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Peeing blood. What should I do and why has it happened?

Updated: Nov 21, 2020

Haematuria is the presence of blood—specifically red blood cells—in the urine. Whether the blood is visible or invisible to the naked eye, it is a sign that something is causing bleeding in the genitourinary tract. It may happen only once or it could be recurrent. It can indicate different problems in men and women. Causes of this condition range from non-life threatening (e.g., urinary tract infection) to serious (e.g., cancer, kidney disease). Therefore, a urologist should be consulted as soon as possible.

Haematuria occurs in up to 10 percent of the general population. The most common causes include the following:

  • Benign prostatic hyperplasia (BPH; enlarged prostate) in men over 40 

  • Kidney stones and bladder stones 

  • Kidney disease 

  • Medications (e.g., quinine, rifampin, phenytoin) 

  • Prostate infection or inflammation (prostatitis) 

  • Trauma (e.g., a blow to the kidneys) 

  • Tumors and/or cancer in the urinary system 

  • Urinary tract blockages 

  • Viral infections of the urinary tract and sexually transmitted diseases, particularly in women 

Symptoms may indicate the site and/or cause of bleeding:

  • Abdominal pain–inflammation of the kidney or ureter caused by trauma, infection, or tumor 

  • Decreased urinary force, hesitancy, or incomplete voiding–lower urinary tract, benign prostate hyperplasia (BPH, enlarged prostate), tumor 

  • Fever–infection, typically kidney infection, prostate infection, or urethral infection

  • Pain in the flank–kidney trauma or tumor 

  • Urinary urgency, pain, or frequency–bladder cancer 

The family history may reveal inherited predispositions to kidney stone disease, sickle cell anemia, von Hippel-Lindau disease, or another genetic disorder associated with haematuria.

A thorough physical examination is performed, with emphasis on the urinary tract, abdomen, pelvis, genitals, and rectum.

Urine should be clear of blood. Presence of blood indicates a referral to a urologist.

Haematuria Tests

In cases of suspected microscopic hematuria, a sample of the patient's midstream urine is applied to a chemically treated strip. The chemical changes color if blood is in the urine. The intensity of the color indicates the amount of blood present. This test (called a dipstick test) is performed in the clinic.

A positive result warrants examination of the urine under the microscope to look for the presence of cancer cells (urine cytology). A urine culture may be grown to check for various infections. Cystourethroscopy, or cystoscopy, is performed when the cause of gross or microscopic hematuria cannot be identified. Local anesthesia is administered and a small, rigid or flexible fiber-optic instrument is inserted into the urethra to visually inspect the urethra, bladder, and prostate through the cystoscope. The procedure takes about 10 minutes. Minor short-term discomfort with urination or slight spotting of blood over the next couple of days may be noticed.

CT Urogram is a special x-ray procedure in which a colorless dye containing iodine is injected into a vein in the patient's arm. The dye collects in the urinary system and provides enhanced contrast for a series of x-rays taken over 30 minutes. This produces a better image of the kidneys, ureters, and bladder and can reveal stones, tumors, blockages, and other possible causes of hematuria. After the procedure, the patient may be asked to go to the bathroom and completely empty their bladder. 

Patients who previously had an allergic reaction to intravenous dye or to shellfish should tell their doctor before undergoing an CT Urogram.

Differential Diagnosis

When no specific cause can be found, bladder and kidney stones, cancer, and other life-threatening diseases can be ruled out. The possible causes that remain include conditions that may correct themselves, or the hematuria may be idiopathic. Men over the age of 50 with no clear diagnosis should have a yearly prostate specific antigen (PSA) test to screen for prostate cancer.

Treatment for Haematuria

Hematuria reatment ranges from antibiotic therapy to surgery, depending on the underlying cause.

Benign prostatic hyperplasia (BPH) may be treated many ways. Eliminating foods and beverages from the diet and over-the-counter medications that irritate the prostate and cause it to swell is one option. Medication (e.g., terazosin) is often prescribed to treat BPH. When the condition does not respond to these measures, surgical removal of all or part of the gland may be recommended.

Kidney and bladder stones typically require procedures that remove or break up the stones, as well as measures to prevent their recurrence.

  • Kidney disease is treated according to diagnosis. In severe cases, dialysis may be necessary.

  • Medications (e.g., quinine, rifampin, phenytoin) that cause hematuria are discontinued.

  • Trauma-induced hematuria (e.g., a blow to the kidneys) is treated according to the severity of the injury, ranging from bed rest and close clinical observation to surgical repair or, in extreme cases, removal of the damaged tissue or organ.

  • Cancerous tumors found in the kidney, ureters, prostate, or bladder may be treated with radiotherapy, chemotherapy, and surgery.

  • Urinary tract blockages are treated with correction or removal of the blockage.

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