Haematuria refers to the abnormal presence of red blood cells in the urine, and can occur in men and women of all ages.

Haematuria is commonly classified as either microscopic or macroscopic.

In microscopic haematuria, red blood cells are present in the urine but the level of bleeding is  so low, it is not visible to the naked eye. People with microscopic haematuria only lose a miniscule amount of blood in their urine, so it is never a cause of anaemia.

Macroscopic haematuria occurs when there is a much higher level of blood in the urine, so that the urine definitely looks pinkish or red in colour. In severe cases of macroscopic haematuria, patients may pass blood clots in their urine, and experience difficulty passing urine due to the blood clots.  Prolonged or severe macroscopic haematuria can definitely result is significant blood loss. The slightly darker urine that most people pass first thing in the morning can sometimes be confused with macroscopic haematuria.

Many patients with haematuria may not have a serious or life-threatening cause for it. The chances of finding a more serious cause is increased with older patients, patients with risk factors for urothelial cancer, and in patients with macroscopic rather than microscopic haematuria.

All cases of haematuria, whether microscopic or macroscopic, need to be evaluated properly.

There are many different causes of haematuria, but from a urological perspective, the most serious cause is urinary tract cancer. This is why a thorough assessment is important. The main urological causes of haematuria are:

• bladder or urothelial cancer
• kidney cancer
• bleeding from an enlarged prostate – this is usually not cancerous bleeding
• urinary tract infection
• bladder stones
• injury or trauma to the urinary tract
• recent prostate or bladder surgery
• advanced prostate cancer

Blood thinning medications (warfarin, aspirin, Plavix, Iscover, Xarelto etc) do not cause haematuria but if you are experiencing haematuria and using one of these medications, the bleeding is often worse

In healthy patients with microscopic haematuria as an incidental finding, it is important to recheck the urine at least two or three times, a few weeks apart, to see if the haematuria has resolved. Only patients with persistent microscopic haematuria need further investigation. It is important when rechecking urine to perform a ‘clean catch’ mid stream urine (MSU) test, and in addition, women who still have their period should make sure that they collect their urine when they are not menstruating.

Any patient who experiences macroscopic haematuria, should be referred to a Urological Surgeon, even if the bleeding lasted only a short time or has stopped.

Assessment of haematuria involves a combination of scans, urine tests and a minor day surgery procedure called a cystoscopy.

For some people, it may be normal to have a small amount of microscopic haematuria picked up on urine tests, and sometimes there might be a family history of this. This is called “benign’ haematuria. However, an individual can only be diagnosed as having benign microscopic haematuria if they have been appropriately assessed, and no other significant causes have been found.

If you have been thoroughly evaluated for haematuria and no serious cause has been found, Dr Patel will advise you on how you should be monitored and what symptoms to look out for in the longer term, and in somes cases, may arrange an additional referral for you to see a kidney physician, or nephrologist.