Haematuria: What men should do if they see blood in their urine

Finding blood in urine (haematuria) can be distressing. It is almost always an indication of an underlying problem, so you should never ignore it.

Professor Francis Chinegwundoh MBE, one of our top urologists based in London, explains why haematuria happens, the investigations involved and which treatments are available.

What is haematuria?

Haematuria is blood in the urine. There should never be visible blood in the urine (VH). If you do see blood, you should see your doctor for further investigations. It is also possible to have non-visible blood in the urine (NVH), detected either by microscopic examination of the urine or by a ‘dipstix’ changing colour. Having a significant amount of NVH also merits investigation.

What is the cause of haematuria?

The more common causes of VH/NVH in men are:

• tumours of the urinary tract, such as cancers of the kidney and bladder
• an enlarged prostate gland (benign prostate hyperplasia)
• prostate cancer
• kidney, ureteric and bladder stones
• a urinary tract infection

Less common causes include inflammatory conditions of the kidney, known as glomerulonephritis. The colour of your urine is influenced by your diet and hydration. Dark urine is usually due to dehydration. Various drugs, such as rifampicin, alter the colour of the urine, while an infection may cause your urine to appear cloudy.

What should men do if they see blood in their urine?

Men with blood in the urine, whether VH or NVH, should be referred to a urologist for examination and further investigations. The more common causes of bleeding are to be excluded and a rectal examination is done to determine the prostate size.

Your urine will be sent off to check for infection and a CT scan, with contrast of the kidneys, will be able to exclude kidney tumours and stones.

The Investigation is incomplete without a flexible cystoscopy. This is a camera inspection of the bladder via the penis under local anaesthesia to check for bladder cancer, which is not readily visible on imaging such as CT scans. 

How is haematuria treated?

The treatment of haematuria depends on the cause:

• Infection - antibiotics will be able to treat infections, such as a UTI
• Enlarged prostate gland - there are drugs available which can shrink the prostate
• Bladder cancer - treatment involves removing the growth from inside the bladder using an instrument called a resectoscope
• Kidney cancer - treatment involves surgery to remove part or all of the involved kidney

The takeaway message is that passing blood in the urine, in whatever sex and whatever age, should be investigated to exclude a potentially serious diagnosis. 

If you have noticed blood in your urine, go to Professor Chinegwundoh’s Top Doctors profile and book a consultation to see him.