BLOOD IN THE URINE

This can be divided into visible and non-visible categories. Though often due to innocent causes, if blood in the urine is visible, it has up to a 30% chance of predicting a cancer in the urinary tract (bladder, kidney or prostate). Therefore it should never be ignored without proper investigation.

CAUSES OF BLOOD IN THE URINE

If blood is seen in the first part of the urinary stream only (or just in the semen in men), then it is usually coming from the prostate gland. If it is mixed throughout the urine, it is coming from the bladder or kidneys. Rapid onset of pain in the bladder or when passing urine is commonly a sign of urinary infection. Pain in the loin or into the groin suggests the bleeding is coming from the kidney, as often seen with a stone.

  • Prostate - benign enlargement or cancer, infection / inflammation

  • Bladder - infection / inflammation, cancer, previous radiotherapy

  • Kidneys - stones, cancer, infections, disorders of kidney function.

Risk factors for significant causes - increasing age, male gender, smoking history, exposure to certain industrial chemicals, previous radiotherapy or some types of chemotherapy. Of these, the most important, increasing your risk of bladder cancer 4 times, and the one you can help with - is to stop smoking.

INVESTIGATIONS

Your GP or Specialist will examine you and test your urine to exclude infection. A kidney blood test, a full blood count and a PSA (if no infection, males aged over 50) are performed and a scan arranged. This may be an ultrasound or CT scan depending on your age and risk factors. If there is a suggestion that a problem with your kidney function is the cause, for example if there is protein excessively in your urine or a significant abnormality with your blood test, you may be referred to a specialist in kidney medicine (nephrologist). Otherwise you will be referred to a Urologist initially. 

If you are aged 45 or more and have visible blood in your urine in the absence of infection, or repeated episodes even if there is infection, you should be referred via a suspected cancer pathway immediately for assessment. (NICE guidelines).

If the bleeding is not visible, but you have pain in the bladder or on passing urine, but there is no infection, and you are 60 or over, again you should be referred urgently on a suspected cancer pathway. Similarly if your white cell count in your blood is elevated with blood in the urine on testing. 

If you fall outside these restrictions, you should still be referred for assessment, but your risk is less therefore this is on a non-suspected cancer pathway.

FLEXIBLE CYSTOSCOPY

If necessary, you will be recommended to have a narrow flexible telescope (cystoscope) inserted through the water pipe into the bladder using local anaesthetic gel. This should only be mildly uncomfortable. The Specialist will be able to show you on a screen what is seen and explain any concerns straight away. The button below links to an information booklet about the procedure.