Blood in the Urine - Should You Be Concerned?Mar 11, 2014
The common and obvious assumption when you see red in the urine is that it’s blood, and it’s bad. A variety of reasons can cause blood in the urine, but the first question to ask is 'is it really blood?' Dr. Tom Miller and Dr. Blake Hamilton discusses what you should do if you notice the color of your urine changing from clear or yellow to red, and you’ll be surprise to find out that red urine can be caused be certain exercises and foods.
Tom Miller: Red urine. What should you do? This is Tom Miller on The Scope, and we're going to talk about that next.
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Tom Miller: I'm here with Dr. Blake Hamilton, who is the Medical Director for the Urology Clinic and the Associate Director of the Division of Urology in the Department of Surgery. Blake, what should someone do if they notice the color of their urine changing from clear or yellow to red? This is something I see in my practice, questions I get not infrequently.
Dr. Hamilton: Well, the obvious assumption when you see red urine is that it's blood and it's bad. So the first question is, 'Is it really blood?' There are some unusual things that will cause red urine. Probably the most notorious is eating fresh beets.
Tom Miller: You know, this is great because two weeks ago, I had a patient who called me. She was frantic, and everyone thinks they will have cancer if they have blood in the urine. So she had red-colored urine. I said, 'Just take a deep breath.' I brought her in, and she did a urine sample. It was totally normal. She was very reassured by that. But 24 hours later, she called me back and she said, 'You know, I just ate a ton of beets the day before that happened. Now I know.'
Dr. Hamilton: Right. A urinalysis is a very simple test that will quickly screen for that and let you know if there's actual blood or if the color is due to something else. There are some other food products, some dyes, some fresh berries, but beets is the main culprit. If you get a urinalysis and there actually is blood, then you've got to have a different conversation. Again, not all of it is cancer, so there's no need to panic right away.
Tom Miller: Is there some difference between the age of the person that might have blood in the urine?
Dr. Hamilton: Yes, certainly.
Tom Miller: And whether that's just short-term, like, one episode or whether it's prolonged?
Dr. Hamilton: As with many cancers, it's more prevalent in the older population. So if you have a young person in their 20's, cancer is very unlikely. In fact, in young women, a urinary tract infection or a bladder infection would be far and away the most common explanation.
Tom Miller: Right. And that would probably turn up on the urinalysis?
Dr. Hamilton: Yes. It would look like an infection, and often it would have symptoms. So when you ask the right questions and you get this information, then you treat them with antibiotics, and it goes away. It's pretty straightforward.
Tom Miller: I understand that in young people, blood in the urine could be due to excessive exercise or vigorous exercise. Is that true?
Dr. Hamilton: That's correct. That is correct. There's something called Jogger's Hematuria where after physical exercise like running you can have blood in your urine. It's thought to simply be some mechanical friction between the walls of the bladder that irritates it and causes a small amount of bleeding.
Tom Miller: So it's like a nosebleed of the bladder?
Dr. Hamilton: Well, a little bit.
Tom Miller: Yeah. A little bit.
Dr. Hamilton: Runners have discovered that if they actually run with their bladder just very slightly full, not completely full but not completely empty, they can avoid this.
Tom Miller: So in older folks, there's a higher risk of blood in the urine being a sign post for cancer, but not always. Not the majority of the time. Is that right?
Dr. Hamilton: Yeah, that's right. Men, for example, get enlarged prostates, and that's a common cause of visible blood in the urine. Again, not related to prostate cancer, but it's just the process of growth and some inflammation. You have to look for some other things in that age group to make sure you're not missing something more important.
Tom Miller: What about kidney stones? Usually when a person has blood in their urine due to kidney stones, it's painful.
Dr. Hamilton: Yeah, that's right.
Tom Miller: But not always. Is that right?
Dr. Hamilton: Kidneys stones that have been around for a while, the patient may have had a painful episode in the past. And then the pain resolves, but they could have new or ongoing bleeding. Certainly, the blood caused by a rigid stone rubbing against delicate tissue could result in blood in the urine.
Tom Miller: So for patients who notice red urine, what would you say to that? For our audience, a lot of them are pretty worried. Should they go immediately to the physician? Should they go to the ED? What would you recommend? What do you think they ought to do?
Dr. Hamilton: I think they ought to have it investigated fairly soon with a simple urine test. If there's no blood, then you can dismiss it, and if there is blood, then I think you go onto some additional testing.
Tom Miller: What if they're less than 35 years old? Would you say that you could watch it if it was just one episode and they were athletes?
Dr. Hamilton: I think you could just watch it. I think that's a pretty safe course of action.
Tom Miller: When would you say that a young person would need to have that investigated?
Dr. Hamilton: Well, for a young person, if it happens one time, it probably is not anything terrible. But if it happens over and over, I think it really needs to be investigated because it could be something much worse.
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