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Blood in the urine (haematuria): what causes it, what it means and treatment

22/06/2021

Haematuria refers to blood in the urine. While it may not be caused by anything serious, it can be alarming to see and still does need to be investigated. But what causes this blood to appear, what should you do if this happens, and how can haematuria be treated?

Professor Francis Chinegwundoh, Consultant Urological Surgeon at The Holly, takes a closer look.

Causes

Common causes of visible blood in the urine (VH) and non-visible blood (NVH) in the urine in men include tumours of the urinary tract, such as cancers of the kidney and bladder. An enlarged prostate gland (benign prostate hyperplasia) or prostate cancer can also lead to blood in the urine. Other causes include kidney, ureteric and bladder stones. Urinary tract infection is also a common cause of bleeding.

Less common causes include inflammatory conditions of the kidney, termed glomerulonephritis.

The colour of the urine is influenced by diet and by hydration. Dark urine is usually due to dehydration. Various drugs, such as rifampicin alter the colour of the urine. Beetroot may alter the colour of the urine. Infection may cause the urine to appear cloudy.

What merits investigation?

There should not be visible blood in the urine (VH). If you do see blood, this requires further investigation. It is possible to have non-visible (NVH) blood in the urine, detected either by microscopic examination of the urine or by a ‘dipstix’ changing colour. Significant NVH also merits investigation.

What should I do if I have haematuria?

Men and women with blood in the urine, whether VH or NVH, should be referred to a urologist for examination and further investigations. The more common causes of bleeding are to be excluded. A rectal examination (men only) is done to determine the prostate size and consistency. The urine is sent off to check for infection. A CT scan, with contrast, of the kidneys would exclude kidney tumours and stones. Investigation is incomplete without a flexible cystoscopy. This is a camera inspection of the bladder, via the ‘water pipe (urethra)’, under local anaesthesia. A bladder cancer may be detected that is not readily visible on imaging.

Treatment

The treatment of haematuria depends on the cause. Infection is treated with antibiotics. Indeed, infection (often called cystitis) is the commonest reason for passing blood in the urine. There are drugs which shrink the prostate. Bladder cancer is treated by removing the growth from inside the bladder using an instrument called a resectoscope. Cancer of the kidney is treated surgically, by removal of part or all of the involved kidney.

1 in 5 adults with visible (VH) blood in the urine turn out to have a bladder cancer.

For non-visible blood (NVH) the figure is 1 in 12.

Conclusion

The message is that passing blood in the urine, in whatever sex and whatever age, should be investigated to exclude a potentially serious diagnosis.

Further information on blood in the urine is available from the website of the British Association of Urological Surgeons (BAUS).

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