Blood in the urine: never 'just an infection' until proven
Visible blood in the urine has a benign cause most of the time. It still needs a full urological check every time, because the exceptions matter. What the assessment involves and why it should not wait.
Two kinds
Visible haematuria is urine that is pink, red or brown. Microscopic haematuria is found on a dipstick or under a microscope with no change you can see. Both need assessment; visible blood needs it promptly, even if it happened once and went away.
Common causes
- Urinary infection
- Kidney or bladder stones
- An enlarged prostate in men
- Vigorous exercise, usually transient
- Some medications and foods (beetroot can mimic it)
The causes that cannot be missed
Bladder and kidney tumours present with painless visible blood more often than any other symptom. Finding them early changes the outcome. This is the reason a urologist does not accept "it was probably an infection" without checking.
The assessment
- History and examination, including smoking history, which matters for bladder cancer risk
- Urine analysis and culture
- Blood tests for kidney function
- Ultrasound of the kidneys and bladder
- Flexible cystoscopy: a direct look inside the bladder with a fine single-use scope under local anaesthetic gel. It takes a few minutes in clinic.
- CT urography when imaging of the upper tract in detail is needed
For most people the result is reassuring and the cause is treated. For the few in whom it is not, the early diagnosis is the point.
What not to do
Do not wait for it to happen again. Do not finish a course of antibiotics and forget about it if the blood was visible. One episode is enough to be seen.
At the clinic
Assessment is arranged as a single visit where possible, with cystoscopy and ultrasound on the day. Results are explained in writing.
