In urology there are bleeding out of the act of urination (urethrorrhea) and bleeding during urination. Urethrorrhea occurs when injuries or tumors of the urethra. Hemorrhage with the urine – hematuria develops in various diseases of the urinary system, as well as pain during urination.
The types of hematuria
Hematuria has many features that help to establish the true cause. It is characterized by such criteria as the time of occurrence of the act of urination, the external parameters, the intensity of the manifestations, the mechanism of development, etc.
On appearance in the act of urination she may be:
- Initial, appear at the beginning of urination. Typically occurs when you lose the initial division of the urethra.
- Terminal blood at the end of urination. It is connected with diseases such as cystitis and urolithiasis. The presence of blood in the urine when urinating in men is observed in lesions of the prostate or internal division of the urethra.
- Total, when blood is observed in all portions of urine. The source of bleeding can be anywhere in the urinary system.
The clinic manifestations of hematuria is persistent and recurrent, painful and painless. Pain bleeding typical for cystitis, kidney stones and uric acid crises. Painless bleeding is characteristic of the bladder. Men painless hematuria is observed in various pathologies of the prostate.
Persistent symptoms of blood in the urine occur when the nephropathy. And glomerulonephritis characteristic recurrent gross hematuria.
Blood in the urine can be
- Vermiform clots indicate bleeding from the kidney;
- Large loose clumps, barely passing through the urethra out of the bladder;
- Red color of urine indicates fresh bleeding;
- Dark brown and brown color indicates stale urine blood in the urinary bladder;
- The form of “meat slops”, brown, with admixture of blood clots.
The intensity of character expression can be macro – and microhematuria. Microhematuria detected by microscopic examination of urine. Gross hematuria detected visually.
Depending on the mechanism of the development of hematuria, it is distinguished by the types:
- Extrarenal. It is not connected with injuries and diseases of the kidneys. Its cause lies outside the body.
- Renal. Cause is renal disease.
- Postrenal. It develops on the background of diseases of the bladder and urinary tract.
Causes of blood in the urine
Blood in the urine can be for many different reasons. It can be inflammatory diseases, trauma and tumors in any part of the urinary system: kidney, ureters, bladder or urethra.
- Infection, acute pyelonephritis, tuberculosis of kidneys.
- Acute and chronic glomerulonephritis. Blood in the urine detected only on microscopic examination.
- Kidney stones is the most common cause of blood in the urine. When the stones irritate the urinary tract that causes bleeding.
- Kidney cancer – renal cell carcinoma invading the hepatic parenchyma. Blood in the urine in the form of worm-like clots – one of the symptoms of this disease.
- Interstitial nephritis in which the blood in the urine is a consequence of the antibiotic or other drug therapy.
- Injuries to the kidneys, which may be blunt or penetrating, resulting from an accident or medical procedures (biopsy, crushing of stones).
Hematuria in the urinary bladder
Blood during urination may be associated with abnormalities of the bladder:
- Stones in the bladder. They are a constant factor in traumatic and cause bleeding of varying intensity.
- Cystitis with blood in the end of urination in women is a worrying sign of hemorrhagic lesions of the urinary bladder.
- Cancer of the bladder. Its main symptom is a discharge of blood from the urethra. Urine becomes dark red or rusty color.
Hematuria in the urethra
Urethra bleeds for many reasons:
- Foreign body;
- Urethritis (in some cases it can manifest itself by the presence of blood in the urine).
- Adenoma of the prostate.
- Prostate cancer is one of the major causes of hematuria.
- Prostatitis – inflammation of the prostate. In very rare cases accompanied by blood in the urine.
One of the most important symptoms of hematuria – blood in the urine
Symptoms of hematuria
Typical symptoms of hematuria, she is a symptom of symptoms of diseases of the urinary system. It often can go with pain in the lumbar region and lower abdomen, increased body temperature, pain during urination.
Clinical manifestations of hematuria are:
- Painful urination and cramps in hemorrhagic cystitis and urolithiasis;
- Bleeding in form of clots secreted in the urine;
- Urine staining in different shades ranging from pink to dark brown;
- General weakness, dizziness, constant feeling of thirst;
- Change the color of the skin;
- The formation of blood clots in the urinary tract, impeding the free flow of urine.
