Red blood in the toilet bowl

Of all the things that frighten us, blood in the urine is near the top of the list. There are many possible causes; some serious, others not.

Regardless, blood in the urine always requires urologic investigation. “Gross Hematuria” is when the patient actually sees the blood. “Occult Hematuria” is the kind that is not visible to the patient and is found by the doctor using a chemical test for blood and microscopic examination of the urine.

Occult hematuria is just as important as gross hematuria because the actual presence of any blood is more significant than the amount of blood. Sometimes, red urine may be caused by the ingestion of certain foods or medications and not be related to blood in the urine at all. That’s why it’s important to tell your doctor about every food, candy, medication, drug, over the counter preparation, herb and supplement you may have taken because any one of a very long list of these items can color the urine red.

The prudent physician will also check for lead and mercury poisoning and other rare medical conditions. So when you see blood in the toilet bowl, the first step is to work with your doctor to determine if the blood came from the urinary tract or from the vagina or rectum.

If blood actually is present in the urine, it is important to determine from what part of the urinary tract it originated. It could be coming from the kidney, ureter, prostate, or urethra.

Most people with hematuria tend to worry about cancer. However, the most common cause of “hematuria” in a middle age man is benign prostate enlargement. There are many other benign, meaning non-cancerous causes of “hematuria” such as urinary tract stones, trauma, infections, inflammations, blood vessel malformations, or the use of various blood-thinning medications such as aspirin, Plavix, Coumadin, and others.

If, despite the best efforts to find the cause of the bleeding, no definitive source can be found, special tests may demonstrate the blood to be coming from the kidney tubules. This is referred to as a “renal leak.”

If the bleeding is found to be due to benign prostate enlargement, Proscar or Avodart is often successful in shrinking the prostate and stopping the bleeding. The important thing is not to panic but to listen to the advice of your doctor.

Albert Einstein observed that doctors were often prone to explain all the symptoms and findings of a patient with one all-inclusive diagnosis. Sometimes there can be more than one thing wrong. The point here is that even if one cause of bleeding is found, the entire interior of the urinary tract must still be evaluated to search for all possible causes of hematuria. A stone in the kidney and a tumor in the bladder can both present in the same patient.

Have a Question? Call Dr. Okun at 718-241-6767

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