Blood in the urine, or haematuria, can be obvious with red or pink urine, or at other times only picked up with urine testing and visible under a microscope. It may be painless or associated with symptoms such as pain, or difficulty passing urine.
It is not normal to find blood in the urine. Although it may be from a benign cause such as an infection or kidney stone, it can sometimes be due to a more significant health issue such as kidney disease, or even an underlying cancer. In fact, somewhere around 20% of patients who see blood in their urine, and more than 2% of those with microscopic haematuria, will be found to have a cancer as the underlying cause. As such, we routinely see all patients who have blood in their urine.
The investigations required to determine the underlying cause will depend on several factors, primarily risk factors for cancer. These are age, smoking history, occupational history, radiation exposure, and chronic inflammation such as from a catheter or recurrent infection.
Investigations may include:
- Urinalysis: The urine can be tested to find cancer cells, infection or kidney disease
- Blood test: A blood test can show kidney disease, and also evaluate if any significant blood loss has occurred
- Imaging tests: They can identify a tumour, a kidney or bladder stone, an enlarged prostate or another cause of haematuria. These tests include ultrasounds, CT scans or retrograde pyelography, the later of which is performed with a cystoscopy
- Cystoscopy: A camera looks inside the urethra and bladder to visually identify the presence or absence of a tumour, where it may be cut out or a biopsy taken. This can be performed under local or general anaesthetic, although we do not perform bladder biopsies or resections under local anaesthetic
If no cause is identified, it is important to continue to have your urine checked, and if it persists or worsens, come and discuss with us again if it requires re-evaluation.