Microhematuria

Overview

What is microhematuria?

Hematuria is the condition of having blood in your urine (pee). There are two types: gross hematuria (you can actually see the blood) and microscopic hematuria. Microscopic hematuria is known by a shorter name, microhematuria.

If you have microhematuria, the blood in your urine can’t be seen without testing or a microscope. If you have gross hematuria, you can see the blood in your urine without a microscope. It might look dark like tea or slightly pinkish or reddish.

Who does microhematuria affect?

Microscopic hematuria can occur in adults and children.

Symptoms and Causes

What are the symptoms of microhematuria?

Often, there are no symptoms of microhematuria. In that case, we say that the condition is asymptomatic. Your healthcare provider might find it when they order routine tests at a check-up.

If you do have symptoms, they might include:

  • Having to pee more often than usual (called frequent urination).
  • Having pain or burning while you pee.
  • Feeling pain in your back or side.
  • Fever.
  • Bad-smelling urine.

What causes microhematuria?

In many cases, you might not discover the cause of microhematuria. When causes are discovered, they might include:

Microhematuria isn’t contagious, but the most common cause of microhematuria is a urinary tract infection (which also isn’t contagious). Although we tend to think immediately of cancer, the most common cause is not cancer. When there is cancer associated with microhematuria, the risk is higher when you are older and when you smoke or use tobacco products.

Diagnosis and Tests

How is microhematuria diagnosed?

Your healthcare provider will ask you questions about your symptoms and about your medical history. For instance, they will ask if you:

  • Have had blood in your urine any other times.
  • Have lost or gained a lot of weight recently.
  • Smoke or use tobacco products.
  • Take any kinds of medicines, over-the-counter supplements or recreational drugs.
  • Have other family members who have had blood in their urine.

If you have symptoms that lead your provider to believe you might have blood in your urine, they might order one or some of the following tests:

  • Urine tests such as urinalysis and urine microscopy. A urine culture can find an infection. A laboratory test will show three or more red blood cells (RBCs) per high-powered field under the microscope, which is the definition of microhematuria according to the American Urological Association. Repeat testing is not required after confirming microhematuria on a first test.
  • Blood tests, such as the complete blood count test.
  • Imaging scans, including a computed tomography (CT) scan.
  • Kidney function tests.
  • Cystoscopy. This is a procedure where a small flexible telescope is used to examine the inside of your urethra and bladder.
  • Biopsy.

Management and Treatment

How do you treat microhematuria?

Treating microscopic hematuria depends on what causes it. If testing does not demonstrate a cause of microscopic hematuria, treatment may not be necessary and observation may be recommended.” After that, observation may continue.

Medications

If you have a urinary tract infection, your provider may prescribe antibiotics.

If you have an enlarged prostate, your provider might prescribe medication to shrink the prostate or relax the bladder, or both. In some cases, surgical treatment may be recommended.

If you have something like kidney stones, your provider might prescribe pain medication, anti-nausea medication and/or medication to relax tissue in your urinary system to allow the stone or stones to pass. In certain situations, you and your provider may decide that surgery is the best way to manage kidney stones.

Prevention

How can I reduce my risk?

It may not be possible to prevent microhematuria from happening. However, drinking plenty of fluids, preferably water, is a good thing to do in general. It’s especially helpful when you’re exercising.

Again, depending on the reason for microhematuria, your provider might have other suggestions about what to eat or drink or what to avoid.

Outlook / Prognosis

What can I expect if I have microhematuria?

The outlook for someone with microhematuria depends on what’s causing blood in the urine. In general, the outlook is good. Many causes are things that resolve without treatment or that can be treated easily.

Living With

When should I see my healthcare provider?

If you have symptoms related to microhematuria, such as pain or fever, give your healthcare provider a call or contact them electronically. If any symptom is severe, you may choose to go to an urgent care provider.

If you’ve had microhematuria before and you happen to notice symptoms of gross hematuria (visible blood in your urine), contact your provider.

Frequently Asked Questions

Is microhematuria serious?

Even though having blood in your urine may sound scary, microhematuria doesn’t always mean that something serious is going on. It may clear up on its own, or it may be the result of something that can be treated easily. This is something best determined by working with your healthcare provider.

Is microscopic hematuria a sign of cancer?

Microscopic hematuria can mean that you have a benign (not cancerous) or malignant (cancerous) tumor somewhere in your urinary tract. However, cancer isn’t the most likely cause.

A note from Cleveland Clinic

You might have blood in your urine and not even know it. Microhematuria is blood in urine that can only be seen under a microscope. It’s often discovered during routine exams. Your healthcare provider will work with you to find out why the blood is there. Many times there’s nothing too serious going on, but it’s best to work with your provider to discover the cause and to take care of it.

Last reviewed by a Cleveland Clinic medical professional on 11/17/2021.

References

  • Barocas DA, Boorjian SA, Alvarez RD, et al. Microhematuria: aua/sufu guideline. Journal of Urology. 2020;204(4):778-786.
  • Saleem MO, Hamawy K. Hematuria. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534213/ (https://www.ncbi.nlm.nih.gov/books/NBK534213/) Accessed 11/17/2021.
  • National Kidney Foundation. Multiple pages reviewed for this article. Know Your Kidney Numbers: Two Simple Tests. (https://www.kidney.org/atoz/content/know-your-kidney-numbers-two-simple-tests) Accessed 11/17/2021.
  • Rodriguez KM, Dao Z, Pastuszak AW, Khera M. Rodriguez K.M., & Dao Z, & Pastuszak A.W., & Khera M Rodriguez, Katherine M., et al.Genitourinary Disorders in Primary Care. In: Bhasin S, O’Leary MP, Basaria SS. Bhasin S, & O’Leary M.P., & Basaria S.S.(Eds.),Eds. Shalender Bhasin, et al.eds. Essentials of Men’s Health. McGraw Hill; 2021.

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