Gross Hematuria

Gross hematuria is the presence of blood in the urine that is macroscopic, ie visible to the naked eye. This is in contrast to microscopic hematuria. In this case, the blood can only be detected under a microscope or other diagnostic methods.

Gross Hematuria

What is gross hematuria?

According to Aviationopedia, hematuria is the presence of red blood cells, ie blood in the urine, and gross hematuria is a red discoloration of the urine that is visible to the naked eye. The bleeding can also be associated with pain, but does not have to be.

Nevertheless, in both cases a doctor should be consulted as soon as possible, since it is unusual and mostly pathological. Inflammation, urinary stones, tumors and a mixture of menstrual blood can be possible causes.

Hematuria is classified according to the source of the bleeding and can be of glomerular or postglomerular origin. Gross hematuria is usually postglomerular hematuria, so the red blood cells are less damaged in structure and shape.


Gross hematuria can have many causes. It can be caused by things like menstrual blood, exercise, sexual activity, viral diseases, trauma, or an infection. Infections, or kidney stones, of the urinary tract, ie the renal pelvis, ureters, bladder and urethra often result in blood in the urine. Other serious causes of gross hematuria are tumors of the kidneys or bladder, as well as inflammation of the kidneys, urethra, bladder or prostate in men.

The genetic polycystic kidney disease can also be decisive. This is characterized by many cluster-shaped, fluid-filled cysts that enlarge the kidneys over time and destroy the kidney tissue. A bleeding disorder, such as hemophilia, or sickle cell anemia can also trigger gross hematuria.

Sickle cell anemia is an inherited condition in which the red blood cells have an abnormal crescent shape and are less able to carry oxygen to the body’s tissues. They often clog the small blood vessels, disrupting healthy blood flow and causing bleeding.

Symptoms, Ailments & Signs

Gross hematuria is primarily manifested by the visible red or brown coloration of the urine. Residual blood or blood clots may also be visible in the urine. The disease can occur painlessly, in some cases it causes severe, usually burning pain when urinating. Affected people need to urinate excessively.

The severity of these symptoms depends on the type of disease. The initial gross hematuria is expressed by the fact that small amounts of blood are noticed in the urine, which usually only occur at the beginning of urination. In terminal gross hematuria, the residual blood occurs at the end of micturition. Total gross hematuria is associated with visible blood in the urine that occurs throughout urination.

Symptoms are usually noticed with each urination, but can vary widely. The disease cannot be diagnosed externally, apart from blood in the urine. However, as the disease progresses, an increasing feeling of illness can set in, which is characterized by paleness and sweating. Gastrointestinal complaints such as nausea, vomiting, diarrhea, constipation and heartburn can also occur. In addition, a slight fever can set in, which is often accompanied by chills and tiredness.

Diagnosis & History

Gross hematuria can be diagnosed with the help of many tests. A urinalysis involves examining a sample of urine. The urine sample is collected in a special container and sent to the hospital laboratory for analysis. The nurse can use a U-stick to test in advance whether it is actually blood.

The next step is to diagnose the cause of gross hematuria. For this purpose, the doctor first carries out a proper anamnesis. If this suggests a reason, investigations must be carried out accordingly. Infection, kidney disease and tumors must be ruled out.

The presence of white blood cells signal a urinary tract infection. Malformed and clumped erythrocytes, as well as large amounts of proteins, also called proteinuria, can be an indication of kidney disease. The urine can also be examined for the presence of cancer cells.

A blood test can detect the presence of high levels of creatinine. This is a normal waste product of muscle breakdown and can indicate kidney disease. A biopsy of the kidney tissue can also be helpful. The removed tissue is then examined by a pathologist for diseases. Cystoscopy, in turn, is used to check the urethra and urinary tract for possible pathologic macroscopic tissue changes. Mass and cysts can also be seen with an ultrasound or a computed tomography. If the cause of gross hematuria is diagnosed, treatment methods must be initiated accordingly.


First and foremost, those affected suffer from bloody urine due to gross hematuria. For many people, blood in the urine can lead to a panic attack or continued sweating, significantly reducing their quality of life. As a rule, the further course of the disease depends heavily on the cause of the gross hematuria, so that a general prediction of this disease is usually not possible.

Bladder cancer can also shorten the patient’s life expectancy if the tumor has spread to other parts of the body. Furthermore, an infection of the urinary tract can also be responsible for gross hematuria, although those affected also experience pain when urinating. It is not uncommon for the pain when urinating to lead to psychological problems or other depressive moods.

In many cases, gross hematuria can be treated with antibiotics. There are no complications. If the treatment is successful, the life expectancy of the person affected is not reduced. Furthermore, in the case of cancer, the cancer must be removed. In general, it cannot be predicted whether this will lead to a positive course of the disease or to a reduction in life expectancy.

When should you go to the doctor?

