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?
- The commonest cause of blood in the urine in the UK is infection (cystitis)
- Proven blood in the urine, whether visible or non-visible (found on a urine test), should always be investigated
- 1 in 5 adults with visible blood in the urine and 1 in 12 adults with non-visible blood in the urine are subsequently discovered to have bladder cancer
- Children with blood in the urine rarely have cancer – they usually have infection in the bladder or inflammation of their kidneys (nephritis)
- A one-off finding of a small trace of blood in the urine on routine testing may not be significant
- Come drugs (e.g. rifampicin, nitrofurantoin) and foodstuffs (e.g. beetroot) can turn the urine red
What could have caused the blood in my urine?
50% (half) of patients with visible blood in the urine will have an underlying cause identified but, with non-visible blood in the urine, only 10% will have a cause identified.
Although there are many potential causes for blood in the urine, those most often identified are:
- Bladder infection
- Cancers of the bladder (pictured), kidney or prostate
- Stones in the kidneys or bladder
- Inflammation of the kidneys (nephritis)
- Urinary tract injuries
- Blood disorders (e.g. sickle cell disease, clotting disorders, anticoagulant and anti-platelet drugs)
- Other causes, including less common infections (e,g. TB, schistosomiasis)
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:
- The development of other urinary symptoms
- Further episodes of blood in the urine
- Increasing levels of protein in your urine
- Progressive deterioration in your kidney function
- The development of high blood pressure
Your GP will arrange urgent referral to the Haematuria Clinic of your local urology unit if:
- You are over the age of 45 years, and have visible blood in the urine in the absence of infection
- The blood fails to clear following antibiotic treatment for urinary infection
- You have non-visible bleeding but significant urinary symptoms
- You have non-visible bleeding, and you are over the age of 60 years with a high white blood count on a blood sample or discomfort when you are passing urine
This will involve a prolonged outpatient appointment when some or all of the following assessments will be performed:
- Detailed questioning about your urinary tract and any related symptoms
- A physical examination (including rectal or vaginal examination)
- Blood tests (if not already performed by your GP)
- Examination of the urine for cancer cells
- X-rays or scans (including):
- CT scan – may involve an iodine-based injection; you must inform the staff if you have a history of allergy to iodine or to previous X-ray injections
- Ultrasound scan
- Intravenous urogram (IVU) – may involve an iodine-based injection; see allergy advice above
- A flexible cystoscopy
This is a telescopic check of the bladder. It is performed under antibiotic cover and local anaesthetic using a small, flexible telescope which allows the clinic doctor to see inside your bladder.