treatment for simple UTIs. Simple UTIs are essentially UTIs that are not severe. For complicated UTIs, where abnormal urinary tracts or difficult bacterial infections, intravenous antibiotics may be recommended to treat the condition. Complicated UTIs have a risk of recurring, so follow-up treatments may become necessary if it comes back. It is important to complete antibiotic prescriptions given by the doctor to prevent the bacteria from building up antibiotic resistance.

Glomerulonephritis

Often referred to as a glomerular disease, glomerulonephritis is inflammation of the glomeruli, which serve as tiny filters (made up of blood capillaries) inside the kidneys. The glomeruli are responsible for filtering excess waste and other fluids from blood, which is then removed from the body as urine. Having glomerulonephritis means that these filters cannot properly remove all this excess waste and fluids.

Glomerulonephritis falls into two categories: acute glomerulonephritis occurs suddenly, possibly because of a viral infection. Chronic glomerulonephritis, on the other hand, occurs over time due to underlying complications, such as high blood pressure. Autoimmune diseases are one such cause of chronic glomerulonephritis, where the immune system mistakenly attacks healthy cells in the body.

Glomerulonephritis does not cause any symptoms at first. If left untreated, symptoms can include:

• Blood in urine
• Foamy or bubbly urine
• Hypertension
• Less frequent urination
• Rashes
• Joint pain
• Anaemia
• Kidney disease, or even failure

Once a glomerulonephritis diagnosis is confirmed, treatment will focus on the root cause of the condition. If it is a case of acute glomerulonephritis, then the treatment plan will be to cure the infection. It may also include simple lifestyle changes, such as modifying one’s diet by reducing salt and potassium intake. Medications to lower blood pressure may also be prescribed to protect the kidneys from straining themselves. A plasmapheresis or dialysis procedure may be ordered if excess waste and fluids need to be filtered out from the bloodstream.

Polycystic Kidney Disease (PKD)

PKD is a genetic disorder that causes fluid-filled cysts to grow in the kidneys. These cysts can alter the shape of the kidneys, interfere with kidney functions, and can cause permanent harm if not treated. PKD is divided into two types: autosomal dominant and autosomal recessive PKD.

Autosomal dominant PKD generally affects adults, with cysts appearing in the kidneys. Symptoms tend to appear at a later stage in a person’s life – often between the age of 30 to 50. Autosomal recessive PKD, or “infantile PKD”, rarely appears in babies in the first few months of life (or even before being born). Symptoms may also appear later in life, usually when the child reaches adolescence. It usually sees cyst growth in the kidneys and liver.

Symptoms may include any of the following:

• Blood in urine
• Headaches
• UTIs
• High blood pressure
• Kidney stones
• Cysts growing in other organs,

Unfortunately, there is still no known cure for PKD. In most cases, early screenings can help with preparing a comprehensive health plan. This ensures that cysts grow slowly and symptoms do not worsen in the long term. Among the steps taken include managing your blood pressure, undergoing dialysis to filter blood, prompt treatment of any diseases or infections of the kidneys and regulating your dietary intake (such as reducing caffeine and alcohol consumption). There may also be medications prescribed to help slow the rate of cyst growth if it is really needed.

Research is still underway to find a reliable cure for PKD.

Kidney Failure

Also called renal failure, this occurs when one or both kidneys can no longer function as they normally should. As such, the kidneys cannot effectively filter waste from the blood, which means waste is slowly building up in your body over time. It is also called end-stage renal disease (ESRD), as it is the final stage of chronic kidney disease.

There are two categories of kidney failure: acute and chronic kidney failure. Acute kidney failure happens suddenly and without warning. At this early stage, it is still possible to treat it before it worsens. Otherwise, if untreated for a long time, it can evolve into chronic kidney failure. When chronic kidney disease progresses, one or both kidneys can start to shrink, begin losing their functions, and develop a host of other complications until the kidneys finally fail.

