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If suddenly passing red or tea-colored urine, with or without pain, consider it blood until proven otherwise. If grossly red, the bleeding is considerable; if tea-colored the bleeding is less, but significant. There should be no blood in the urine beyond zero to four red blood cells per high-powered microscopic field. Zero to four is the normal. If the bleeding is not enough to color the urine, the patient will be unaware. Here is where a routine urinalysis including a microscopic examination of the urine as part of a complete physical examination, can be life saving.

The causes of blood in the urine include:

•A stone in the kidney, ureter, or bladder. The stone may be painless if it is in the kidneys or bladder, but pain will be its hallmark if it is stuck in the ureter

•Bacterial infection including tuberculosis or a fungal infection

•Trauma can cause bleeding as well

•Benign tumor

•The most urgent and main cause is a malignant tumor of the urinary bladder, and, less commonly, the kidney