No need to panic if urine is pink or red

No need to panic if the urine is pink or red. 

Urological Health

Hematuria ( Blood in urine)

Urine with red blood cells is called hematuria.

Bloody urine is common. It may not change your urine color, so you may not notice. pee tests can help your doctor identify minute amounts of blood in your pee.

Hematuria—pink or red urine—may suggest a more serious health issue. Consult a doctor.

Microscopic hematuria

Two primary types:

1. Gross hematuria: Pink, crimson, or cola-colored urine.
2. Microscopic hematuria: Blood only appears under a microscope.

Gross hematuria

Crimson blood cells make urine pink, crimson, or cola-colored. You can observe it with your naked eyes, and while it may be frightening, it is not unpleasant.

Key gross hematuria features:

• Urine may turn pink, crimson, or brown.
• Urination can be painful due to blood clots.
• Not always painful: Unless clots obstruct urine flow or there are stones or infections, it may not hurt.

The next step:

Contact a doctor if gross hematuria is present. They may suggest:

• Urine culture/analysis
• CT or ultrasound imaging
• cystoscopy (bladder inspection)

Hematuria causes

Blood in the urine has many causes, from mild to severe. An organized breakdown will help you understand

Common Hematuria Causes:

* Infections

• Urinary tract infections often affect women, leading to symptoms such as burning, urgency, and murky or bloody urine.
• Pyelonephritis-related fever, back discomfort, and malaise are common.
• Stones: Sharp crystals can irritate the urinary system lining, causing apparent or microscopic bleeding.

*Trauma or exercise is a common cause.

• Accidents or contact sports cause kidney or bladder injuries.
• In rare cases, long-distance running can produce transient hematuria (dubbed “runner’s hematuria”).

* Structure or function issues are also a common cause.

• Enlarged prostate (BPH): Common in older men; can block urine flow and bleed.
• The kidneys' filtering units are inflamed.
• Polycystic kidney disease causes cysts and bleeding and is hereditary.

* Cancer:

• Cancer can affect the bladder, kidney, or prostate, especially in individuals who are older or smokers. 
• Pee testing detects these cancers painlessly.

Medication and Substances

• Blood thinners (warfarin, aspirin)
• Antibiotics like penicillin
• Cyclophosphamide (chemo)

Other reasons

• Women's endometriosis can affect the bladder or ureters.
• Disease or trait: sickle cell
• Radiotherapy can irritate the bladder lining.

Note: Beets and phenazopyridine can cause crimson urine.

Hematuria therapy

Hematuria is a symptom, not a diagnosis; thus, its treatment depends on its etiology. This systematic overview will help.

• Treatment Options: Cause-Based Approach
• Infection of the urinary tract-Antibiotics to cure the illness
• Stones in the bladder or kidney-Management of pain, hydration, or lithotripsy to break up stones
• An enlarged prostate-Treatment with alpha-blockers or surgery if severe.
• Glomerulonephritis—In advanced cases, immunosuppressants, blood pressure management, or dialysis
• Bladder, kidney, prostate cancer-Stage- and type-specific surgery, chemotherapy, radiotherapy, or immunotherapy
• Injury or trauma-Observation or surgery, depending on severity
• Caused by exercise-Usually resolves with rest.
• Medication—Drug adjustment or cessation under medical supervision

Supportive Measures

• Fluid intake helps flush the urinary tract.
• Avoid irritants: Limit caffeine, alcohol, and spicy meals if symptoms worsen.
• Monitoring: Urine tests or imaging may be needed for resolution.

In Cases Without Cause

Sometimes the cause is unclear. In such cases:

• Regular monitoring is advised, especially for cancer risk factors.
• Periodic urine testing, imaging, or cystoscopy may be indicated.

Hematuria ICD-10

Hematuria is coded R31 in ICD-10, which encompasses different blood in urine. A breakdown:

• ICD-10 Codes for Hematuria: Code Description
• R31.0: Gross hematuria (blood in urine) R31.1: Benign essential microscopic hematuria
• R31.21: Asymptomatic microscopic hematuria R31.29: Other little hematuria
• R31.9 Unspecified hematuria

This documentation and the billing code assist in the diagnostic evaluation process. Acute cystitis with hematuria may require a distinct code, such as N30.01.

Microscopic hematuria

Microscopic hematuria is blood in the urine that can only be seen under a microscope or in a lab-tested urine dipstick test.

What It Means

• Defined as 3 or more RBCs per high-power urine microscopy field.
• Urine looks normal; therefore, it's typically found during routine checkups or unrelated tests.

Common Reasons

• Urinary tract infections
• Stones in the kidney or bladder
• Men's BPH
• Hard exercise (particularly long-distance running)
• Menstruation or external genitalia pollution
• NSAIDs, anticoagulants, and antibiotics
• Urethral strictures, glomerulonephritis, or chronic kidney disease
• Rare bladder, kidney, and prostate cancers, especially in younger persons

Strategy for Evaluation

• Urinalysis should be repeated if the initial test was during menstruation or illness.
• If you're over 35, smoke, or have other risk factors, imaging and cystoscopy may be required.
• No clear cause? Monitoring often follows.

