Blood in the Urine
What should I do if I have blood in my urine?
If you see blood in your urine, with or without symptoms of cystitis, you should contact your GP immediately for further advice
Your GP will normally investigate blood in the urine as a matter of urgency. Most GPs will perform some simple, baseline tests. You may be started on antibiotics to treat a presumed infection. However, if the urine test result comes back showing no evidence of infection, you will normally be referred to your local urology department for more detailed investigations using the "2-week wait" (fast-track) system.
What are the facts about blood in the urine?
Your GP will ask you questions about any recent symptoms, any associated matters (including any drugs you are taking) and will enquire about smoking habits. Exposure to industrial chemicals or to substances that may be related to bladder cancer development are also important.
You should inform your GP if you are taking blood-thinning drugs (warfarin, dicoumarin, rivaroxaban, prasugrel or dabigatran) or if you take anti-platelet treatment (aspirin, dipyridamole, clopidogrel). If the bleeding is painless and associated with clots of blood in the urine, it is likely that your GP will arrange urgent referral to a urologist.
A general physical examination will be performed, together with a rectal or vaginal examination. Your blood pressure may be measured as part of this examination.
The usual tests performed are:
General blood tests
The actual tests performed will be left to your GP's discretion. It is common to measure kidney function, clotting factors, prostate-specific antigen (PSA) and to check the blood cells for anaemia or other problems
A urine test will normally be sent for infection. Your GP may commence you on antibiotics whilst awaiting the result of this test. Fresh urine may also be sent to the laboratory for microscopic examination and to look for cancerous cells. Your GP may arrange a 24-hour urine collection to measure your urine protein levels
Other specific tests
Your GP may arrange an ultrasound scan of your kidneys and bladder, pictured right (or a CT scan of your abdomen) although this is usually performed in the urology department
What could have caused the blood in my urine?
Although there are many potential causes for blood in the urine, those most often identified are:
What happens next?
Your GP may decide that you do not require any further tests at this stage. In this case, you should have regular monitoring to assess the following, which may be signs that re-investigation is needed:
Your GP will arrange urgent referral to the Haematuria Clinic of your local urology unit if:
This will involve a prolonged outpatient appointment when some or all of the following assessments will be performed:-
Download an information leaflet about Flexible Cystoscopy Click here
If you have concerns about this, or have experienced problems with local anaesthetic in the past, you should ask about having your examination under a brief general anaesthetic (i.e. whilst you are asleep).
Download an information leaflet about Examination under General Anaesthetic Click here
When your tests have been completed, the medical staff will advise you on what to do next:
If an abnormality requiring further treatment is detected, the medical staff will advise you on what treatment is necessary and what this would involve (e.g. admission for telescopic removal of a bladder tumour.
Download an information leaflet about this procedure Click here
If no specific abnormality is found, you should report any further bleeding, or other urinary symptoms, to your GP who will be informed of the result of your assessment.