Can Stress Cause Blood in Urine? 4 Facts.

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Stress and anxiety can cause complex symptoms and profound effects on your body. However, the role of stress in hematuria is yet to be established as there is no scientific evidence linking the two conditions.

This article will teach you some facts about stress and its relation to bloody urine.

1. Stress is NOT an established cause of blood in the urine.

Blood in urine results from injury or inflammation in the kidneys, urinary bladder, or any other part of the urinary tract, such as the ureters or the prostate.

Anxiety and psychological stress are NOT among the established causes of blood in the urine. So, don’t attribute hematuria to stress; always work with your doctor to identify the cause.

For instance, UpToDate.com, a well-established resource for doctors in medicine, didn’t mention anxiety or stress as a cause of bloody urine.

However, some studies linked chronic stress to urinary conditions such as interstitial cystitis or bladder pain syndrome.

Only very few small studies linked stress to blood in the urine. However, they cannot be used as (sufficient evidence) as they are not high-quality, large-scale research.

In the next section, I will discuss some of these studies and their limitations.

2. Scientific evidence is weak.

As researchers, we classify the quality or strength of evidence according to the type of the studies, their design, and the size of the samples.

The highest level of evidence is systemic reviews and meta-analysis studies that analyze all other studies on a specific topic in a systemic method to reach a conclusion about a certain topic.

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The lowest levels of evidence are small, non-randomized studies, case reports, and expert opinions.

Regarding the role of stress and anxiety as a cause of hematuria, NO high-quality studies showed that stress, anxiety, or other psychological conditions directly cause blood in the urine.

One small study (case report) showed that stress and anxiety were associated with hematuria after excluding other common causes. In addition, researchers found urine (unexplained) blood disappeared gradually after four psychotherapy sessions.

Also, the researchers followed up with the patients for an entire year without recurrence of hematuria.

Limitations of this study:

  • Case reports are not considered (high-quality) scientific evidence.
  • In addition, it only included (one patient).
  • The unexplained hematuria of this patient doesn’t necessarily cause by anxiety or psychological conditions. Many causes of hematuria are undetectable by investigations and need more invasive methods, such as kidney biopsy.
  • Millions of patients with anxiety, stress, and other psychological conditions don’t have hematuria.

3. Never ignore the established causes of blood in the urine.

As doctors, we always have a philosophy while pursuing the diagnosis of a medical condition such as hematuria. The philosophy is “common is common.”

So, We don’t pursue unconfirmed or extremely rare causes of the medical condition before searching for the common causes.

Interestingly, many causes of blood in urine can be difficult to assess by routine laboratory investigations and imaging studies such as ultrasound and CT.

This difficulty in assessing the cause of hematuria opens the door to theories and assumptions such as stress and anxiety as a cause of hematuria.

So, getting a thorough medical evaluation for your hematuria by a urologist or nephrologist is a way better option before theorizing about the causes.

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Your doctor will always investigative the common causes first, such as:

  • History of exercise (exercise-induced hematuria).
  • Urinary tract stones.
  • Urinary tract infections
  • Drugs.
  • Bladder cancer.
  • Urinary tract endometriosis in females.
  • Glomerulonephritis (kidney inflammation).
  • Traumas and urinary tract instrumentations.

If the initial evaluation couldn’t define a cause of blood in urine, your doctor will search for rare causes of hematuria.

The table below illustrates the most possible causes of hematuria (common and rare) (reference).

KIDNEY CAUSES
1. benign or malignant kidney tumors.
2. Glomerulonephritis (IgA nephropathy, Thin basement membrane disease, or Alport syndrome).
3. Adult Polycystic Kidney Disease (APKD)
4. Medullary sponge kidney.
5. Pyelonephritis (kidney infection).
6. Kidney distension with urine (hydronephrosis).
7. Increased excretion of calcium or uric acid in urine.
8. Severe (malignant) hypertension.
9. Obstruction of the renal artery or renal vein.
10. Arteriovenous malformation (abnormal blood vessels of the kidney).
11. Papillary necrosis (with sickle cell disease).
URETERIC CAUSES
1. Malignant ureteric tumor.
2. Stone ureter.
3. Stricture (narrowing) in the ureter.
4. Polyp.
5. Post-surgery (fistula between the iliac vessels and the ureter or ureteroiliac fistula).
URINARY BLADDER CAUSES
1. UB cancer (most serious).
2. Cystitis (UTI).
3. UB stone.
4. UB radiation.
PROSTATE & URETHRA
1. BPH (benign prostatic hypertrophy).
2. Prostatic cancer.
3. Prostatic procedures such as taking a biopsy or operations.
4. Trauma during urinary catheter insertion.
5. Urethritis (inflammation of the urethritis).
6. Urethral diverticulum.
ANYWHERE (KIDNEY, URETER, BLADDER, OR URETHRA)
1. UTI (infection with bacteria, viruses, or fungi).
2. Tuberculosis.
3. Schistosomiasis
4. Trauma.
5. Exercise-induced hematuria.
6. Recent interventions such as lithotripsy.
7. Bleeding disorders or anticoagulant medications.
8. Endometriosis of the urinary tract.
1. Menstruation.
2. Drugs (Pyridium, phenytoin, rifampin, nitrofurantoin).
3. Red pigments in urine as myoglobinuria
4. Beeturia.
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4. Loin Pain-Hematuria Syndrome & stress.

Loin pain-hematuria syndrome (LPHS) was first described in 1967 as a rare disease with kidney (loin) pain and blood in the urine.

The disease is not a well-established entity and doesn’t have widely accepted criteria for diagnosis (reference.

The primary form of Loin pain-hematuria syndrome occurs without an identifiable cause or glomerular lesions.

Several studies investigated the cause of this rare condition. Some of these studies proposed that LPHS is a somatoform pain disease in which stress and anxiety can lead to both loin pain and blood in the urine.

For instance, one study compared patients with hematuria due to LPHS to those with hematuria due to kidney stones disease and found that LPHS sufferers are more likely to have an adverse psychologic event preceding the onset of pain and blood in the urine (reference).