The Tribune

By DR GREGGORY PINTO

Are you seeing red in your toilet bowl?

Blood in urine has the medical term of haematuria. There are two types of haematuria, gross or macroscopic haematuria, which are visible blood in urine, and microscopic haematuria, which is not visible to the naked eye but detected on urine dipstick or urine analysis.

Blood in the urine can be alarming and distressing.

Both microscopic and macroscopic haematuria should never be dismissed and ignored. The cause of haematuria could potentially be an early sign of a serious medical condition.

The possible causes of blood in the urine are numerous. The 10 common causes of haematuria include:

1. Kidney or bladder stones

Calculi/stones in the urinary tract system may be present in the kidney, ureter, bladder or urethra. The presence of a stone may not have any physical symptoms depending on it’s anatomical location and the size of the stone, and blood in the urine might be an early sign.

The gold standard for the detection of kidney or ureteric stones is a plain CAT scan, but the drawback is the exposure to radiation that should be avoided if possible and most importantly in the case of children. An ultrasound should first be requested that should pick up 70 to 80 percent of kidney stones.

1. Urinary tract infection

Blood in the urine could be caused by an infection, more commonly an infection of the bladder, cystitis or kidney/ pyelonephritis.

All cases of blood in the urine should be thoroughly investigated and simply treating haematuria with antibiotics could potentially miss serious medical conditions including cancer.

1. Cancer

Malignancy of the urinary tract that includes the kidney, ureter, bladder, urethra and in men prostate cancer, often have symptoms of haematuria, either microscopic or macroscopic. Thorough history, physical exam and appropriate exams must be performed.

Appropriate imaging and scope of the bladder/ cystoscopy with urine sent to the lab for analysis for cancer cells. Early detection of cancer leads to improved cure rates.

1. Medications

Blood thinners prescribed for medical conditions such as a previous stroke or clot/thrombus of the venous system could lead to haematuria. Xarelto, coumadin, heparin, aspirin are some of the drugs that can lead to haematuria.

1. Trauma

Blunt or penetrating trauma to the abdomen, groin or flanks/ upper sides of the back, could lead to haematuria. Iatrogenic trauma might be caused by the passage or removal of an urinary catheter, that could cause internal trauma to the urethra or bladder or the prostate in men.

The placement of an urinary catheter, relieving a distended urine filled bladder could lead to decompression haematuria, whereby the capillaries in the distended bladder collapse and rupture when the bladder pressure is relieved by placement of a catheter.

1. The prostate

For men, especially middle aged men, haematuria could originate in the prostate. It is more likely that a non-cancerous, benign prostate with a very rich blood supply could lead to haematuria but prostate cancer could also present with blood in the urine.

1. Rigorous exercise

Strenuous prolonged activity could lead to haematuria. The cause of exercise induced haematuria are numerous, including the breakdown of red blood cells or muscles and dehydration. Myoglobin in the urine is often mistaken for blood. It usually resolves within 24 to 72 hours but it must be investigated and monitored.

1. Kidney disorders

Glomerulonephritis, an inflammation of the kidney’s filtering system can lead to haematuria, often microscopic type. Nephritic syndrome can lead to haematuria and proteinuria.

1. Sickle cell disease

Sickle cell patients have sickled – crescent shaped – red blood cells instead of normal round blood cells and these sickled cells do not flow normally in the blood vessels and obstruction by these sickled cells could lead to red blood cells in the urine.

1. Alport syndrome

An inherited condition that causes an abnormality in the kidney’s filtering mechanism that can lead to microscopic haematuria. Alport syndrome is a less common cause of haematuria, affecting one in five to ten thousand children.

Never ignore blood in your urine. Haematuria could be an early sign of a serious medical condition.

Cancer is unlikely the cause of haematuria, especially without risk factors such as cigarette or tobacco smoking or occupational exposure to carcinogens.

Do not let fear keep you from seeking urological consultation. Seek confidential and compassionate urological care if you note blood in your urine or you are told that blood in urine is detected on urinalysis.

• Dr.Greggory Pinto is a board certified Bahamian urologist and laparoscopic surgeon trained in South Africa, Germany, and France. He can be reached at Urology Care Bahamas at the Surgical Suite, Centreville Medical Centre, 68 Collins Avenue/Sixth Terrace, Nassau. Call (242) 326-1929 or e-mail welcome@urologycarebahamas.com or visit the website:www.urologycarebahamas.com.