Haematuria / blood in urine

• Haematuria is the presence of any blood in the urine
• This may be visible (macroscopic) or invisible (microscopic)
• It may only happen once however it must be investigated to exclude the presence of cancer (bladder, kidney, prostate, ureter)

• Haematuria may be painless or may be associated with pain in the back or bladder region
• There may be associated burning with urination, frequency of urination or fever

• Haematuria should always be investigated even if only a single episode that clears up quickly
• Your family doctor will arrange a number of investigations which may include:
  • Urine tests – to look for infection or cancer cells
  • Blood tests – to check kidney function, blood count and clotting problems
  • Scans – ultrasound or CT scan to look for the cause of bleeding

• Treatment of haematuria depends upon thorough investigation and accurate diagnosis of the underlying cause. Some possible causes for haematuria include:
  • Cancer (bladder, kidney, ureter, prostate)
  • Infection
  • Stones (kidney, ureteric or bladder)
  • BPH (enlarged prostate)

  Your family doctor will arrange preliminary investigations and refer accordingly to a Urologist for further evaluation and management.

  Normal blood and urine tests and scans are unable to definitively exclude a bladder cancer. In most cases you will require a flexible cystoscopy to directly visualize the lining of the bladder. This is a very safe and minimally invasive diagnostic day-procedure which can be performed under local anaesthetic or light sedation.
  

  General health and Wellbeing

• The biggest risk factor for urothelial cancer (cancer of the lining of the bladder, ureter or kidney) is cigarette smoking
• Painless haematuria is the most common presenting symptom of urothelial cancer
• We strongly encourage you to discuss smoking-cessation strategies with your family doctor

Written by Dr. Shekib Shahbaz and Dr. Tony de Sousa

Linder, B. J., Bass, E. J., Mostafid, H., Boorjian, S. A., (2017), Guideline of Guidelines: asymptomatic microscopic haematuria, BJU International, 121(2), [https://doi.org/10.1111/bju.14016], accessed 18/02/21.