Blood in the urine — what it means and which doctor to see

What haematuria is

Haematuria is the presence of red blood cells in the urine. Their number may be large enough to give the urine a pink or brownish colour, but it may also be minimal and show up only in a laboratory test. Depending on the number of cells, a distinction is made between:

• microhaematuria — detectable only by laboratory methods
• macrohaematuria — in which the abnormal colour of the urine is visible to the naked eye

The most common causes

Haematuria may be a symptom of many conditions, mainly of the urinary tract. The following are listed first of all:

• inflammation of the bladder or urethra — one of the most common causes, especially in women; accompanied by frequent and painful urination, bladder urgency, lower abdominal pain and cloudy urine
• kidney stones — deposits damage the urinary tract as they move, accompanied by severe colicky pain in the flank or back radiating to the groin
• prostate conditions — an enlarged prostate may press on the urethra and the vessels around the bladder neck
• glomerulonephritis — alongside haematuria there is proteinuria, swelling, high blood pressure, fatigue and nausea
• mechanical injuries to the lumbar region, pelvis or lower abdomen
• tumours of the urinary tract — of the bladder, prostate or kidneys; they cause no symptoms for a long time and are therefore often diagnosed late

Which doctor to see

The first step is usually a visit to a family doctor or internist, who takes a history, performs a physical examination and orders basic laboratory tests — a general urine test and a blood count.

Depending on the results and the suspected cause, the doctor refers the patient to a urologist, who deals with diseases of the urinary and reproductive system, or to a nephrologist, who deals with kidney disease.

Urgent urological consultation is required for heavy haematuria, for haematuria accompanied by severe pain, and for haematuria that appears without an identifiable cause.

What tests are done for haematuria

Diagnosis starts with a general urine test, which detects red blood cells even when blood is not visible to the naked eye. The sample is then examined under a microscope to determine the number and appearance of the cells and to establish the probable source of bleeding. A blood test is performed in parallel to assess kidney function.

Further diagnosis includes imaging — ultrasound and, in some cases, computed tomography — as well as cystoscopy, an endoscopic examination of the bladder. The scope of the tests is decided by the doctor.

Treatment depends on the cause

Haematuria is a symptom, not a disease, so treatment is directed at its cause.

• urinary tract infection — antibiotics or chemotherapeutic agents, supplemented with anti-inflammatory and antispasmodic medication
• stones — for small deposits, medication and increased fluid intake; for larger ones, extracorporeal shockwave lithotripsy (ESWL) or endoscopic procedures such as ureteroscopy
• prostate enlargement — medication to reduce the size of the gland or minimally invasive procedures, including transurethral resection of the prostate (TURP)
• tumours of the urinary tract — oncological treatment: surgery, chemotherapy or radiotherapy

The method of treatment is chosen by the doctor individually, once the diagnosis has been established.