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Blood in Urine

Blood in the urine can be very scary especially if you see it with your own eyes. Sometimes it is only detected by microscopic examination. Blood in the urine can be painful but most of the time it is painless. There are a lot of causes of blood in the urine. If it is painful, it could be due to inflammation, infection or stones. If it is not painful, it could be due to cancer. Macroscopic or gross haematuria is more worrying as about one in five adults are subsequently found to have bladder cancer, as opposed to microscopic haematuria, where about one in 12 had bladder cancer.

In fact, roughly 50% of those with visible blood in the urine will have an underlying cause identified. In microscopic haematuria, only about 10% will have an identifiable cause.

Sometimes, certain medications can also cause blood in the urine. Surprisingly, strenuous exercise like long-distance running, rowing, swimming, cycling, football and boxing, have also been documented to give rise to haematuria, but this usually resolves spontaneously with rest.

To investigate the cause of the blood in the urine, doctors will usually do a urine check, some blood test, ultrasound or CT scan, and cystoscope. Ultrasound uses ultrasonic waves to look into the body while CT scan uses high dose x-rays to create an image of the inner part of the body. However, small tumours in the bladder can be missed by ultrasound and CT scan. Therefore, cystoscope is needed to look into the bladder. Cystoscope has a camera which enters the bladder through the opening where the urine comes out (urethra) and can pick up any small tumours. Usually it is done under sedation or local anaesthesia where medication is given to make it painless and sometimes help you to sleep during the procedure.

Once the cause is discovered, it can be treated accordingly. Usually blood in the urine will resolves by itself. If the bleeding persists, a cystoscopy may be done under anaesthesia to remove blood clots and “burn” (diathermise) the areas in the bladder that are bleeding.

If it is due to the prostate, a resection of the prostate may need to be done. Likewise, if it is tumour in the bladder, resection of the tumour needs to be done.

If it is due to infection, a course of antibiotics will usually solve the problem. Medications that may affect blood-clotting need to be stopped, and if there is a medical disorder affecting the clotting of blood, this will need to be treated with blood products (like platelets and fresh frozen plasma).

If it is due to a tumour or injury to the kidney, removal of the kidney (nephrectomy) or angioembolisation (occluding the blood vessel, which is bleeding, with substances such as coils) may be required.

The greatest worry is cancer and stones. If it is painless blood in the urine that can be seen with your own eyes, please see a doctor quickly as it is most likely due to cancer.

Article by, 


Dr. Christopher Ho Chee Kong 何志光医生

FICS (US), FRCS (Urol) (Glasgow), FECSM, FRCSEd, FACS



Full-Time Consultant

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