Identifying why there is blood in urine

MEN'S HEALTH MATTER: Testing for the cause of haematuria

MEN'S HEALTH MATTER:Testing for the cause of haematuria

Q I am 61 years old and recently noticed some blood in my urine. I did not have any symptoms to suggest an infection. What does this mean and what tests will need to be performed?

A The term haematuria signifies the appearance of blood in the urine and is most commonly present in very small quantities (microscopic haematuria), which is detected by a simple urine test performed by your GP. Less often, visible blood (as in your case) may be seen with the naked eye in the urine as a brown discolouration (old blood) or bright red. Blood should not normally appear in the urine as red blood cells are kept in the blood stream and are not normally allowed to escape into the urine via the kidneys. Haematuria can originate from the kidney itself due to various inflammatory conditions in the kidney affecting the filtering units (glomeruli). When this is the cause of haematuria there are often other signs of kidney disease such as protein in the urine (proteinuria), high blood pressure, abnormal blood tests of kidney function. Kidney cysts and stones can also cause haematuria. Similarly, blockages or stones in the tube from the kidney to the bladder (ureter) may cause haematuria. The bladder may also be the cause of haematuria, due to cystitis (bladder infection) or stones. Diseases of the prostate gland such as normal benign enlargement associated with ageing may also cause haematuria. Most importantly, cancer in the kidney, ureter, bladder or prostate may present with blood in the urine (either microscopic or visible) as the first sign. Haematuria is also more common when taking medication to thin the blood (eg, Warfarin, aspirin or plavix).

Haematuria may not be important, especially during a menstrual period, during a urine infection, and after strenuous exercise. Some medicines and foods can colour the urine red. Blood tests are generally not required but may be done to check for a low blood count (anaemia) and to check that the kidneys are functioning normally. The urine will be checked for protein and for infection. A radiology scan (an ultrasound and/or an X-ray dye test called an IVU or a CT scan) will be ordered to look at the kidneys and bladder for cysts, stones or tumours. A special test called a cystoscopy is often needed to examine the bladder. This test uses a camera at the end of a flexible tube to examine the bladder wall. It is possible to do this test under local anaesthetic while you are awake by passing the flexible camera via the water passage into the bladder.

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The main reason for tests is to look for any definite cause of the haematuria which may require medical treatment or surgery at an early stage. More often than not no definite cause for the bleeding is found. Usually this means that the risk of there being a serious underlying cause for the bleeding is very low.

Q I am 45 years of age and a little confused at to what and where the prostate is.

A The prostate is a gland, which is only found in men and is just below the bladder at the junction between the bladder and the water passage (urethra). When you pass urine it flows through this tube and out through the penis. The prostate has two functions: it plays a small part in urinary control and, secondly, the fluid produced by the prostate forms part of the semen. When men talk about prostate disease they generally mean the spongy-type enlargement of the gland which gives rise to symptoms of poor flow when passing water. The other more important disease is prostate cancer.

This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Mr Rowan Casey, St James's Hospital, Dublin