Merck Manual

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Some Causes and Features of Blood in the Urine

Some Causes and Features of Blood in the Urine

Cause

Common Features*

Tests†

Benign prostatic hyperplasia (noncancerous enlargement of the prostate gland)

Mainly in men over 50

Often difficulty starting urination, a weak urine stream, a sensation of incomplete urination, or dribbling at the end of urination

An enlarged prostate detected during a digital rectal examination

Blood tests to measure the PSA level

Often ultrasonography of the bladder to measure how much urine remains in the bladder after voiding (postvoid residual urine volume)

Mainly in people over 50 or with risk factors for these cancers (smoking, family members who have had cancer, or exposure to chemicals that may cause cancer)

Sometimes burning or pain during urination or an urgent need to urinate

Often symptoms that affect the whole body (such as fever, chills, weight loss or sweating)

Examination of the interior of the bladder using a flexible viewing tube inserted through the urethra (cystoscopy)

Possible bladder biopsy

Sometimes CT or MRI

If prostate cancer is suspected, prostate biopsy

Cystitis (bladder infection)

Usually in women and girls

A frequent and urgent need to urinate

Burning or pain during urination

Getting up at night to urinate

Sometimes blood in the urine or foul-smelling urine

A doctor's examination

Injury

Usually an obvious injury

Usually CT of the abdomen and pelvis

Kidney filtering disorders (glomerular disorders, such as glomerulonephritis)

Sometimes high blood pressure and swelling in the feet or legs

Possibly red or dark (cola-colored) urine

Sometimes occurring after an infection

Sometimes in people who have family members with a kidney or a connective tissue disorder

Urinalysis

Blood tests

Long-lasting pain in the flank or abdomen

High blood pressure

Sometimes enlarged kidneys detected on an imaging test done for another reason or during a doctor's examination

Ultrasonography

Often CT or MRI of the abdomen

Mainly in men over 50

Sometimes a lump in the prostate detected during a digital rectal examination

Occasionally a weak urine stream, difficulty starting urination, and dribbling at the end of urination

Blood tests to measure the PSA level

If the PSA level is elevated, biopsy of the prostate

Prostatitis (infection of the prostate gland)

Often fever, difficulty starting urination, frequent urination, the need to urinate during the night, and burning or pain during urination

Often symptoms of a long-standing blockage in the urinary tract (including a weak urine stream, difficulty passing urine, or dribbling at the end of urination)

In an acute infection, an enlarged, tender prostate detected during a digital rectal examination; in chronic prostatitis, there may not be any significant symptoms

A doctor's examination

Urinalysis and urine culture

Sometimes transrectal ultrasonography or cystoscopy

Usually in people already known to have sickle cell disease

Mainly in people of African or Mediterranean descent

Often in children and young adults

Blood tests to check for abnormal hemoglobin in red blood cells

Severe pain in the lower back side (flank) that occurs suddenly or pain in the abdomen or groin that comes in waves

Sometimes the urge to urinate but an inability to do so

Sometimes vomiting

CT or ultrasonography of the kidneys, ureters, and bladder

* Features include symptoms and the results of a doctor's examination. Features mentioned are typical but not always present.

† Tests include urinalysis in all people, blood tests to evaluate renal function in most people, and imaging of the kidneys and pelvis in most older people.

CT = computed tomography; MRI = magnetic resonance imaging; PSA = prostate-specific antigen.