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Blood in Urine (Haematuria)

Expert investigation of blood in the urine in Wrexham, Chester and Shrewsbury

Seeing blood in your urine can be worrying. Blood in the urine, known medically as haematuria, is relatively common and can have many different causes, ranging from urinary tract infections and kidney stones to prostate problems and, less commonly, cancers of the urinary tract.

Blood may be obvious to the naked eye or detected only on a urine test.

As a Consultant Urological Surgeon specialising in endourology, I provide specialist assessment and investigation of blood in the urine for patients in Wrexham, Chester and Shrewsbury.

The aim is to identify the cause of the bleeding and, where necessary, make sure important conditions are diagnosed or excluded promptly.

What is haematuria?

Haematuria means blood is present in the urine.

There are two main types:

Visible haematuria

This is when you can see blood in your urine. The urine may appear:

  • Pink

  • Red

  • Dark red

  • Brown or tea-coloured

The amount of blood does not necessarily indicate how serious the underlying cause is. Even a small amount of visible blood should be assessed, particularly when there is no obvious explanation.

Non-visible haematuria

This is blood that cannot be seen with the naked eye but is detected by a urine test or laboratory examination.

What causes blood in the urine?

There are many possible causes of haematuria.

Common causes include:

Blood in the urine can also be associated with cancers of the urinary tract, including:

  • Bladder cancer

  • Kidney cancer

  • Upper urinary tract cancer

  • Prostate cancer in some circumstances

In some patients, no specific cause is identified despite appropriate investigation.

Is blood in the urine serious?

Blood in the urine is not necessarily a sign of cancer, and many people investigated for haematuria will have a benign explanation.

However, visible blood in the urine can sometimes be an early warning sign of a urinary tract cancer.

Importantly, bladder cancer and other urinary tract cancers do not always cause pain. This is why unexplained visible haematuria should not simply be ignored, even if you otherwise feel completely well.

The purpose of a urological assessment is to establish the cause rather than assume that the bleeding is due to a particular condition.

When should I see a urologist?

You should seek medical assessment if you notice blood in your urine, particularly if:

  • The blood is visible and there is no obvious explanation

  • The bleeding is painless

  • The bleeding keeps coming back

  • You have previously smoked

  • You are over the age of 45

  • You have persistent urinary symptoms

  • You have recurrent urinary tract infections

  • You have a history of urinary tract problems

  • You have previously had bladder or kidney cancer

  • You take blood-thinning medication

Blood thinners can make bleeding more noticeable, but visible haematuria should not automatically be attributed to anticoagulant or antiplatelet medication. An appropriate assessment may still be required.

How is blood in the urine investigated?

The exact investigations depend on your age, symptoms, medical history and whether the blood is visible or non-visible.

Urine tests

A urine sample may be tested for:

  • Blood

  • Infection

  • Protein

  • Other abnormalities

A urine culture may be performed if a urinary tract infection is suspected.

Blood tests

Blood tests may be used to assess kidney function, blood count and other relevant factors depending on the clinical circumstances.

A PSA blood test may also be appropriate for some men as part of an assessment of prostate health.

Ultrasound or CT scan

Imaging of the urinary tract may be recommended to assess the:

  • Kidneys

  • Ureters

  • Bladder

  • Prostate

Depending on the circumstances, this may involve an ultrasound scan or CT urography, which provides detailed imaging of the urinary tract.

The most appropriate imaging test depends on the individual patient.

Flexible cystoscopy

One of the most important investigations for unexplained visible haematuria is flexible cystoscopy.

A small flexible camera is passed gently through the urethra into the bladder. This allows the bladder lining to be examined directly for abnormalities such as:

  • Bladder tumours

  • Bladder stones

  • Inflammation

  • Other abnormalities of the bladder lining

  • Flexible cystoscopy is usually performed using local anaesthetic gel and generally takes only a few minutes.

  • If an abnormality is identified, further investigations or treatment may be recommended.

What happens after the investigation?

The treatment depends entirely on the underlying cause.

Examples include:

Urinary tract infection: appropriate antibiotic treatment when infection is confirmed.

Kidney or bladder stones: observation, medication or stone treatment depending on the size and location of the stone.

Enlarged prostate: medication or, when appropriate, procedures such as HoLEP laser prostate surgery.

Bladder abnormality: further investigation or treatment depending on the findings.

Kidney abnormality: further specialist assessment and treatment where required.

If no significant cause is identified, appropriate follow-up may be recommended depending on your individual circumstances.

When should blood in the urine be treated as urgent?

Seek urgent medical attention if blood in your urine is associated with:

  • Inability to pass urine

  • Heavy bleeding or large blood clots

  • Severe abdominal, side or back pain

  • Fever or shaking chills

  • Vomiting

  • Feeling very unwell or faint

Blood clots can occasionally obstruct the bladder and cause acute urinary retention.

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