Quick Summary: Finding a few red blood cells (RBCs) in your urine is usually normal. Generally, up to 0-2 RBCs per high power field (HPF) is considered acceptable. Higher numbers might indicate a problem, like an infection, kidney issue, or other medical condition. If your test shows elevated RBCs, see a doctor for further evaluation.
Seeing blood in your urine can be alarming, but don’t panic! It’s a common issue that can stem from many things. Sometimes, it’s just a minor, temporary problem. Other times, it could signal something that needs medical attention. Understanding what’s normal and what’s not is the first step. We’ll walk you through what those lab results mean, potential causes for high RBC counts, and what steps you should take next to stay healthy. Let’s get started!
Understanding RBCs in Urine: What’s Normal?
When you get a urine test, one of the things the lab checks for is red blood cells (RBCs). A small number of RBCs in urine is often considered normal. But what exactly does “normal” mean? And when should you be concerned?
The Normal Range
Typically, a normal urine sample will have very few or no RBCs. Most labs report the number of RBCs per high power field (HPF) under a microscope. Here’s a general guideline:
- Normal: 0-2 RBCs/HPF
- Acceptable: Up to 5 RBCs/HPF (may be normal depending on individual factors)
- Elevated: More than 5 RBCs/HPF
Keep in mind that these ranges can vary slightly between different labs, so always refer to the specific reference range provided on your lab report.
What if My Results Are Slightly Higher?
If your results show a slightly elevated RBC count (e.g., 3-5 RBCs/HPF), it doesn’t always mean there’s a serious problem. Several factors can cause a temporary increase, such as:
- Exercise: Strenuous physical activity can sometimes cause a temporary rise in RBCs.
- Menstruation: Women may have slightly higher RBC counts during their menstrual period.
- Sexual Activity: Recent sexual activity can sometimes cause trace amounts of blood in the urine.
If your RBC count is only slightly elevated and you have one of these factors, your doctor may recommend retesting your urine after a few days to see if the count returns to normal.
What’s Considered a High RBC Count in Urine?
A high RBC count in urine, also known as hematuria, means there are more red blood cells than normal. While the specific threshold varies, generally, more than 5 RBCs per high power field (HPF) is considered elevated. But what does that really mean for you?
Defining Hematuria
Hematuria can be classified into two types:
- Microscopic Hematuria: This is when blood in the urine can only be seen under a microscope. You won’t notice any change in the color of your urine.
- Gross Hematuria: This is when you can see blood in your urine. The urine may appear pink, red, or even brownish.
Even if you can see blood in your urine (gross hematuria), it doesn’t necessarily mean the problem is more serious than microscopic hematuria. Any visible blood should always be investigated by a healthcare professional.
Quantifying High RBC Counts
Here’s a more detailed breakdown of what different RBC counts might indicate:
| RBCs/HPF | Interpretation | Possible Actions |
|---|---|---|
| 0-2 | Normal | No action needed |
| 3-5 | Slightly Elevated | Repeat test, consider possible causes (exercise, menstruation) |
| 6-20 | Moderately Elevated | Further investigation needed (imaging, cystoscopy) |
| >20 | Significantly Elevated | Prompt medical evaluation required to determine the cause |
Possible Causes of High RBC Count in Urine
There are many reasons why you might have a high RBC count in your urine. Some are relatively harmless, while others require medical attention. Here’s a look at some of the common causes:
Urinary Tract Infections (UTIs)
UTIs are one of the most common causes of hematuria, especially in women. An infection in the bladder, urethra, or kidneys can cause inflammation and bleeding.
- Symptoms: Frequent urination, burning sensation during urination, cloudy urine, strong-smelling urine, pelvic pain.
- Treatment: Antibiotics prescribed by a doctor.
Kidney Infections (Pyelonephritis)
A kidney infection is a more serious type of UTI that can also lead to hematuria. It occurs when bacteria travel up from the bladder to the kidneys.
- Symptoms: Fever, chills, back pain, side pain, nausea, vomiting, frequent urination, painful urination.
- Treatment: Requires prompt treatment with antibiotics, often intravenously in severe cases.
Kidney Stones
Kidney stones are hard deposits that form in the kidneys. As they move through the urinary tract, they can cause irritation and bleeding.
- Symptoms: Severe pain in the side and back, pain that radiates to the lower abdomen and groin, nausea, vomiting, blood in the urine, frequent urination, painful urination.
