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.
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:
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.
Bladder training gets rids of bad habits and teaches your bladder good habits so you can get control over your bladder instead of the other way round.
Bad habits take many months or years to form and you will need time, commitment and patience to break these habits. You will have to learn – sometimes through trial and error – which messages your bladder is sending you are real (meaning your bladder is really full) versus the messages that are fake (meaning your bladder isn’t full but it is sending you a false signal to go).
Visit a urogynaecologist, who is a gynaecologist specialising in female urinary disorders, to determine if bladder training is an appropriate treatment option for you and to exclude other causes of your urinary frequency e.g. other medical conditions, certain drugs, urinary tract infection (UTI) etc.
You should start a bladder diary before, during and after your training to keep track of your progress.
Foundation steps
Building steps
Your bladder will have good and bad days – very much like a child learning – do NOT give up! Remember that this will take time. Once you have trained your bladder successfully, you need to continue with the good habits learned!
Bladder pain syndrome (previously known as interstitial cystitis) is the condition of bladder discomfort or pain associated with urinary symptoms which may include:
The symptoms of bladder pain syndrome varies vastly depending on the woman.
The exact cause is unknown, but it is thought to be related to a defect in the protective bladder lining which exposes the bladder wall to toxic contents of urine. This irritates and causes inflammation of the bladder wall, with increase in nerve cells.
In severe cases this can result in bladder scarring and stiffening such that it is unable to hold too much urine. In some cases, a cystoscopy (camera inserted into the bladder) may pick up pinpoint bleeding or ulcers in the bladder wall as the bladder is being filled; however, in many cases, no obvious abnormality is seen on cystoscopy.
You should consult a urogynaecologist, who is a gynaecologist specialising in female urinary disorders. Your doctor will take a detailed medical history and perform a pelvic examination to check for other conditions that may mimic bladder pain syndrome.
Depending on your symptoms, you may require an ultrasound to check your uterus and ovaries, vaginal swabs to rule out sexually transmitted infections (STIs), urine tests to look for urinary tract infections or blood in the urine, bladder scan (to check the amount of urine remaining in your bladder after you have passed urine), a cystoscopy (inserting a camera into the bladder and filling it to look for abnormalities) and/or urodynamic study (this is a test to check for your bladder function and bladder muscle stability).
Bladder pain syndrome is a long-term condition with no definite cure. Most women will need trial and error to find a combination of treatments that improve their symptoms. Treatment options include:
Keeping a food diary is important to find out foods that trigger your symptoms. Common foods to avoid include alcohol, acidic food like citrus (including drinks), tomatoes, artificial sweeteners, caffeine, chocolate, spicy food. You may need to eliminate these foods from your diet and try them one at a time to see which one triggers your symptoms. Smoking may worsen symptoms so try to quit smoking.
Relaxation techniques, meditation, music, regular exercise can help relieve symptoms of bladder pain syndrome.
Simple painkillers like panadol and non-steroidal anti-inflammatory drugs (ponstan, synflex, ibuprofen) can help manage pain as needed. Long-term chronic pain may need referral to a pain specialist.
Some women find acupuncture relieves their symptoms of bladder pain.
Your urogynaecologist may prescribe oral medications like amitriptyline or cimetidine to relieve symptoms of urinary urgency, frequency and bladder pain.
Certain medications e.g. local anaesthetic, drugs thought to help restore the protective lining of the bladder, Botox can be instilled into the bladder or injected into the bladder wall to provide relief from symptoms. Some of these treatments need to be done on a weekly basis while others e.g. Botox can last for a few months.
This is typically a last resort measure where all the above have failed, where electrical stimulation is applied to the nerves of the bladder. Effects may last a few months.
Remember that bladder pain syndrome is a chronic, long-term condition. Although there is no single cure available, there are many good ways to keep your symptoms under control so that your life does not revolve around your bladder.
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