Ask the experts

When Should I Worry About Blood in my Urine?

Blood in your urine is called hematuria. There are two types of hematuria: gross hematuria and microscopic hematuria. Gross hematuria is when you can see blood in your urine. Pink, red or brown urine is often the only symptom of gross hematuria. Microscopic hematuria is blood in the urine that you can’t see. It can only be found with urine tests or seen under a microscope. Most people with microscopic hematuria have no symptoms. Microscopic hematuria is most often found during routine health visits when a urine sample is given by the patient.

There are many causes of hematuria. These can involve infections or swelling in the bladder, kidney or prostate. Other causes include tough exercise, female menstruation and sexual activity. People are more likely to develop hematuria if they have an enlarged prostate, family history of kidney disease, or kidney or bladder stones.

Any time blood is found in your urine, your doctor will want to make sure that there is not a serious underlying health issue. Your doctor will give you a physical exam, gather your medical history and have you take a urine test to better see what’s going on. In some cases, extra procedures such as a blood test or an ultrasound will be needed. Treatment for hematuria will depend on the cause. If the issue is not serious, you may not need care at all.

Never ignore blood in your urine. Get it checked by your doctor, especially if you are having problems passing urine. The good news is that most patients with blood in the urine do not have major problems. For example, urological cancers rarely cause hematuria.

Dr. Brian McNeil is a urologist with SUNY Downstate Health Sciences University in Brooklyn, New York.

Is it Normal to Leak Urine?

If you leak urine, you likely have urinary incontinence. This is a loss of bladder control that can range from mild leaking to uncontrollable wetting. Millions of Americans—about 1 out of 2 women, and 1 out of 4 men—have urinary incontinence symptoms.

There are several kinds of urinary incontinence:

  • Stress incontinence, when urine leaks due to pressure on the bladder like during exercise, coughing, sneezing, laughing or lifting heavy objects.
  • Urge incontinence, also known as overactive bladder. This is when you have a sudden need to urinate and urine leaks out.
  • Overflow incontinence, when the body makes more urine than the bladder can hold or the bladder gets too full. This causes leaking or “dribbling.”

If you leak urine, the first step to keeping you dry is to try lifestyle changes, such as limiting caffeine and alcohol, which may bother your bladder. Your doctor may also advise you not to drink for a few hours before bed. Another treatment is exercise to tighten and relax certain muscles in the pelvis, known as Kegels.

When lifestyle changes do not help enough, your health care provider may suggest prescription medications. There are also office procedures and surgeries that can help stop leaks so you may not need long-term medications.

You don’t have to live with urinary incontinence. If the fear of leaking urine stops you from doing things you enjoy, talk to your doctor.

Dr. Elizabeth Timbrook "Brook" Brown is a urologist with MedStar Georgetown University Hospital in Washington, DC.

Do Catheters Increase UTI Risk?

A urinary catheter is a flexible tube that drains urine from your bladder. The goals of catheterization are to empty your bladder regularly, keep you dry and avoid over-swelling of the bladder.

There are 3 main types of catheters.

  • Indwelling catheters, which are left in the bladder and collect urine by attaching to a drainage bag.
  • Intermittent self-catheters are used when the patient advances the catheter into their bladder themselves. It is typically removed after the bladder has been drained. This is unlike an indwelling catheter that remains in place.
  • Condom catheters are used almost exclusively for urinary incontinence in men. A condom-like device is placed over the penis and a tube leads from the device to a drainage bag.

Urinary tract infections (UTIs) are a common problem with urinary catheters. These infections are sometimes called catheter-acquired or catheter-associated UTIs.

Symptoms of UTIs may include pain or burning when you urinate, an urgent need to urinate often, cloudy or smelly urine and pain in your back. The good news is there are ways to lower your chances of getting a UTI while using catheters.

  1. Keep the area around the catheter clean.
  2. Always wash your hands before and after placing your catheter.
  3. Drink plenty of fluids to help prevent infections, especially water.
  4. Keep the catheter tubes from “kinking” or twisting.
  5. Keep your urine bag below the level of your bladder.

Dr. Brian Stork is a urologist with Michigan Medicine in Muskegon, Michigan.  |  WINTER 2020/2021  |  UROLOGYHEALTH extra