- Treatment: Small stones may pass on their own with plenty of fluids and pain medication. Larger stones may require medical intervention, such as shock wave lithotripsy or surgery.
Bladder Stones
Similar to kidney stones, bladder stones can also cause hematuria. These stones form in the bladder when minerals in urine crystallize.
- Symptoms: Abdominal pain, difficulty urinating, frequent urination, painful urination, blood in the urine.
- Treatment: Small stones may pass on their own. Larger stones may require cystoscopy to remove them.
Glomerulonephritis
Glomerulonephritis is an inflammation of the glomeruli, which are tiny filtering units in the kidneys. This condition can be caused by infections, immune disorders, or other diseases.
- Symptoms: Blood in the urine, protein in the urine, swelling in the face, hands, feet, and abdomen, high blood pressure.
- Treatment: Treatment depends on the underlying cause and may include medications to control inflammation and blood pressure.
Enlarged Prostate (Benign Prostatic Hyperplasia – BPH)
In older men, an enlarged prostate can put pressure on the urethra and cause bleeding.
- Symptoms: Frequent urination, difficulty starting urination, weak urine stream, dribbling after urination, blood in the urine.
- Treatment: Medications to shrink the prostate or surgery to remove excess tissue.
Bladder Cancer or Kidney Cancer
In some cases, hematuria can be a sign of bladder cancer or kidney cancer. It’s important to note that cancer is not the most common cause of hematuria, but it’s essential to rule it out.
- Symptoms: Blood in the urine, frequent urination, painful urination, back pain, pelvic pain, weight loss, fatigue.
- Treatment: Treatment depends on the stage and type of cancer and may include surgery, radiation therapy, chemotherapy, or immunotherapy.
Medications
Certain medications, such as blood thinners (anticoagulants) like warfarin or aspirin, can increase the risk of bleeding in the urinary tract.
- Symptoms: Blood in the urine (usually microscopic).
- Treatment: Your doctor may need to adjust your medication dosage or switch you to a different medication.
Strenuous Exercise
As mentioned earlier, intense physical activity can sometimes cause temporary hematuria.
- Symptoms: Blood in the urine after exercise, usually resolves within 24-48 hours.
- Treatment: Usually no treatment is needed. Rest and hydration are recommended.
Trauma
An injury to the kidneys or bladder can cause bleeding and hematuria.
- Symptoms: Blood in the urine, pain in the side or abdomen.
- Treatment: Treatment depends on the severity of the injury and may include rest, pain medication, or surgery.
When to See a Doctor
It’s always a good idea to see a doctor if you notice blood in your urine, even if it’s just a small amount. While it may be due to a minor issue, it’s essential to rule out any serious underlying conditions. Here’s when you should seek medical attention:
- Visible Blood in Urine: If your urine is pink, red, or brownish, see a doctor as soon as possible.
- Painful Urination: If you have blood in your urine along with pain or burning during urination, it could indicate a UTI or kidney stones.
- Flank Pain: Pain in your side or back, especially if accompanied by blood in the urine, could be a sign of kidney stones or a kidney infection.
- Frequent Urination: If you’re urinating more often than usual and also have blood in your urine, it could be a sign of a UTI, enlarged prostate, or other urinary tract issues.
- Underlying Medical Conditions: If you have a history of kidney disease, diabetes, high blood pressure, or other medical conditions, it’s even more important to see a doctor if you notice blood in your urine.
How is High RBC in Urine Diagnosed?
If your urine test shows a high RBC count, your doctor will likely order additional tests to determine the cause. Here’s what you can expect:
Medical History and Physical Exam
Your doctor will start by asking about your medical history, including any symptoms you’re experiencing, medications you’re taking, and any underlying medical conditions you have. They’ll also perform a physical exam to check for any signs of infection, inflammation, or other abnormalities.
Repeat Urine Test
Your doctor may order a repeat urine test to confirm the initial results. This is especially important if the first test was done during menstruation or after strenuous exercise.
Urine Culture
A urine culture can help determine if you have a UTI. The lab will grow bacteria from your urine sample to identify the type of bacteria and determine which antibiotics will be most effective.
Blood Tests
Blood tests can help assess your kidney function and check for other underlying conditions, such as glomerulonephritis.
