Painless Hematuria

Hematuria is a medical problem, characterized by the presence of blood (specifically red blood cells) in the urine. Based on the amount of blood excreted in the urine, hematuria is categorized into two types, namely, macroscopic (or gross) hematuria and microscopic hematuria. In the former case, the blood quantity is significantly high, thus changing the urine color to pink or red. Whereas in microscopic hematuria, the amount of blood present is relatively less and microscopic analysis is required for detecting the red blood cells. Even though blood in urine is mostly associated with pain, some patients do report painless hematuria or hematuria in absence of dysuria.

Painless Hematuria Causes and Symptoms

Both painful and painless hematuria should be taken seriously, as they can be a sign of severe, life-threatening medical conditions like cancer, chronic kidney diseases and infections. Very often, painful hematuria signifies kidney stones and infections, while painless hematuria may be a associated with several other diseases that are related to kidney, bladder and urinary system. Following are some of the probable health conditions that may result in painless hematuria:

Glomerulonephritis: Almost all disorders related to glomerulus are accompanied with painless hematuria. In addition to painless hematuria, glomerulonephritis may also cause decrease in urine production and edema.

Arteriovenous Fistulas: Arteriovenous fistulas refers to abnormal accumulation of blood vessels in the kidney and other parts of the urinary system. Many a times, arteriovenous fistulas cause bleeding, which in turn results in recurrent onset of painless hematuria.

Kidney Infections: Kidney infections (pyelonephritis) also cause painless hematuria. At times, inflammation of the kidney (nephritis) occurs without any known cause, which results in painless hematuria.

Renal and Bladder Tumor: Majority of the patients with kidney cancer and/or bladder cancer experience painless hematuria. Nevertheless, painless hematuria is not the only symptom for presence of tumors in these organs. Considering this, thorough examination is necessary for evaluation of painless hematuria. Read more on kidney cancer symptoms.

Urinary Tract Cancer: Gross painless hematuria is a common sign of urinary tract cancer, both in men and women. Ultrasonography is usually recommended in order to locate the cancerous cells and identify the types of cells. Other noticeable symptoms of urinary tract cancer are frequent urination and enlarged lymph nodes.

Benign Prostatic Hypertrophy (BPH): Painless hematuria can also be resulted due to benign prostatic hypertrophy (BPH) that causes enlargement of the prostrate. Other symptoms of BPH include general discomfort and inability to urinate. To know more on BPH, you need to read more on enlarged prostrate.

Sickle Cell Disease: Patients of any form of sickle cell disease experience painless hematuria. The doctor may conduct hemoglobin electrophoresis and/or sickle cell preparation for confirming whether sickle cell disease is the cause for painless hematuria or not. Read more on sickle cell trait.

Strenuous Exercise: Another reason for causing painless hematuria is strenuous exercise. If exercise is the sole cause for painless hematuria, then the symptoms usually subside within two to three days. However, if painless hematuria is reported even after three days, the doctor may recommend further urologic evaluation.

Medications: Certain drugs and medications (antibiotics, analgesics, anticoagulants) may cause painless hematuria. In such a case, the doctor may prescribe alternatives for the current medicines, which are responsible for causing painless hematuria. Further urinalysis (after changing the medications) is necessary for checking the presence of blood in the urine.

In some cases, painless hematuria is manifested as a result of urinary tract infections (UTI), renal papillary necrosis, kidney stones and polycystic kidney disease. Depending upon the underlying cause, painless hematuria can be a mild condition or a life-threatening problem.

Painless Hematuria Differential Diagnosis

As there are several possible reasons for causing painless hematuria, complete investigation is always advisable to rule out serious health conditions. The best method for identifying the exact cause of painless hematuria is differential diagnosis. Painless hematuria severity is then confirmed, after which the doctor may advocate certain medications (if necessary) and other treatment options. Depending upon the medical history and physical examination of the patient, the doctor may recommend any of the following techniques for diagnosis of painless hematuria:

Dipstick Test: For patient with painless hematuria, dipstick analysis is the most common test for identifying urinary tract disorders. In this method, cellulose strips are used to check the amount of blood present in the urine. If the strip changes to dark green after dipping in the urine sample, then it indicates presence of high amount of blood in the urine.

Imaging Tests: Computed tomography urogaphy is the latest differential diagnostic method for hematuria, which helps in examining the entire urinary tract in one session. Nevertheless, for pediatric painless hematuria, the physician may perform other imaging tests that involve minimum exposure to radiation, such as ultrasound and intravenous pyelogram (IVP).

Urinalysis: Urinalysis is done to check the composition of urine. Presence of white blood cells along with red blood cells indicates urinary tract infections. Likewise, abnormalities in the urine composition helps in ruling out other health conditions. In case infection in the urinary tract is suspected, urine culture is done to check for presence of bacteria and other pathogens.

Blood Test: Blood test is also a common diagnostic examination, which is performed for confirming the causes of painless hematuria. If there is presence of wastes in the blood sample, then it signifies impairment of the kidney functionality. Thus, a blood test is useful for detecting kidney diseases.

Cystoscopy: Cystoscopy involves optical examination of the bladder with the help of a scope. In a cystoscopy procedure, a thin tube fixed with a tiny camera is introduced in the urethra and images of the bladder are taken. This way, presence of abnormalities in the bladder is diagnosed by performing cystoscopy.

Treatment of painless hematuria depends upon the underlying cause and the diagnostic result. On a general note, painless hematuria in children and adults are treated differently. It is also to be borne in mind that painless hematuria can also be manifested without any specific reason. As per statistics, asymptomatic hematuria occurs in about 2.5 percent of the global population. Thus, painless hematuria workup can only reveal whether the current condition requires any medical intervention for treatment or not.