While both men and women can experience blood in the urine, also known as haematuria, there are some causes that are specific to, or more likely to affect, women. Oxford urologist, Mr Simon Brewster, explains more.
What is haematuria?
Haematuria means the presence of blood cells in the urine. This can be visible to the eye when the urine looks pink or red, or it may be detected by a sensitive urine dip test even when the urine looks its normal yellowish colour; this is termed "non-visible" or "microscopic" haematuria.
What are the main causes in women?
The most common causes are not serious, especially with non-visible haematuria. In many cases, a cause is never identified and this is regarded as harmless. Frequently though, haematuria is associated with urinary tract infection, such as cystitis and settles after treating the infection. However, more than 20% of visible haematuria and 5% of non-visible haematuria (if persisting after any infection is treated) do have a serious cause and so investigations of the kidneys and bladder with imaging and direct endoscopic inspection (cystoscopy) are usually recommended.
Serious causes can include kidney and bladder cancer, stones and rare non-infective inflammatory conditions, such as interstitial cystitis and amyloidosis. If blood is detected in the urine together with protein, this may indicate an intrinsic medical disease of the kidney filtering system, such as can occur with diabetes or high blood pressure.
Is blood in the urine an emergency?
Haematuria is rarely an emergency, although it does warrant an urgent investigation if an infection has been excluded. Emergency admission is necessary in the rare circumstances where blood clots have formed in the bladder and are blocking the bladder outlet into the urethra, or when the bleeding is so heavy over a period of weeks that anaemia has resulted in symptoms such as breathlessness or a raised heart rate.
Will it disappear on its own?
Sometimes it does disappear, especially if it’s associated with a urinary tract infection. If not, it should be investigated even if it does settle, to rule out a serious underlying condition.
What sort of treatments are given?
If the urine shows features of urinary tract infection, antibiotics are usually successful and are prescribed by GPs in primary care. If anticoagulants are being prescribed for other medical conditions, these may be safely discontinued in many cases to allow the body's blood clotting mechanism to stop the bleeding. If during the subsequent investigation a stone or cancer is identified, often surgical biopsy/removal is the main treatment under the care of a urologist.
Stones are increasingly treated with external shock-wave lithotripsy in hospital but as an outpatient. If intrinsic kidney disease is suspected, long-term monitoring of kidney function and blood pressure is necessary, often under the care of a kidney physician, sometimes called a renal physician or a nephrologist. If no cause is found after investigation, no treatment is necessary.
If you have noticed blood in your urine and would like to see a specialist, visit Mr Simon Brewster’s profile and check his availability.