Painless hematuria, don’t take it seriously
Blood in urine undoubtedly means illness, but some people think that there is no discomfort and no pain in urine, so they take it lightly and think it will not hurt to delay.
In fact, this kind of intermittent, painless hematuria is often a clear sign of urological tumors. Bladder cancer accounts for almost 50% of patients with painless hematuria, and most of these cancers occur in middle-aged and elderly people over 40 years old.”
Hematuria is one of the common symptoms in urology, often signaling a red light for the health of the body’s urinary system. In men, the cause of painless hematuria can be prostate enlargement, glomerulonephritis or even a tumor of the urinary system.
Many diseases of the urinary system may show symptoms of hematuria, once they appear, do not take it for granted and judge the cause and condition based on your own feelings, you should seek prompt medical attention.
How did the blood get into the urine
Human urine is produced in the kidneys and discharged to the body through the renal pelvis, ureter, bladder and urethra. Any disease in these organs and bleeding can cause hematuria, including roughly the following cases.
Urinary system diseases: More than 95% of hematuria is due to diseases of the urinary system itself, of which glomerular diseases, renal cysts, stones (kidney, ureter, bladder, urethra stones), prostatic hyperplasia, infectious diseases of the urinary tract (tuberculosis, pyelonephritis, cystourethritis, prostatitis) and tumors (kidney, ureter, bladder, prostate tumors) are most common.
Systemic diseases: firstly, infections, such as infective endocarditis, sepsis, epidemic hemorrhagic fever, scarlet fever, leptospirosis, and filariasis. Next are hematological diseases, mainly including thrombocytopenic purpura, allergic purpura, leukemia, hemophilia, etc. In addition, there are connective tissue diseases and cardiovascular diseases, such as systemic lupus erythematosus, renal stasis, renal artery embolism, renal infarction, etc.
In addition, some other systemic factors may also cause hematuria. For example, sports hematuria is caused by excessive pressure on the kidney area due to certain postures used in sports.
In addition, some cold medications are toxic to the kidneys and may cause drug-interstitial nephritis, which may also cause hematuria, which usually disappears after stopping the medication.
Some psychotropic drugs may also cause damage to the kidneys after long-term use. However, some so-called “hematuria” is actually caused by the red color of the drug after metabolism in the body, such as aminopyrine, phenytoin sodium, rifampin, phenol red, and so on. This red urine does not contain red blood cells and is actually “pseudohematuria”.
Since hematuria is a clinical symptom, not a disease, and the cause is complex, it requires a differential diagnosis by experienced professionals. For example, in acute glomerulonephritis, in addition to hematuria, the patient may also have hematuria, proteinuria, swelling, hypertension, etc.
How to understand the source of hematuria
When hematuria occurs, the following steps can usually be followed for the initial response. The first step is to rule out pseudohematuria. For example, some people have urine contaminated by menstruation or uterine bleeding, and others have urine that has changed color due to the use of certain foods or medications.
After the location of the hematuria is clarified, the next step is to investigate the cause of the hematuria. In general, when urination starts as hematuria and the latter part of the urine is normal, this is mostly due to urethral disease.
If urination starts normally and ends with hematuria, it is more likely to be a bladder infection or prostate disease. If the urine is “hematuria” with a dark red color, it is likely to be caused by kidney disease.
Patients can also perform the “three cups of urine test” to find out the source of hematuria, which is very simple. Take three cups and in a single urination, take the first cup for anterior urine, the second cup for middle urine and the third cup for posterior urine.
If the first cup is hematuria means the blood comes from the urethra; the third cup hematuria lesion is mostly in the bladder or posterior urethra; the first cup, the second cup and the third cup are all blood-colored that is the whole hematuria, suggesting that the lesion is in the kidney or in the urinary tract above the bladder. Of course, to clarify which disease is causing the hematuria, it is best to seek professional medical consultation and treatment.
Hematuria is mostly caused by tumors
What motivates many patients to come to the urology department is that they find themselves with symptoms of hematuria, but not all people who develop hematuria will actively seek medical attention.
