Haematuria (Blood in Urine) In Men – A Definitive Guide

Haematuria (Blood in Urine) In Men


Are you alarmed to see blood oozing out with your urine? Have you been noticing this strange phenomenon for quite some time now but unable to understand why? Are you -wracking your brains trying to connect the dots on what went wrong, but not deriving any logical explanations?

Well, you might be suffering from haematuria, which causes blood to come out with your otherwise normal urine. This is a common occurrence in males and in the majority of cases, is quite harmless. However, in some situations, it may lead to a serious disorder if it is not diagnosed at an early stage.

Thus, if you spot any such anomaly in your urine, it is best to determine the cause of the bleeding and get diagnosed at the earliest to prevent any further complications.

When the blood is clearly visible, it is gross haematuria. Often, the blood in your urine is not visible with the human eye but can be detected once it is viewed under a microscope. This is known as microscopic haematuria and can be detected when the doctor runs a few tests on your urine sample.

Either way, you should not waste any time and take the necessary measures of getting yourself tested and treated by a local GP.

But first, let us look at this condition in detail and understand its many causes, consequences, complications and finally, the latest treatments.

Haematuria (Blood in Urine) In Men

Haematuria in men basically refers to the evidence of blood in the urine. It occurs when there is a presence of RBCs (red blood cells) in the urine. Usually, when there is 10 or more number of RBCs in a high-power field, it is considered to be abnormal and must be taken seriously and treated urgently.

Sometimes, it is visible with the naked eye and you can clearly spot it. But there are a few instances when the only way to detect it is by using a urinary dipstick or running a test by providing your sample urine.

The visible or gross haematuria is also known as macroscopic or frank haematuria. As such, the colour of regular and normal urine is generally in shades of yellow that vary between pale straw to light amber colour. However, visible haematuria causes the urine to appear pink, red, brown or tea-coloured due to the presence of excess blood and blood clot.

Surprisingly enough, even a meagre amount of 1ml blood can impart colouration to a 1L of urine. This may not show any immediate symptoms or reactions but might indicate the presence of a serious impending disease, thus requiring an urgent diagnosis.

Moreover, the abnormalities and anomalies largely depend on age, differing in results for children and adults, mostly over the age of 35 years. 

The invisible condition is referred to as microscopic haematuria, and it becomes chronic when the RBCs in your urine exceed more than 3 as detected.

In the aftermath of its detection, your local GP may want to further investigate the various parallel and underlying causes that lead to such a condition and what could be its future implications, including urological cancer and malignancy.

What Are the Causes for Haematuria In Men?

The organs that are fundamentally responsible for the occurrence of haematuria in men are the kidney and the urinary tract. Both these organs allow blood to leak out into the urine, resulting in visible or invisible haematuria.

There are various reasons and underlying issues that cause this leakage. These are mainly:

1.      Urinary Tract Infection or UTI

This is one of the most common causes of blood in the urine. UTIs are commonly seen in women although there are chances of men developing them as well. Urinary tract infection can be investigated by the methods of urine microscopy, culture and sensitivity.

You can develop UTI when the bacteria from outside enters your body through the urethra, which is a tube that carries urine all the way from the urinary bladder throughout the body. These bacteria can, in turn, spread to the urinary bladder and multiply there as well.

The symptoms of UTI include:

  • A constant and persistent urge to urinate
  • An induced urgency to urinate
  • Pain or a burning sensation inside the urethra
  • Urine that has a very strong smell and pungent odour
  • The appearance of microscopic blood in the urine, especially for older men

In rare cases, the UTI caused in the urethra and bladder spreads right up to the kidneys and affects them. If such a thing happens, the infection takes a more severe and extreme turn, displaying these additional symptoms:

  • A sensation of nausea and vomiting
  • Pain in the back, sides and the groin area
  • Fever and heightened sensitivity to cold

The risk factors of UTI in men can vary from prostate cancer to the recent application of catheter.

2.      Infections in the Kidneys or Pyelonephritis

Pyelonephritis causes inflammation in the kidneys that is a result of any kind of bacterial or viral infection which affects both the kidneys. This may be in the case of UTI, when the bacterial infection moves upstream to the kidneys from the bladder and urethra, as mentioned in the previous point. Apart from infecting the kidneys and blood in the urine, its symptoms include:

  • Fever
  • Severe muscle pain throughout the body
  • Pain while urinating

If immediate and urgent treatment is not provided, it may lead to serious disorders.

If you have a kidney infection, consult your local GP at the earliest and get it checked out. Moreover, eat lots of fruits and vegetables with high water content and keep yourself hydrated at all times.

Depending on your age, medical history and response to treatment, your GP may diagnose this as the cause of haematuria.

3.      Stones in the Bladder or Kidney

When the amount of waste products exceeds the liquid content in the blood, it converts to stones in the kidneys and bladder. Kidney stones are nothing, but the coagulation of dissolved minerals and hard acids present in the kidney wall lining.

These stick together in the urine that is concentrated in nature and can vary in size and structure. The small ones may pass through the urinary tract unnoticed, but the bigger, sharper and crystalline ones cause immense pain and may even get stuck in their tracks, causing permanent damage.

