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INTERPRETING BLOOD IN THE URINE

Q: I am a female and have had a trace of blood in my last three urine tests. What are the possible ramifications of this, and what should I do? Thank you very much.

-- V.

A: Before discussing hematuria (blood in the urine), I'd like to express my concern that you have repeatedly found blood in your urine and seem to have so little additional information.

If you have been doing you own urine tests at home, then I commend you for taking more control of your health and medical care. But the purpose of home screening tests, such as urinalysis, is to detect and then act on abnormalities.

Repeating an abnormal test (whether done at home or in a medical facility) is often a good idea to guard against acting too prematurely based on a false positive. But you do not need to repeat a test three times before taking some action.

If you have had these tests done as part of a visit to medical office, I'm very concerned and amazed that you have not had a full discussion with a health practitioner about your situation.

The urinary tract consists of the kidneys, which filter waste products from the blood; the ureters, which are tubes (one from each kidney) that take the urine to the bladder for storage; and the urethra, a single tube that transports the urine to outside the body.

The presence of blood in the urine (hematuria) suggests irritation and inflammation somewhere along the urinary tract. This irritation can be due to infection, injury, anatomic deformity, stones or tumors.

Infection is the most common cause of urinary tract inflammation. And bacteria are the most common cause of infection. Infection can also be caused by viruses, fungi or parasites.

Although the most common site for a urinary tract infection is the bladder, infection can occur anywhere within the urinary tract. The higher up the urinary tract, the more dangerous it is.

Home medical tests are also available to detect chemicals that increase as a result of urinary tract infections. Often the same dipstick that is used to detect blood or too much sugar will also provide this information.

In women and girls, organisms causing bladder infection almost always ascend up the urethra. This also occurs more often in elderly men. The bacteria are more likely to be introduced into the urinary tract as the result of sexual activity, poor personal hygiene, or other physical means.

As long as the infection is bacterial and confined to the lower urinary tract, it can often be rinsed out by drinking a lot of fluids, especially cranberry juice. A recent study found that certain chemicals in cranberry juice decrease the ability of bacteria to stick to the walls.

If flushing with fluids is not effective, then adding an oral antibiotic almost always provides a quick cure. Waiting too long to start taking antibiotics increases the risk of the infection working its way up into the kidneys.

Persistent or recurring UTI suggests either a "superinfection," involving multiple or unusual organisms, or the presence of a complicating factor such as blockage by stones or structural deformities.

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