What is haematuria
Haematuria is blood in the urine. There are two kinds of haematuria:
- Microscopic haematuria is when blood in the urine is invisible to the naked eye; it only shows up under a microscope or on dip-stick testing.
- Frank (Macroscopic) haematuria is when the urine is noticed to be pink, red or tea-coloured. It is also called Gross haematuria.
Knowing there is blood in your urine can cause anxiety however in most instances the cause is benign. 20% of people with frank haematuria and 5% with microscopic haematuria however have a serious disorder. It is important therefore to determine the reason for the bleeding. Treatment depends on the underlying cause.
It takes very little blood to produce red urine, and the bleeding usually isn’t painful. If you’re also passing blood clots in your urine, that can be painful. Bloody urine often occurs without other signs or symptoms.
You should see your doctor anytime you notice blood in your urine. Some foods, including beets, rhubarb and berries, can cause your urine to turn red. Your GP will send the urine for further testing to confirm the presence of blood cells.
Ghat causes haematuria?
With haematuria, your kidneys — or other parts of your urinary tract — allow blood cells to leak into urine. A number of problems can cause leakage, these including:
- Urinary tract infections. Urinary tract infections occur when bacteria enter your bladder and begin to multiply. Symptoms can include a persistent urge to urinate, pain and burning with urination and extremely strong-smelling urine. Something, especially in the elderly, bleeding may be the only sign of an infection.
- A bladder or kidney stone. The minerals in concentrated urine sometimes precipitate out, forming crystals. Over time, the crystals can become stones. The stones are generally painless and you often don’t know you have them unless they cause a blockage. Bladder or kidney stones can cause both frank and microscopic bleeding.
- Enlarged prostate. The prostate gland is located below the bladder and surrounding the urethra. It often enlarges as men age. As it enlarges its blood supply increases. Sometimes the blood vessels, which can be very thin walled, run on the surface of the prostate. Straining and increases in abdominal pressure can cause these vessels to rupture and suddenly bleed.
- Kidney disease. Microscopic urinary bleeding is a common symptom of glomerulonephritis, which causes inflammation of the kidneys’ filtering system. Glomerulonephritis may be part of a systemic disease, such as diabetes, or it can occur on its own. It can be triggered by viral or streptococcus infections, blood vessel diseases (vasculitis), and immune problems such as IgA nephropathy, which affects the small capillaries that filter blood in the kidneys (glomeruli).
- Cancer. Urinary bleeding may be a sign of kidney, bladder or prostate cancer.
- Inherited disorders. Alport syndrome, which affects the filtering membranes in the glomeruli of the kidneys, can cause blood in urine.
- Kidney injury. A blow or other injury to your kidneys from an accident or contact sports can cause blood in your urine that you can see.
- Anti-cancer drugs like cyclophosphamide can cause urinary bleeding. Anticoagulant, such as aspirin, warfarin, xeralto and eliquis, can increase bleeding so it becomes visible, however, it is rarely the cause the of the bleeding.
- Strenuous exercise. Strenuous exercise may cause visible bleeding. It is unclear as to why this occurs. It may be due to trauma to the bladder, dehydration or the breakdown of red blood cells following sustained aerobic exercise. Runners are most often affected.
- Endometriosis. Endometriosis can occur is the bladder. Bleeding then tends to occur in time with the monthly cycle.
It is important to remember that bleeding may be the first sign of a serious illness. All bleeding therefore needs to be fully investigated to exclude such conditions or if diagnosed, to allow early treatment and/or cure.
What investigations are required?
In order the identify the cause of the bleeding the following investigations are frequently required:
- Urine microscopy and culture: To confirm the presence of blood cells and exclude infections
- Urine cytology: Can identify urothelial cancer cells in the urine
- Imaging: Either a renal tract ultrasound or CT scan of the kidneys
- Cystoscopy: An instrument with a light and camera that allows the inside of the bladder to be visualised.
- Haematuria is the presence of red blood cells in the urine
- Haematuria can be the first sign of a serious medical condition.
- Anyone with haematuria needs to be fully investigated.