It is usually these larger masses that cause different symptoms in the body such as:

  • Blood in the urine
  • Intense lower back pain on both sides
  • Continuous stomach ache
  • Nausea and vomiting
  • Urine that has a strong smell
  • Burning sensation during urine
  • Less urination than normal
  • Presence of white blood cells or pus in the urine
  • Chills and fever

One of the main causes of stones is drinking less water than is required by the body, which makes the urine acidic in nature and creates a favourable condition for stone formation. Kidney and bladder stones lead to both frank and microscopic haematuria and are difficult to detect unless they pass through some blockage or obstruction in their path.

By undergoing surgery or other alternative treatment from a health care professional and adopting a change in diet and lifestyle, it is possible to reverse kidney stones and in turn, haematuria.

4.      Other Kidney Diseases

There are certain other kidney diseases including cysts and tumours that may cause bleeding in the urine. This group of diseases is collectively known as glomerulonephritis, which results in an inflammation of the kidney’s complete filtering system. It is caused when the minute capillaries present inside the kidney’s structure that is responsible for filtering the blood is infected by various diseases and pathological infections. It has microscopic haematuria as one of its symptoms.

Glomerulonephritis is a result of various kinds of viral or strep infections, blood vessel disorders such as vasculitis and immune problems such as IgA nephropathy. In many cases, it can be accompanied by diabetes or other systemic diseases.

For people suffering from glomerulonephritis, the injured kidneys are no longer able to remove waste materials and excess fluids out from the human system. A chronic version of this often affects younger men, who suffer from loss of hearing and vision.

Acute GN is quite sudden and unprecedented, having the following symptoms:

  • Urinary bleeding
  • Puffiness of face in the morning
  • Less urine than normal
  • Shortness of breath
  • Frequent coughing
  • High blood pressure

However, chronic GN injures the kidneys slowly and gradually, often going unnoticed for several years until the symptoms finally begin to appear. They include:

  • Blood in urine
  • Presence of protein in the urine
  • Swollen face and ankles
  • Urination in frequent intervals during the night
  • Foamy and bubbly urine

5.      Injury to the Kidney:

Often while playing heavy contact sports or engaging in intense and rigorous physical activities may lead to an injury to the kidneys. The same thing may happen in the form of an accident.

During such instances, the blow to the kidney might rupture the kidney walls or affect its internal mechanism, resulting in macroscopic urinary bleeding or gross haematuria in men.

6.      Prostate Enlargement

The prostate is a gland that is located just below the urinary bladder and in front of the rectum in men. It is one of the main parts of the male reproductive system and is responsible for the production of semen.

When the prostate enlarges in size, it can press down on the urethra, making it difficult for you to urinate. This medical condition of an enlarged prostate is known as benign prostatic hyperplasia or BPH. Due to blockage of the urethra, the urinary bladder tries to overcompensate by straining itself and putting extra effort to release the urine out. This often leads to rupture and subsequent bleeding that passes out through the urine.

Over 50 per cent of adult men are affected by BPH and around 90 per cent of them are above 80 years of age.

Its symptoms include:

  • Constant urge to urinate
  • Urinating in frequent intervals, especially at night
  • Difficulty in urination
  • Weak or irregular flow of urine
  • Needing to exert force or push while urinating
  • A feeling of fullness of bladder even after urination
  • Spotting blood in the urine

In extreme cases and situations of emergency, you may not be able to urinate at all. Thus, it is best to consult the advice of your local GP and get it diagnosed at the earliest.

7.      Haematuria caused by Exercise

You might notice blood in your urine after a workout session at the gym or anywhere else which involves partaking in some physical exercise such as running or swimming. This type of haematuria is usually referred to as exercise-induced haematuria or post-exertional haematuria.

Although doctors have split opinions about EIH, most studies reveal that it depends more on the intensity of the exercise routine rather than its duration.

Moreover, not being sufficiently hydrated before engaging in such strenuous and intense exercise increases the chance of urinary bleeding.

EIH commonly gets back to normal within 3 days. However, if the bleeding persists for more than 3 weeks, visit your nearest GP and get a proper check-up done.

8.      Recent Application of Catheter

The urinary catheter helps drain out urine from the body in the wake of a surgery, injury or disease. In men, the indwelling and external catheter are two types of commonly used catheters that are inserted into the urethra and penis respectively for urine collection and drainage.

Both these types allow the external bacteria to make way into the urethra and multiply, resulting in a catheter-associated urinary tract infection (CAUTI). One of its main symptoms is the presence of blood in the urine, along with other symptoms such as spasms in the lower back and abdomen.

9.      Medications

If you are on certain types of medication, it is important to be aware of the ones which make you susceptible to haematuria. These are:

  • Nonsteroidal anti-inflammatory drugs: Using these for long periods of time result in kidney damage that may lead to microscopic haematuria.
  • Blood thinners: They are used to prevent blood clotting but a few such as warfarin and aspirin may cause urinary bleeding.
  • Cyclophosphamide and ifosfamide: These chemotherapy drugs can cause haemorrhagic cystitis. Its symptoms include sudden onset of blood in urine along with pain and irritation in the bladder.
  • Senna: Using this laxative for a long period of time can cause haematuria.

