Blood in urine: causes and solutions

There are a couple of things that you might expect to see in the toilet bowl after nature calls, but blood is not one of them (unless you’re menstruating, but that’s a different context). When blood is in the urine, it is called haematuria, and it could be a sign of a serious issue somewhere along the urinary system, which is comprised of the kidneys, ureters, bladder, and urethra. We spoke to a leading urologist, Mr Arun Jain, about what blood in urine might signify, and what you should do.

What is haematuria?

Urine should normally be clear, yellow or pale, but when blood is in the urine it will become pink, red, or brown, depending on the amount of blood. There are instances where the blood may not be visible with the naked eye but is still present and can only be detected using a dipstick test or under microscope.

Leading causes of haematuria are:

• urinary tract infections (UTIs)
• kidney, ureter or bladder stones
• enlarged prostate (in men only)
• cancer of the kidney, ureter, bladder or prostate
• injury
• glomerulonephritis (Inflammatory conditions of kidney)

When should I be concerned about blood in urine?

Causes of haematuria tend to be usually benign, however, up to one in five cases with visible haematuria can be related to an underlying cancer. The risk of an underlying cancer is higher in those who are older than 45, a smoker, or have a family history of kidney cancer. So, it is important to consult with a doctor or urologist for appropriate investigation. Unless you have been recently investigated and any significant underlying cause has been excluded or you have undergone a surgical procedure and blood in urine was expected, it is advisable to seek medical attention as soon as possible if you notice any visible blood in urine.

How is haematuria diagnosed and treated?

A thorough diagnostic process will involve laboratory testing of the urine, blood tests, CT scans or other form of imaging to look for abnormalities in the urinary system, or using a small camera to assess the condition of the bladder and urethra. Some patients with suspicion of glomerulonephritis may also need referral to a nephrologist and biopsy of kidney.

The treatment for haematuria will depend on the underlying cause. In most patients the bleeding stops spontaneously but has a tendency to recur. Increasing intake of water can help to ease or stop the bleeding. If bleeding is profuse, you are passing clots, or have associated difficulty in passing urine, then you should report to the nearest accident & emergency department.

Infections can be managed with antibiotic prescriptions. For enlarged prostate, there are medications and a variety of minimally-invasive surgeries available, such as TURP, Rezum^TM, and laser surgeries to reduce its size and thereby treat haematuria. Some kidney and bladder stones can pass spontaneously but surgical treatment or shockwave therapy (ESWL) may be necessary for large stones. Most early cancers are curable with minimally invasive surgical treatment options.

If you have encountered blood in your urine, or have concerns regarding your urinary tract, you can consult  with Mr Jain via his Top Doctors profile.