What are the symptoms?

Usually asymptomatic, although pain, fever, or frequent urination may indicate a problem.

Does hematuria affect women?

Female hematuria can have many reasons, some of which are unique to female anatomy and others shared by all genders. Here's how it breaks down:

* Infections of the bladder

• Urethral shortening is the main cause in women.
• Symptoms: burning, urgency, murky, foul-smelling urine, and pelvic pain.
• Stones in the kidneys or bladder
• Crystals can irritate the bladder lining.
• Pain, frequent urination, and blood may occur.
• Either menstruation or vaginal bleeding
• Blood from the vagina, cervix, or uterus may mix with urine, simulating hematuria.
• It's crucial to distinguish urinary bleeding from contamination.
• Endometriosis is the growth of endometrial tissue in the bladder or ureters.
• Cyclic hematuria, pelvic discomfort, and urinary symptoms can result.

Hematuria from Exercise

• Hematuria often occurs after intense physical activity such as long-distance running or cycling.
• Usually, the condition self-corrects.

Sexual or Traumatic Experience

• Urethral or bladder irritation might cause bleeding.

* Medications

• Aspirin, warfarin, NSAIDs, and antibiotics can induce bleeding.
• Glomerulonephritis or Kidney Disease
• Microscopic or gross hematuria can result from the kidney filter.

*Cancer

• Although it is rare, bladder or kidney cancer can lead to painless hematuria in older women and smokers.

Also, read https://www.pvurology.org/hematuria.php

Diagnosis

Hematuria is diagnosed step-by-step to determine the reason for blood in the urine, whether visible or microscopic. How doctors usually do it:

(1) Urinalysis

Perform a dipstick test for blood, proteins, or infections.

Microscopy: Verifies red blood cells and casts, crystals, and microorganisms.

(2)  Medical History and Physical Exam

• Smoking, recent infections, trauma, drugs, and family histories of kidney disease or cancer are risk factors.
• Women use this test to distinguish between urinary bleeding and vaginal bleeding.

(3)  Imaging Tests 

• These tests visualize the urinary tract and inspect its structure.
• Ultrasound benefits the kidneys and bladder without radiation.
• CT scans are effective for spotting stones, malignancies, and bleeding.
• In certain circumstances, physicians utilize MRI for soft tissue detail. 

(4) Cystoscopy

• The urethra inserts a narrow camera tube into the bladder.
• It is used to detect bladder cancers, stones, and inflammation.

(5)  Urine Cytology

• Urine tests are conducted to detect abnormal or malignant cells.
• The test is particularly helpful in cases of suspected cancer.

In Cases Without Cause

• If all tests are normal, the cause of hematuria may be idiopathic. In such cases:
• Monitoring is advised, especially for cancer risk factors.
• Testing can occur every 6–12 months.

Would you like a diagram of how doctors prioritize tests?

Test and blood in the urine

Testing and treating hematuria—blood in the urine—requires precise diagnosis and treatment. A clear breakdown:

• Tests for Blood in Urine
• Urinalysis
• A dipstick test detects blood, protein, or illness.
• RBCs, crystals, bacteria, and casts are detected by microscopic investigation.

Health history and exam

• Doctors inquire about symptoms, infections, drugs, trauma, and kidney disease or cancer in the family.
• Imaging Tests
• Cystoscopy
• A narrow camera-equipped tube is introduced into the bladder to detect tumors, stones, and inflammation.
• Urine Cytology
• Urine tests for abnormal or malignant cells.

The treatment for blood in the urine varies based on its underlying cause.

• The treatment for UTI is antibiotics.
• Hydration, pain relief, or lithotripsy for kidney/bladder stones
• BPH: Enlarged prostate. Medications or surgery to reduce the prostate
• Blood pressure management, immunosuppressants, or dialysis for severe kidney disease
• Stage-based surgery, chemotherapy, radiation, or immunotherapy for bladder, kidney, or prostate cancer.
• Exercise-induced Hematuria usually fixes it.
• Medication-related: Drug adjustment or discontinuation under medical supervision
• If no reason is established and no risk factors exist, monitoring may be enough.
• Many advise monitoring.

If risk factors like smoking or age are present, urine testing or imaging may be repeated.

Conclusion

Hematuria is a symptom, not a disease, indicating a urinary tract or kidney issue. 

While infections, exercise, and minor trauma can be cured or may resolve on their own. Kidney disease and cancer necessitate further investigation and personalized treatment. The managerial secret is identifying the cause through urinalysis, imaging, and maybe cystoscopy. Treatment can be customized, ranging from antibiotics and water to surgery or long-term monitoring.  A timely review can transform a red warning into a manageable or even curable issue.