If you suspect medications to be the cause of urinary bleeding, consult your GP for a change in the prescription and go for alternative medication.

10.  Cancer

Blood in the urine and decolouration of urine are few of the earliest signs of bladder cancer and must be treated as soon as it is suspected.

Moreover, evidence of visible blood in the urine can be an indication of an advanced stage of prostate cancer.

Prostate cancer is probably the most commonly found cancer in men. If diagnosed at an early stage, it can be cured easily. However, due to the rare occurrence of symptoms in the early stage, unfortunately, you must conduct regular tests and medical examinations to get yourself checked.

11.  Inherited diseases

Certain inherited and genetic diseases such as sickle cell anemia and cystic kidney disease are also responsible for haematuria, both gross and microscopic.

What Are the Symptoms of Haematuria?

You may not notice any symptoms immediately if you have microscopic haematuria where the RBCs are not present in enough numbers to be visible to the naked eye. For this, you may have to run a few urinary tests for further diagnosis. However, signs such as pain while urinating, a persistent urge to pee, incomplete urination and lower back pain should not be ignored and could indicate haematuria.

In the case of frank haematuria, the most common way to detect it is by observing the colour of your urine. If it is pinkish or reddish-brown in colour, it indicates the presence of an alarming rate of red blood cells that clearly points to haematuria.

Apart from this, the additional symptoms mentioned for microscopic haematuria are also applicable here such as excruciating pain while urinating and constant urge to urinate at regular intervals.

What is the Diagnosis?

There are a number of tests and diagnosis that are used to detect haematuria in men. They are:

  • Urinalysis: Urinalysis accompanied with microscopic examination of your urine sample can reveal any evidence of blood and other infections. These infections, such as the presence of white blood cells in the form of pus and other bacteria in the urine can also be signs of kidney disease.
  • Urine Culture: These tests are run solely for the purpose of identification of the genetic material of microorganisms. This helps in identifying the cause of infection and its origins.
  • Blood Tests: Regular blood tests and check-ups at the local laboratory are also effective in diagnosing haematuria and detecting any abnormal kidney function.
  • Cystoscopy: This procedure involves a thorough examination of the inner walls of urethra and bladder, using a narrow tube-like instrument. These employ tissue samples for cancer diagnosis as well.
  • Renal Biopsy: Biopsies are performed in order to diagnose any undetected kidney disease that may lead to haematuria.
  • Imaging: Different tests relating to imaging such as Computed Tomography or CT scans, kidney ultrasounds or intravenous pyelograms can be carried out to determine the cause of haematuria in the upper urinary tract.

What Complications Can You Face?

The most common complications that you may face as an adult male would be in the form of high blood pressure and pain in your lower back and sides. Furthermore, you may also experience pain in your groins. If you already have hypertension, haematuria might worsen the condition.

Apart from this, the very act of urination becomes difficult. Intense pain while urinating along with a constant urge and sensation to urinate at frequent intervals can be an issue when you are at work or attending a social event.

Those who are at an increased risk factor of developing haematuria depends on the following factors:

  • Age: Haematuria is commonly seen in men over the age of 50. This is due to an enlarged prostate gland that pressures the bladder into urinary bleeding and causes gross haematuria.
  • Recent infection or injury: Any sort of inflammation in the kidney due to a recent infection or injury develops a high risk of haematuria.
  • Sexual intercourse: There have been numerous cases where sexual intercourse has resulted in the leaking of blood from urine, which is commonly known as post-coital gross haematuria. However, this condition usually resolves itself within a few days without any further complications.
  • Family history: If you possess a family history of various kidney stones and kidney diseases, your chances of developing haematuria is quite high.
  • Strenuous activity: Engaging in vigorous physical activity of any kind, especially exercise and running has been proven to contribute to urinary bleeding.
  • Faulty medication: Certain medicines such as aspirin, non-steroidal anti-inflammatory pain relievers and few antibiotics have been known to cause urinary bleeding. Consult your GP before consuming such medicines.
  • Smoking cigarettes: For men above the age of 50, regular smoking habits may also increase the risk factor for haematuria.
  • Exposure to industrial chemicals: With the amount of air pollution on the rise, certain industrial chemicals can have serious effects on the body and harbour different disorders like urinary bleeding without your knowledge or awareness.

What Is the Treatment?

It is imperative to find out the underlying cause for haematuria before undergoing any form of treatment. In most cases, haematuria occurs in small amounts and is not a matter of grave concern. Most GPs recommend running a few important tests to find out the cause. This is because haematuria is often a symptom of a more serious disease or disorder that has gone undetected for a long time. Once your doctor finds out the cause, he or she may initiate the necessary treatment that best suits your present health condition or opts to conduct further investigations, screenings or diagnostics. If a need for further investigation appears, it is best for you to cooperate with your GP all throughout the process and have faith in their decisions.

However, in most cases, no treatment is necessary, and the condition resolves itself in a few days.