Blood in the urine (haematuria)

Haematuria is when you have blood in the urine. Although it may not be caused by anything serious, blood in the urine can be alarming to see. It is important that you get medical advice.

Professor Francis Chinegwundoh MBE explains what can cause blood to appear in the urine and what you should do if this happens. He also discusses how haematuria can be investigated and treated.

If I have blood in the urine, does this need to be investigated?

There should not be any visible blood in the urine. If you do see blood, this should be investigated. You need to make a GP appointment without delay.

It is possible to have non-visible blood in the urine. This can be detected either by examining the urine under a microscope or by a urine test strip called a dipstick changing colour. If there is a large amount of non-visible blood in the urine, this also needs to be investigated.

 What causes blood in the urine?

Common causes of visible and non-visible blood in the urine are:

• a urinary tract infection (an infection in any part of the urinary system)
• an enlarged prostate gland in older men (benign prostatic hyperplasia)
• prostate cancer
• bladder or kidney stones
• tumours of the urinary tract, such as bladder or kidney cancer

Less common causes include a group of inflammatory kidney conditions called glomerulonephritis.

The colour of urine is influenced by your diet and whether you are hydrated (that is, whether your body has enough fluid to work properly). Dark urine is usually a sign of dehydration. Various medicines like Rifampicin (an antibiotic) and foods like beetroot can change the colour of urine. An infection may make the urine appear cloudy.

What medical tests can help to find the cause of blood in the urine?

Men and women with blood in the urine, whether visible or non-visible, should be referred to a urologist. This doctor specialising in the urinary system firstly excludes the more common causes of bleeding.

Various medical tests can help to find what is causing blood in the urine:

• Physical exam: The urologist asks about your medical history and examines you. Men have a rectal (back passage) examination to check the size and consistency of the prostate.
• Urine test: A urine sample is sent to a laboratory to test for infection.
• CT scan: You may have a CT scan of the kidneys to check for kidney stones and tumours. A special dye called a contrast can improve the quality of the pictures.
• Flexible cystoscopy: This is a camera inspection of the bladder. A thin tube with a tiny camera passes through the urethra (the ‘water pipe’ that carries urine out of the body) and into the bladder. The test is not painful because a local anaesthetic gel makes the area numb. It may be possible to detect a bladder cancer that cannot be seen easily on a scan.

How is blood in the urine treated?

The treatment for haematuria depends on what is causing the blood in the urine:

• Antibiotics: If you have an infection, this is treated with antibiotics. A bladder infection called cystitis is the most common reason for blood in the urine.
• Medicine for an enlarged prostate: If you have an enlarged prostate, you may be given medicine to reduce the size.
• Bladder cancer treatment: Bladder cancer is treated by removing the growth from inside the bladder using an instrument called a resectoscope.
• Kidney cancer treatment: Kidney cancer is treated surgically by removing part or all of the affected kidney.

About 1 in 5 adults with visible blood in the urine have bladder cancer. For non-visible blood in the urine, the figure is about 1 in 12.

Summary

Whatever your gender and age, it is important to see a doctor if there is any blood in your urine. This needs to be investigated to exclude a potentially serious diagnosis.

There is more information about blood in the urine on the British Association of Urological Surgeons (BAUS) website at: baus.org.uk

About Professor Francis Chinegwundoh MBE

Professor Francis Chinegwundoh MBE has clinics at The Holly Private Hospital. To book an appointment, please call 020 3504 8481 or complete this form.