MADISON, Wis.—Few health symptoms are as unsettling as blood in the urine.
Should you freak out? Not necessarily. The technical term for the condition is “hematuria,” and experts at the University of Wisconsin School of Medicine and Public Health say it’s likely the result of one of several health conditions, only one of them serious.
“The first thing I’d say to a patient is, ‘Don’t panic,’” says Dr. Jeremy Smith, an internist and assistant professor of medicine at UW. “The majority of the time, blood in the urine is not dangerous.”
It could, however, be an indication of several annoying health conditions, including a urinary tract infection, a kidney stone, an enlarged prostate gland or some kind of minor injury to the bladder or kidney—maybe even caused by something as innocuous as vigorous exercise.
A handful of simple tests can usually shed light on the situation.
“The good thing about the hematuria work-up is that it’s pretty standard,” says Dr. Tracy Downs, a bladder-cancer surgeon with the UW Carbone Comprehensive Cancer Center and an associate professor of urology at UW. The process can involve simple urinalysis, a CT scan, or a cystoscopy, a procedure in which physicians insert a small camera into the bladder.
If the hematuria is caused by an infection—this is more commonly found in women than in men—antibiotics can usually resolve it. In a handful of cases, the cystoscopy may reveal the one medically concerning condition for which hematuria is also a symptom: bladder cancer. Only about 10 percent of hematuria cases are linked to cancer, and it’s more common in patients over age 50.
“Blood in the urine can definitely be a red flag for cancer,” notes Dr. Downs. “For some patients it’s one flag, while for others it’s one of two or three flags.”
Cancer cells can lurk in the lining of the bladder, or a tumor can be imbedded in the organ itself, increasing the risk that the cancer will spread elsewhere in the body. Some can be surgically removed or treated with chemotherapy.
Unfortunately, the recurrence of bladder cancer is high—it can be as high as 20 to 50 percent, what Downs calls “the dandelion effect.” In the small number of more serious cases, Downs must surgically remove the patient’s bladder, replacing it with an internal neobladder created from the patient’s intestines or an external pouch.
While hematuria can be a sign of serious cancer, it can also indicate nothing at all.
“It’s also frequently the case that people have blood in their urine for unexplained reasons,” says Smith. “We do extensive testing, the tests are normal, and the bleeding doesn’t happen again. We and the patients are left wondering what caused it, but it obviously wasn’t anything serious.”
Downs and Smith agree that patients who’ve noticed blood in their urine shouldn’t ignore it. Instead, they should check first with their primary-care physician.
“If you’re having repeated infections or pain, you might want to ask for a referral to an urologist,” says Downs. “Chances are good we can do something to help you.”
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