Blood in Urine in Women: Specialized Treatment in New York City
The highly trained and experienced urologist at New York Urology Specialists treats women with blood in urine.
Visible and Microscopic Blood in Urine in Women
Blood in urine is known medically as ‘hematuria’. Other descriptions are sometimes used such as: a trace of blood in urine, red blood cells (RBCs) in urine, or visible blood in urine. When blood in urine is microscopic, the severity is measured as red blood cells (RBC) per high power field (HPF) under the microscope. Usually, >3-5 RBCs/HPF is considered abnormal. With >20-50 RBCs/HPF, a significant urological or medical problem often exists.
Blood in urine can originate from the kidneys, ureters, urinary bladder and the urethra.
Blood in urine
Blood in urine in women can sometimes originate from vaginal bleeding, uterine bleeding or menstrual period. Sometimes rectal bleeding can be confused with hematuria.
It is important to distinguish whether the blood if from genital or urinary tract as the causes, evaluation and treatments are different.
The finding of microscopic red blood cells in urine is fairly common in women. Usually it is found incidentally during a routine urine analysis. If diagnosis is made using dipstick urinalysis, the test needs to be confirmed with microscopic examination to make sure that there are red blood cells present. Sometimes dipstick test can produce unreliable results.
Visible or Gross Hematuria is Less Common.
If the blood in urine is visible to the eye as pink or red-colored urine, no additional tests to confirm the presence of blood in urine are required. Visible blood in urine is usually a diagnosis that is established by the patient herself. Even if visible blood in urine resolves spontaneously, a thorough evaluation by a urologist is advisable.
Blood in urine can occur in women with bladder infection. Blood in urine can also be a symptom of other medical and urological problems such as bladder cancer, kidney or bladder stones and kidney cancer in women.
Women who have history of smoking, even if they quit as long as 20 years before are at increased risk for bladder cancer; so are women over age 40.
Sometimes blood in urine can cause symptoms that mimic UTI. Unless bacterial culture showed a UTI, caution should be exercised in attributing blood in urine to an infection. Sometimes blood in urine is episodic and disappears on its own within a day or a few days. An antibiotic given for a UTI when there is no UTI can make it appear that it’s helping.
The causes of hematuria vary depending on the age of a woman and underlying risk factors.
Common Causes of Hematuria or Bloody Urine in Women are:
- Cystitis, Urinary tract infection (UTI), kidney infection and pyelonephritis
- Kidney stones and Ureteral stones can cause usually microscopic hematuria but occasionally gross hematuria occurs
- Bladder lesions, polyps, masses including bladder cancer and carcinoma in situ (CIS) of the bladder can first present with hematuria.
- Hematuria may be the first sign of intrinsic kidney disease (glomerular disease).
- Kidney cysts including polycystic kidney disease
- Kidney masses and Kidney cancer occasionally present with hematuria; now we often find them before they are large enough to cause hematuria.
- Bladder stones
- Ureteral cancer is a less common cause of hematuria.
- Transitional cell carcinoma of the upper tract and lower tract
- Urethral tumors polyps masses and diverticuli
- Urethral cancer
- Radiation cystitis can occur in women who had pelvic radiation in the past for cervical or uterine cancer.
- Chemotherapy-induced hemorrhagic cystitis(cyclophosphamide)
- Less common causes of hematuria include Colon cancer invading the bladder,
- Metastatic cancer to the bladder from other sites.
- Locally invasive cancer to the bladder and urethra from ovaries uterus and cervix.
UTI is Not the Only Cause of Urinary Bleeding in Women
It is important to note that because urinary tract infections or cystitis are common in women often hematuria is incorrectly attributed to a urinary tract infection especially in women who are prone to having urinary tract infections.
While that is possible that blood in urine is caused by UTI, a thorough evaluation may still needs to be performed depending on individual risk factors.
Studies show that it is not infrequent that blood in urine and symptoms of UTI can coexist with other more serious causes such as bladder stones, bladder cancer and kidney dysfunction. Women with risk factors include those who are over age 40, current and former smokers and those with history of underlying medical problems such as diabetes and cancer.
We see patients from all parts of New York City (Manhattan, Brooklyn, Queens, Bronx, Staten Island), Long Island, Westchester and New Jersey as well as other parts of the USA. We also see international patients from Canada, Japan, South America, Russia, Asia, Europe, Middle East, Africa, the Caribbean and other parts of the world.