What is haematuria?
Haematuria simply means blood in the urine. Sometimes it is clearly visible, turning the urine pink, red or brown — this is called visible (or gross) haematuria. At other times it is invisible to the eye and only picked up on a urine test, known as non-visible (or microscopic) haematuria.
Both types are typically painless, can be intermittent, and require medical assessment. Visible haematuria can be especially alarming and always requires prompt medical attention - you should not wait for it to happen again before seeking advice.
What can cause blood in the urine?
There are many possible causes, and the great majority are not cancer. Common reasons include:
- A urine infection or inflammation
- An enlarged prostate
- Kidney or bladder stones
- Recent vigorous exercise
- Cancers of the bladder, kidney or prostate
Because the causes range from harmless to more serious, the aim of assessment is to identify the cause quickly, provide reassurance where appropriate, and start the right treatment as early as possible if needed.
When should you see a specialist?
Blood in your urine should always be checked. Seek prompt medical advice if you notice visible blood or develop symptoms such as a weaker urine stream, urgency, frequency or pain when passing urine. If you are passing blood clots or are unable to pass urine, seek urgent medical attention immediately.
How it is investigated
Most patients can expect a comprehensive evaluation to be completed within one or two visits. Investigation typically includes:
- Urine tests — To check for infection and examine for cells in the urine.
- Blood tests, including PSA — Done where appropriate.
- Imaging — An ultrasound or CT scan of the kidneys and urinary tract.
- Flexible cystoscopy — A quick, gentle camera examination of the urethra and bladder, performed under local anaesthetic.
Treatment
Treatment depends entirely on the cause. An infection is treated with antibiotics, stones are typically managed by minimally-invasive laser treatment, and an enlarged prostate has its own range of options. In the unlikely event that something more serious is found, early identification gives the best possible chance of successful, straightforward treatment.