Imaging Tests
Imaging tests, such as a CT scan, MRI, or ultrasound, can help visualize your kidneys, bladder, and other urinary tract structures to look for stones, tumors, or other abnormalities. According to the Mayo Clinic, CT scans are more likely to detect even small kidney stones. Mayo Clinic – CT Scan
Cystoscopy
A cystoscopy involves inserting a thin, flexible tube with a camera into your bladder to visualize the lining of your bladder and urethra. This procedure can help detect bladder tumors, stones, or other abnormalities.
Treatment Options for High RBC Count in Urine
The treatment for high RBC count in urine depends on the underlying cause. Here are some common treatment options:
Antibiotics for UTIs
If your hematuria is caused by a UTI, your doctor will prescribe antibiotics to kill the bacteria causing the infection. Be sure to take the full course of antibiotics as prescribed, even if you start feeling better after a few days.
Pain Relief and Hydration for Kidney Stones
Small kidney stones may pass on their own with plenty of fluids and pain medication. Your doctor may also prescribe medications to help relax the ureter and make it easier for the stone to pass.
Medical Procedures for Kidney Stones
Larger kidney stones may require medical intervention, such as:
- Shock Wave Lithotripsy (SWL): This non-invasive procedure uses shock waves to break up the stone into smaller pieces that can pass through the urinary tract.
- Ureteroscopy: This procedure involves inserting a thin, flexible tube with a camera into the ureter to remove the stone or break it up with a laser.
- Percutaneous Nephrolithotomy: This surgical procedure involves making a small incision in your back to remove the stone directly from the kidney.
Medications for Enlarged Prostate (BPH)
If your hematuria is caused by an enlarged prostate, your doctor may prescribe medications to shrink the prostate or relax the muscles in the prostate and bladder neck. In some cases, surgery may be necessary to remove excess prostate tissue.
Treatment for Glomerulonephritis
Treatment for glomerulonephritis depends on the underlying cause and may include medications to control inflammation, suppress the immune system, or lower blood pressure.
Cancer Treatment
If your hematuria is caused by bladder cancer or kidney cancer, your doctor will develop a treatment plan based on the stage and type of cancer. Treatment options may include surgery, radiation therapy, chemotherapy, or immunotherapy. The National Cancer Institute is a great resource for learning more about these treatments. National Cancer Institute
Preventing High RBC Count in Urine
While you can’t always prevent hematuria, there are some steps you can take to reduce your risk:
- Stay Hydrated: Drinking plenty of fluids can help prevent UTIs and kidney stones.
- Practice Good Hygiene: Wipe from front to back after using the toilet to prevent bacteria from entering the urethra.
- Empty Your Bladder Regularly: Don’t hold your urine for long periods of time.
- Maintain a Healthy Diet: A balanced diet can help prevent kidney stones and other urinary tract problems.
- Manage Underlying Medical Conditions: If you have diabetes, high blood pressure, or other medical conditions, work with your doctor to manage them effectively.
FAQ About RBCs in Urine
1. Is it normal to have trace amounts of blood in urine?
Yes, it’s generally considered normal to have up to 2 RBCs per high power field (HPF) in a urine sample. Higher amounts need investigation.
2. Can exercise cause blood in urine?
Yes, strenuous exercise can sometimes cause temporary hematuria. This usually resolves within 24-48 hours with rest and hydration.
3. What are the symptoms of a UTI?
Common symptoms include frequent urination, burning sensation during urination, cloudy urine, strong-smelling urine, and pelvic pain.
4. How are kidney stones treated?
Small kidney stones may pass on their own with plenty of fluids and pain medication. Larger stones may require medical intervention, such as shock wave lithotripsy or surgery.
5. Can medications cause blood in urine?
Yes, certain medications like blood thinners (e.g., warfarin, aspirin) can increase the risk of bleeding in the urinary tract.
6. When should I see a doctor for blood in urine?
See a doctor if you notice visible blood in your urine, painful urination, flank pain, frequent urination, or have underlying medical conditions.
7. What tests are done to diagnose the cause of high RBCs in urine?
Tests may include repeat urine tests, urine culture, blood tests, imaging tests (CT scan, ultrasound), and cystoscopy.
Conclusion
Discovering a high RBC count in your urine can be concerning, but understanding what’s normal and what’s not is crucial. While a slightly elevated count might be temporary, it’s always best to consult with a healthcare professional to rule out any underlying issues. They can conduct thorough evaluations and suggest appropriate treatments based on the root cause. By staying informed and proactive about your health, you can address any potential problems early and maintain your overall well-being. Remember, your health is your wealth, and taking that first step towards clarity is always a step in the right direction.