If blood appears in the urine after performing heavy physical work or intensive sporting activities, it can be a one-off event. If the organism is overloaded, it is possible for blood vessels to burst and the blood that has escaped to be excreted in the urine. If you see an improvement within a few hours, you don’t need a doctor. A doctor’s visit must be made if the blood in the urine is noticed over several days or repeatedly when going to the toilet. There is also a need for action if the proportion of blood increases.

If you have additional abdominal discomfort, swelling or a feeling of pressure near the bladder or intestines, a doctor should clarify the symptoms. Changes in the amount of urine excreted is another signal that there is a discrepancy. If the amount of urine decreases despite constant fluid intake, a doctor is needed. The cause of the observation must be investigated and treated. If you have high blood pressure, heart rhythm disorders or burning pain when urinating, you should see a doctor. Tiredness and chills are warning signs of the organism for an existing health impairment. If they occur in connection with vomiting, nausea or diarrhea, a doctor should be consulted. If the person concerned suffers from a feeling of illness or a decrease in his or her performance,

Treatment & Therapy

Gross hematuria is treated according to the diagnosed cause. If no serious illness is causing it, no treatment is necessary. Hematuria caused by infection is cured with the help of an antibiotic.

A urinalysis should be repeated after six weeks. Kidney stones are often excreted on their own in the urine. It is important to drink a lot so that these are flushed out. However, if these are too large, stone crushing by shock waves must be used. The stage of a tumor determines how it is treated. Small and previous tumors of the bladder are removed with a minor operation. The procedure is performed through the urethra with an endoscope.

The removed tissue is then forwarded to the pathology department for further microscopic examinations. If the tumor is larger, the entire bladder must be removed and a replacement made. Gross hematuria therefore has many treatment methods.

Outlook & Forecast

Since it is not a disease in its own right, alleviating symptoms depends on the curability of the primary disease. For some people affected, it is blood that naturally escapes during menstruation in women. Spontaneous healing can therefore be expected as soon as the bleeding time is over. In addition, sexual activity can injure the vessels in the abdomen. Here, too, spontaneous healing can be expected within a short period of time.

However, if the bleeding is due to the presence of foreign bodies in the organism, medical attention is required. In the case of kidney stones, removal of the foreign bodies must be initiated in order for recovery to take place. Medical care is also required for inflammation in the kidney area. The administration of medication kills the pathogens and prevents them from multiplying. If the affected person suffers from a blood clotting disorder, a life-threatening condition can develop if the disease progresses unfavorably.

Without medical care, a further increase in symptoms is to be expected. Therefore, in the case of gross hematuria, the clarification of the cause is important for the prospect of a cure. In particular, persistent or increasing bleeding indicates a serious underlying disease.


Gross hematuria is difficult to prevent. Since this has many different causes, only the corresponding causes can be prevented. An infection of the urinary tract can be prevented with the help of an adequate water intake and a balanced diet. Likewise the formation of kidney stones. A bladder tumor cannot always be prevented. However, smoking nicotine is often a cause of tumor development.


After the actual treatment of gross hematuria, those affected need ongoing care. In addition to regular medical examinations and the use of other therapies, a change in lifestyle is also part of the aftercare. Those affected must now try to build up their usual quality of life. Sometimes it can help to go to a support group.

Depending on the type of cancer, nutritionists, sports groups and other authorities must also be consulted. The aftercare plan is drawn up together with the doctor and is based on the symptoms, the general course of the disease and the prognosis. In the first phase, when patients are still processing the consequences of the disease and treatment, aftercare is particularly important. The key is to support patients until remission is achieved.

Gross hematuria can lead to a variety of symptoms and complications if not treated properly or in a timely manner. Many of those affected also suffer from depression or other mental disorders that can have a very negative effect on the quality of life of the person concerned. They continue to suffer from severe tiredness and exhaustion and can no longer actively participate in everyday life. The further course of the disease depends very much on the exact time of diagnosis, so that no general prediction can be made.

You can do that yourself

Gross hematuria can have a variety of causes. Even if it can be diagnosed or at least suspected by the patient himself, self-therapy is strongly discouraged. Some causes of gross hematuria can be treated and healed well under medical supervision, while others can be caused by a life-threatening condition. A patient who finds or suspects gross hematuria in themselves should therefore urgently consult a doctor.

If there is a concrete diagnosis of the causes and the underlying disease, the doctor will draw up a therapy plan for the patient and discuss it with him. Now the patient can contribute a lot to his recovery by sticking to the treatment plan that has been set up and following the recommendations of his doctor. Depending on the diagnosed cause, different therapeutic approaches are necessary. Some therapies require surgery, while others require pills to be taken regularly.

Diet plans or even a complete change in diet and lifestyle often follow in a second step. Every patient can make a major contribution to their own well-being by understanding the therapeutic approach and consistently striving to comply with the guidelines. This also includes carrying out any check-ups.