Blood in the Urine

    Blood in the urine that you can see (macroscopic haematuria)

    If you see blood in your urine, you should see you GP as soon as possible. There are some benign causes for seeing blood in your urine, but you will need an assessment to see if there is another cause. In most cases, your GP will consider referring you to a urologist for a consultation.

    The purpose of the consultation with a specialist urologist is to work out where in your urinary tract the bleeding has come from, and the significance of the bleeding.

    Blood in the urine that you can’t see (microscopic haematuria)

    A urine test may have revealed red blood cells in the urine that can only be seen using a microscope. This is known as microscopic haematuria. Often a ‘dipstick’ of the urine is done prior to this, but the presence of blood does need to be confirmed with microscopic examination of a urine sample.

    There are many causes of microscopic blood in the urine. Some causes do not require further investigation. These include:

    • Menstruation (some blood accidentally gets into the urine when a sample is taken)
    • Urinary tract infection (following treatment, a dipstick should be repeated to confirm absence of haematuria).
    • Exercise induced haematuria. This can occur with strenuous or unaccustomed exercise. Following a period of rest, a dipstick should be repeated to confirm absence of haematuria.

    Once these causes have been ruled out, your GP may refer you if you straight away if you have symptoms associated with the blood in the urine. If you have no symptoms, it is typical to repeat the urine microscopy test, and if there are 2 of 3 tests positive, then a referral to a urology specialist is usually made. If you take blood thinners, this makes no difference to the need for referral.

    Your Consultation

    This consultation will involve the following:

    • Your medical history will be reviewed, including the events around the time you saw blood
    • A physical examination
    • Blood tests will be reviewed, or organised
    • Urine tests will be reviewed, or organised
    • You may need a CT scan of you kidneys, ureter and bladder
    • You may need a cystoscopy, which is a telescope examination of the bladder.

    The CT scan of the urinary tract is a painless investigation that is done in a radiology department. Intravenous contrast injection is used, so you must tell your urologist and radiographer if you have a history of allergy to contrast. The CT itself is very quick, and takes 2 or 3 runs of images, one before contrast and one or 2 after the contrast injection. These images give a detailed picture of the kidneys and ureter. The bladder pictures are not so clear, which is why a cystoscopy is still needed.

    How is blood in the urine (haematuria) treated?

    Treatments for haematuria vary widely depending on the cause. It is impossible to say what, if any, treatment will be needed until a cause is found.

    What if no cause is found for the blood in my urine?

    Quite often, no obvious cause for haematuria is found. A complete workup effectively rules out the serious causes for blood in the urine (for example, cancer), so it is appropriate to just keep things under review. Sometimes, there can be a cause for microscopic blood in the urine that is not related to a problem dealt with by urologists. Typically, this may be a problem with your renal function. If blood and urine tests (or your blood pressure) give an indication of such a problem, Nick Brook will refer you to a renal physician as necessary.

    Do you have a question about Blood in the Urine?

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