You should seek medical attention if you see blood in your urine
There are two types of haematuria: gross haematuria and microscopic haematuria.
Gross haematuria is when blood in the urine is visible to the naked eye.
Microscopic haematuria is when the blood is not visible in the urine. The blood is detected under a microscope or through a urine test called a urinalysis.
How common is blood in urine?
Blood in the urine, known as haematuria, is quite common, affecting between 2-20% of people at some point in their lives.
However, it's more likely to occur in certain groups, such as older adults, smokers, or those with a history of bladder or kidney problems.
It's important to know that haematuria can be a symptom of different conditions, from minor infections to severe illnesses such as bladder or kidney disease or prostate cancer. Therefore, seeing an NHS urology consultant or private urologist if you notice blood in your urine is crucial.
What are the common causes of blood in urine?
- Benign prostatic hyperplasia (BPH): An enlarged prostate gland that can cause urinary symptoms.
- Cancer of the urinary system: abnormal growth of cells in the kidneys, ureters, bladder, or prostate gland that can be cancerous.
- Calculi, or stones, are hard mineral deposits that cause pain or blockage that can form in any part of the urinary system.
- Certain medications: Blood thinners, antibiotics, and pain relievers are some examples of medications that can increase the risk of haematuria.
- Strenuous exercise: Activities that require intense physical effort, such as long-distance running, can cause haematuria.
- Urinary tract infections (UTIs): Infections caused by bacteria or viruses, such as streptococcus or hepatitis, can sometimes cause haematuria.
- Interstitial cystitis
- Trauma: like kidney injury
- Medical conditions like Glomerulonephritis (a type of kidney disease that affects the kidneys' filtering units and can cause blood in the urine), blood clotting disorders (haemophilia), sickle cell disease, Alport syndrome
Can certain foods or drinks change the colour of urine?
Some foods, certain medicines and drinks can cause urine to appear red or pink due to natural pigments or compounds excreted in the urine. The following are typical culprits:
Beetroot: Eating or drinking beetroot juice can cause urine to turn pink or red.
Blackberries and blueberries: These fruits can also cause urine to turn pink or red.
Rhubarb: Eating rhubarb or drinking rhubarb juice can cause urine to appear reddish-brown.
Food dyes: Some brightly coloured foods or drinks that contain artificial food dyes may also cause urine to change colour.
Medications: Certain medications, such as rifampicin, phenazopyridine, and some laxatives, can also cause urine to appear reddish-brown or orange.
What can I feel if I have blood in my urine?
When you have visible haematuria, your urine can look from pink to red or brown because of the blood in it. Only a tiny amount of red blood cells can make your urine look different. One may experience painful urination, back pain or lower abdominal pain, especially if the cause of gross hematuria is a stone, bacteria causing a urinary tract infection or passing blood clots that can block the urine flow.
'Doctors are more alarmed if you experience painless haematuria as there is a greater chance of cancer being the cause.'
On the other hand, microscopic haematuria doesn't change the colour of urine and usually doesn't cause any other symptoms. This is typically found when testing your urine.
I have visible blood in my urine. Do I have cancer?
The presence of visible blood in urine can be a symptom of many conditions, ranging from relatively harmless to severe. While cancer can cause gross hematuria, it is not the most common cause.
Studies have shown that only a tiny percentage of people with gross hematuria have cancer. The exact value varies depending on age, gender, and risk factors. Generally, the risk of cancer increases with age, and men have a higher risk than women.
According to the American Urology Association (AUA), under 40 years with no risk factors, the likelihood of cancer when they have blood in their urine is less than 1%.
In people over 50 years or those with risk factors such as a history of smoking (including a family history of smoking), the cancer risk increases to around 10-20%.
How do healthcare professionals diagnose haematuria?
When you go to a healthcare professional with symptoms of haematuria, they will use your medical history, perform a physical exam, and conduct a urine test called urinalysis to diagnose the condition and identify its cause. If you are a man, your own healthcare provider or professional may perform a digital rectal exam, which involves inserting a lubricated, gloved finger into your rectum to check the prostate gland for abnormalities. If you're a woman, the healthcare professional may perform a pelvic exam, which involves checking the vagina, cervix, uterus, ovaries, and rectum for any signs of bleeding or inflammation.
A urinalysis will be performed.
Urinalysis involves examining your urine sample for the presence of red blood cells, white blood cells, bacteria, and other substances that may indicate an underlying condition. During the test, you will be asked to provide a urine sample, which will be tested using a dipstick or microscopic examination.
If the test shows the presence of blood in your urine, your healthcare professional may order further lab tests, such as blood tests or imaging tests, to identify the underlying cause.
Sometimes, women may test positive for haematuria when menstruating because menstrual blood can mix with urine and cause the test to show false positive results. To avoid such errors, women may be asked to repeat the test after their menstrual period ends
An urgent referral to a urologist is commonly done for additional testing.
More tests may be asked like
Blood test:
This typically will include a complete blood count (looking for signs of anaemia, clotting disorders), a kidney function test, a clotting screen test (if one is on warfarin) and in men a PSA test.
Computed Urogram (CT urogram):
This diagnostic imaging test uses X-rays and contrast material to create detailed images of the urinary tract (kidneys, ureters and bladder). This test is commonly used to detect the presence of kidney stones, tumours, or other abnormalities that can cause blood in the urine. The contrast material used in a computed urogram can also help identify areas of inflammation or infection causing blood up in the urinary tract.
While the risks associated with a computed urogram are generally low, they can include an allergic reaction to the contrast material used in the test and radiation exposure. Pregnant or pregnant patients should inform their healthcare provider or professionals before undergoing such test.
Patients may also need to inform their doctor of any allergies to iodine, as the contrast material used in the test contains iodine.
Flexible Cystoscopy:
This minimally invasive procedure allows doctors to examine the bladder and urethra. This test can detect bladder cancer, inflammation, or other conditions that can cause blood in the urine. A thin tube, a flexible camera, is introduced into the patient's urethra and gently advanced into the bladder. This is commonly performed under local anaesthetic as a gel or, in certain circumstances, under general anaesthetic.
MRI prostate
This medical test takes detailed pictures of the prostate gland using a strong magnet and radio waves. It can help doctors find problems with the sometimes enlarged prostate gland, such as infections or prostate cancer. This investigation is ordered when a digital rectal exam is abnormal or a prostate-specific antigen (PSA) blood test results are high.
Ultrasound of the urinary system:
This non-invasive, safe test uses sound waves to picture the kidneys and bladder. This may show growths or masses, stones and swelling of the kidneys and growths (bladder cancer), stones and emptying issues of the bladder.
What is the treatment for blood in urine?
The underlying cause determines the treatment.
Treatment options may include:
- Antibiotics: Antibiotics may be prescribed if a bacterial infection causes the blood in the urine.
- Medications: If the cause of haematuria is due to medications that affect the bladder or kidneys, the doctor may adjust the dosage or prescribe an alternative medication.
- Surgery: If the blood in urine is caused by kidney cancer or bladder cancer or prostate cancer, or kidney stones, surgical intervention may be offered depending on one's health condition.
- Lifestyle changes: In some cases, lifestyle changes like drinking more fluids may be beneficial.
Reflection from a urologist on bloody urine
Urologic diseases need to be excluded by a healthcare professional. The chance of cancer increases if there is visible blood in the urine.
The bottom line is that even if urine blood disappears without treatment, this should still be investigated.