Among all kinds of hematuria, painless hematuria is precisely the most alarming, because the sign of urological tumors such as renal pelvis cancer, bladder cancer and ureteral cancer is often painless hematuria! If the hematuria is indeed caused by tumor, the condition is usually in the middle to late stage, because the blood vessels of early stage tumors are not easy to rupture, and the location of early stage tumors also determines that it is not easy to cause hematuria.
Take kidney cancer as an example, in the early stage of the disease, the tumor only grows on the surface of the kidney, only when the disease gradually develops to the advanced stage and the tumor grows to the inner part of the kidney, the blood flowing out of the tumor blood vessels will follow the urine to the ureter and be discharged to the outside of the body through the bladder and urethra.
Patients with kidney cancer do not feel pain when draining blood urine, but occasionally they may feel back pain and a lump may be felt in their lower back. Back pain, lump and painless hematuria are the three major symptoms of advanced kidney cancer.
Don’t think that hematuria is only a minor problem because it is not painful and occurred only once. Many patients recalled that they “did have hematuria once” when they were questioned by doctors after the detection of urological tumor.
However, because it only happened once, they did not take it seriously and did not seek medical attention, thus delaying treatment. Of course, not all painless hematuria is caused by tumors, such as some elderly men, because of the long-term enlargement of the prostate gland caused by the rupture of capillaries, will also appear painless hematuria, but because the patients themselves can not tell, so once the symptoms appear, the best way is to seek medical attention as soon as possible.
The most painful hematuria is caused by stones
In contrast, hematuria caused by urinary stones is often easier to pay attention to because most of them are accompanied by discomfort in the lower back or dull pain in the lower back after exertion, and in severe cases, patients may experience cutting or cramping pain in the lower back, which radiates to the perineum.
Patients with urinary stones often present with painful hematuria, so more patients will actively seek medical attention, and the diagnosis of urinary stones is relatively simple, usually requiring only an ultrasound for initial diagnosis.
Some people develop hematuria after exercise
Some people often feel very fatigued after exercise, their leg muscles are sore and tender, and they find blood in their urine when they urinate. This disease is medically known as “sports hematuria”.
When a person exercises, the blood vessels in the muscles and joints of the body expand and blood flow increases dramatically. In order to meet this need, the blood flow to the glomerulus is reduced and the oxygen supply is temporarily inadequate, so the cells on the capillary wall cannot function adequately and the cell arrangement is changed and the cell gap is increased.
The red blood cells, which originally flowed only in the blood vessels, filter through the enlarged cell gap into the capsule, and hematuria occurs. Sometimes hematuria occurs in healthy people after exercise as a sign of excessive exercise, and this kind of hematuria is a non-pathological hematuria.
If sports hematuria occurs, don’t worry, as long as you stop exercising, it will gradually disappear after a week, and it will be better if you take some vitamin K or C. The key to preventing “sports hematuria” is to exercise in a gradual manner, from small to large amounts.
Women with hematuria are on the alert for acute cystitis
Women have a short urethra and are in close proximity to the vagina and anus, making them susceptible to bacterial infections that can lead to acute cystitis. Women are especially prone to develop the disease when they are busy at work, have no time to drink water and often hold urine. The bladder is a very vascular organ, and when acute cystitis occurs, the microvasculature of the bladder mucosa is damaged, so most patients will have hematuria.
In mild cases, blood is seen on wiping, and in severe cases there is a large amount of bright red blood in the urine, often causing the patient to panic.
In addition to hematuria, patients with acute bacterial cystitis will also have frequent urination, difficulty urinating, burning in the urethra and pain in the lower abdomen and urethral opening. The first thing you should do in this case is to drink a lot of water, which can quickly relieve the symptoms.
Many patients are afraid to drink more water because of the burning and stinging pain when urinating, which in turn can aggravate the condition. Patients with acute cystitis are treated with antibiotics as prescribed by the doctor and can be cured in about 1 week.