Blood in urine (haematuria)

This article focuses on haematuria in women. 

Blood in the urine is known as haematuria. There are 2 types: microscopic (blood cells can only be seen under the microscope and) and macroscopic/gross (blood that can be seen by you). Most people have no symptoms, but some may have associated symptoms including painful urination, smelly urine or fever. 

What are the causes of blood in the urine?

• Urinary tract infections (UTI): this can occur anywhere from your kidneys, ureters (tubes connecting your kidneys and bladder), bladder, and urethra (pipe connecting your bladder to the outside)

• Menopause changes: menopause women have low estrogen which causes thin and dry vaginal skin that cracks easily (vaginal atrophy)

• Stones in the kidneys, ureters or bladder: these usually cause symptoms if there is an infection or are being passed 

• Interstitial cystitis: this is a condition where the bladder wall is inflamed and irritated resulting in microscopic haematuria 

• Kidney disease: there may be an inflammation of the kidney’s filtering system (glomerulonephritis) causing loss of blood cells into the urine 

• Cancer: gross haematuria is usually a sign of advanced kidney or bladder cancer 

• Medications: certain drugs e.g. blood-thinners like warfarin or aspirin can cause microscopic haematuria 

• Strenuous exercise: this is rare and only occurs after intensive workouts; see a doctor if this happens 

• Unknown: no cause found despite tests

What tests do I need if I have blood in my urine?

You will be asked to produce a urine sample – clean your vaginal lips before passing urine and catch the middle portion of your urine stream. A microscopic analysis is first done to check for the presence of red and white blood cells in your urine sample to rule out the possibility of a UTI. If this is suggestive of a UTI, a urine culture is then performed over a few days to determine the bacteria in your urine (if any) and the appropriate antibiotics that kill the bacteria. 

If you are menopausal, your gynaecologist will perform a pelvic examination to check if you have vaginal atrophy which could be contributing to your haematuria. Other tests you may need to undergo include:

• Ultrasound or CT of your kidneys and bladders
• Cystoscopy (scope to check the inside of your bladder)

What treatment do I need for my haematuria?

This depends on the cause. Antibiotics are prescribed for UTI. Topical vaginal estrogens may be required for vaginal atrophy. If you are found to have stones or kidney disease, you will be referred to a urologist/ kidney specialist for further management.