Kidney failure is commonly caused due to either diabetes or high blood pressure. Unmanaged diabetes and hypertension can easily cause lasting damage to the kidneys. Other causes include untreated kidney conditions (such as kidney stones), heavy metal poisoning (such as mercury or lead), and drug and alcohol abuse. Symptoms may include:

• Reduced urination
• Blood in urine
• Discolouration of urine
• Fatigue
• Poor, or loss of, appetite
• Unexplained weight loss
• Swelling at the feet/ankles
• Nausea

While incurable, it is entirely possible to mitigate the effects of acute kidney failure. Dialysis is the most important treatment option available to ensure that blood is filtered and all the excess waste and fluids are removed from the body. Kidney transplants are a more permanent measure, where your kidneys are replaced by a healthy one (or pair) from a donor (whether alive or deceased). Lifestyle changes are also an important factor in preventing kidney disease from progressing faster, such as regular physical activity, diet management and more.

Kidney/Bladder Cancer

Cancers that affect the kidneys or bladder are chronic conditions, where abnormal cells rapidly multiply in an uncontrolled manner. Over time, these cells will form a mass called a tumour. Tumours can either be benign, meaning they do not spread to other parts of the body, or cancerous. Benign tumours can still present problems, as they may still grow in size.

Kidney cancers usually start with tumour growth in the kidneys. Renal cell carcinoma is the most common form of kidney cancer. There are two types of renal cell carcinoma: clear cell and non-clear cell. The former refers to abnormal cells that look very pale or clear, while the latter exhibits certain features in abnormal cells, such as finger-like projections called papillae found on the tumour. There are also other types of kidney cancer, such as transitional cell carcinoma which affects the lining of the renal pelvis, where the ureters (the tube carrying urine from the kidneys to the bladder) connect to the kidneys.

For bladder cancer, transitional cell carcinoma is the most common form since it starts in these urothelial cells that line the inside of the bladder. As such, tumours may not just grow in the bladder, but also along the urinary tract where urothelial cells exist. Rarer forms of bladder cancer are squamous cell carcinoma, which is due to a chronic infection of the bladder; and adenocarcinoma, where cancer starts in the mucus-secreting glands of the bladder.

In the early stages, kidney/bladder cancer presents no symptoms. Cancer may be discovered by accident during a routine medical check, or even when investigating some other medical complication. When symptoms appear, they may include:

• Blood in urine
• Pain that does not go away
• A lump in the side of the abdomen
• Frequent, or painful, urination
• Nausea
• Tiredness
• Unexplained weight loss
• High blood pressure
• Anaemia

There are a variety of reasons that causes cancer. Smoking, poor health choices, old age, obesity and a family history of kidney or bladder cancer are a few risk factors that increase the risk of getting it.

Treatment of early-stage cancer offers the best prospects of survival, as the cancerous cells have not spread to other parts of the body. If only benign tumours are found, active surveillance would be advised to monitor the tumours for any signs of growth or change. Ablation may be ordered as a permanent solution to remove small tumours. Either cold gases (cryoablation) are passed through a probe to freeze and destroy tumour cells, or an electric current is passed through the tip of a probe, heating up and destroying tumours.

For advanced cancers, surgery options include either partially removing a portion of the kidney(s) or bladder affected by a cancerous growth, or fully removing them if they are permanently damaged. Radiotherapy, chemotherapy and immunotherapy are also options worth considering, as they use different methods to kill cancer cells in the body. However, these options do come with the risk of destroying healthy cells in the process, weakening your body over time. The frequency and dosage of therapies will depend on the severity of cancer.

Take Care of Yourself

Early screenings are always the way to go to keep yourself aware of your overall health. If you discover blood in your (or your loved one’s) urine, do not immediately jump to conclusions. Quickly consult a nephrologist, specialists who diagnose and treat urinary tract complications, and find out what the problem really is. Discuss what the best option is to treat the underlying issue. If need be, do not hesitate to consider a second opinion.

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Why would a man have blood in his urine?

Is blood in urine serious?