Diagnosis of hematuria
For the diagnosis of hematuria are comprehensive studies:
- The abdominal radiograph. Now is rarely performed;
- Mr urography and CT urography. Methods help to identify the condition of the urinary tract and kidneys.
- Abdominal ultrasound is the most informative method that allows you to see the condition of the kidneys, bladder and ureters, and to determine their pathology.
- The intravenous pyelogram helps to determine excretory function of the urinary system;
- The cystoscopy.
Microscopic urine analysis is an effective method for the diagnosis of microscopic hematuria
- Urinalysis and blood;
- Biochemical analysis of blood;
- Urine analysis according to Nechyporenko.
Another test used in the diagnosis of hematuria – trehstakannaya test. Urine is collected in three tanks. Each sample is tested for the presence of erythrocytes, leukocytes, and other elements. Blood in the first sample indicates a lesion of the urethra. Blood after urination in the second and third samples may indicate cervical cystitis and prostate cancer. The blood in all three portions of urine may be a consequence of tumor development in the bladder, kidneys or prostate.
Methods of treatment
Since hematuria is not an independent disease, but only a consequence of urinary pathologies, therapy is aimed at eliminating the causes that caused it. With infections of the urinary system apply conservative methods of treatment, specific medications, antibiotics. If necessary surgery (kidney stones, cancers of the urinary system), then this question is solved in a specialized clinic by doctors-urologists. For the relief of serious bleeding apply a hemostatic drugs. For large blood loss is kind of therapeutic, complementary volume of blood lost.
The treatment of hematuria is directed at the elimination of its causes
Differentiated interpretation of hematuria in patients of different age and sex
The age and sex of the patient, as well as the symptoms greatly help differentiate hematuria, to identify for further diagnosis.
Hematuria in men
Blood during urination in men is most often benign in nature. It often occurs after strenuous exercise and resolves on its own without consequences.
The second incidence of hematuria in men is a result of cancer. It is primarily associated with tumors of the prostate, especially prostate cancer. The cause of bleeding – the destruction of the vessel walls glands germinating in them structures of the tumor.
Hematuria in women
The main cause of hematuria in women is hemorrhagic cystitis. It develops on the background of treatment with antibacterial drugs, taking combined oral contraceptives. The mechanism of development of hemorrhagic cystitis is a devastating impact of these drugs on the urinary tract walls. The degree of development of vascular permeability different – from microscopic hematuria to gross hematuria.
About hematuria in women can be blood spotting in the urine during menstruation.
Hematuria in children
The main factors contributing to the blood in urine in children are kidney and urinary tract, hemorrhagic diathesis and blood disease. In diseases of the blood change not only the properties of the blood itself, but also the condition of the blood vessels. Therefore, more fragile blood vessels and thin blood diseases such as hemophilia, thrombocytopenia and other blood diseases give symptoms of hematuria. Blood in the urine of children may be in viral diseases, because the virus infects the walls of blood vessels. Most frequently a pathological condition seen in the treatment of non-steroidal anti-inflammatory drugs.
Hematuria during pregnancy
Blood in the urine of pregnant women – a phenomenon quite frequent.
It can be caused by natural processes taking place in the body of a pregnant woman:
- hormonal changes of the body;
- when the mechanical effects of the enlarged uterus on the kidneys and urinary tract;
- microcline of small renal veins due to the increase of intra-abdominal pressure in the later stages.
This hematuria alone passes after birth.
Prevention of blood in the urine
Prevention of hematuria is to timely treatment of major diseases of the urinary system. In addition, to the presence of these diseases to pay serious attention to proper nutrition, eliminate harmful habits, dosing of physical load, to observe the drinking regime. Special attention should be paid to prevention of renal diseases in children, as they largely are the complications of viral and bacterial infections that can cause serious diseases of the urinary system.
You can’t ignore the change in color of urine, if it is not associated with eating foods that may be causing the problem. Especially carefully it is necessary to monitor the urine of pregnant women. Bloody discharge of urine early in pregnancy can cause serious complications. That’s why if you suspect hematuria, the pregnant woman should immediately contact your doctor.