haematuria

Haematuria

What is Haematuria?

Haematuria is a medical term that refers to blood in the urine in Singapore. Although it is a common symptom of several easily treated conditions, it may also indicate a more serious underlying medical problem. Haematuria can be classified into two main types:

  • Gross haematuria: this type of haematuria is when blood in the urine is visible to the naked eye. Urine may appear pink, red, or brown, depending on the amount of blood present. It is also known as macroscopic haematuria.
  • Microscopic haematuria: when there is no blood visible to the naked eye and can only be detected through a urine test, it is referred to as microscopic haematuria. A laboratory analysis of the urine will be done to identify the presence of red blood cells. Microscopic haematuria is usually discovered incidentally during a routine urine examination.
haematuria
There are two types of haematuria: microscopic haematuria and gross haematuria.

What are the symptoms of Haematuria?

The symptoms of haematuria depend on the severity and the underlying condition that is causing it. In general, these are the common symptoms associated with haematuria: 

What are the common causes of Haematuria in Singapore?

It depends on the individual, as various factors can cause haematuria. While some causes are harmless and self-limiting, others may be more serious and require medical attention. Common causes of haematuria include:

  • Dehydration: concentrated urine can irritate the urinary tract lining, making it more prone to bleeding.
  • Urinary tract infection (UTI): urinary tract infections of the bladder or the urethra can irritate the urinary tract lining, leading to bleeding in the urine. This is more common in women.
  • Kidney stones: kidney stones can irritate the urinary tract and lead to bleeding.
  • Trauma or injury: blows to the kidneys or bladder, such as in accidents or extreme sports, can result in haematuria.
  • Enlarged prostate: an enlargement of the prostate gland can obstruct urine flow, leading to blood in the urine. This is more common in older men.
  • Medication: some medications, especially blood thinners, can increase the risk of bleeding and cause haematuria.
  • Exercise-induced haematuria: strenuous exercise can occasionally cause microscopic haematuria due to minor trauma to the urinary tract, especially in long-distance runners.
  • Catheter: the use of urinary catheters can sometimes cause irritation and bleeding in the urinary tract.
  • Sexual activity: sexual activity can lead to haematuria, mainly if friction or minor trauma is involved.
  • Inherited conditions: some individuals may have inherited medical conditions, such as Alport syndrome or thin basement membrane disease, which can predispose them to haematuria.
  • Cancer: tumours in the bladder or kidney (link to kidney cancer service page) can cause haematuria, particularly in older adults.

If you are experiencing these symptoms, make an appointment with Aare Urocare today.

UTI
Haematuria can be caused by urinary tract infections.

Who is at risk of Haematuria in Singapore?

In Singapore, haematuria can occur in individuals of all ages and backgrounds. With that being said, certain factors and conditions can increase the risk of developing haematuria, which include:

  • Ageing: older people are more likely to develop haematuria. In particular, older men are more prone to developing haematuria due to enlarged prostate glands. 
  • Smokers: smoking is also associated with haematuria. 
  • Urinary tract infection: those who suffer from frequent UTIs may be at a higher risk of haematuria as it is one of the top causes of the condition. 
  • Family history: individuals with kidney or bladder problems in their genetic history may be more likely to develop haematuria. 
  • Medication: individuals on blood thinners or antithrombotic drugs may be at risk of developing haematuria. 
  • Extreme exercise: athletes who play contact sports and marathon runners have been known to be at risk for haematuria. 

It is important to note that while these factors can increase the risk of haematuria, it does not mean that individuals without these risk factors are immune to the condition.

Is Haematuria painful?

Haematuria itself does not typically cause pain. Instead, it is usually a symptom or indicator of an underlying condition, and any associated pain or discomfort is more likely due to that condition.

How is Haematuria diagnosed in Singapore?

Diagnosing haematuria would involve a series of medical evaluations and diagnostic tests to determine the underlying cause. In general, the following diagnostic options typically apply for haematuria patients:

  • Medical history and physical examination: a detailed medical history will be taken, and a physical examination of the patient will be performed.
  • Blood and urine tests: a urine sample for a urinalysis may also be collected to differentiate the type of haematuria. If there are symptoms of a urinary tract infection, a urine culture may be suggested to identify the specific bacteria causing the infection. Blood tests may also be ordered to check for markers of kidney function and to assess for conditions that might contribute to haematuria, such as clotting disorders or kidney diseases.
  • Imaging tests: depending on the clinical findings and the type of haematuria, various imaging studies may be recommended, including ultrasound, computed tomography scan (CT scan), and even magnetic resonance imaging (MRI) if necessary.
  • Cystoscopy: in some cases, a cystoscopy may also be needed. During this procedure, a thin, flexible tube with a camera is inserted through the urethra to inspect the inside of the bladder and urethra visually. This procedure can help detect bladder abnormalities or tumours.
  • Additional tests: depending on the findings of the initial evaluations, further specialised tests may or may not be necessary. For example, if cancer is suspected, a biopsy of the affected tissue may be performed for a more definitive diagnosis. The specific diagnostic approach will vary based on the individual’s clinical presentation and the suspected causes of haematuria.
haematuria
A cystoscopy helps detect bladder abnormalities if there is blood in the urine (haematuria).

What are the treatment options for Haematuria in Singapore?

The treatment plan for patients experiencing haematuria depends on the specific diagnosis and findings of the tests done. As haematuria is a symptom, treatment will typically focus on addressing the specific condition or factor responsible for the bleeding. Here are some common treatment options for haematuria based on its underlying causes:

  • Antibiotics
  • Pain management
  • Increase fluid intake
  • Rest and observe
  • Removal of kidney stones
  • Medication adjustment
  • Further evaluation if no cause is determined

One of the most important treatments for haematuria is lifestyle changes. Lifestyle changes can be beneficial in managing haematuria and addressing some, if not most, of its underlying causes or risk factors. 

Specific lifestyle changes needed will depend on the underlying cause of the haematuria. Some general lifestyle modifications that may be recommended to improve overall health such as:

  • Hydration: drinking adequate water can help dilute urine and reduce the risk of kidney stones that could cause haematuria.
  • Healthy diet: a balanced diet that is low in salt and artificial flavours and includes plenty of fruits and vegetables can support overall health and a healthy urinary tract.
  • Manage blood pressure: if high blood pressure contributes to haematuria, lifestyle changes such as a low-sodium diet, regular exercise, and stress management can help control it.
  • Exercise regularly: regular physical activity can promote overall health and may help prevent obesity and its associated risk factors for haematuria.
  • Weight management: maintaining a healthy weight through diet and exercise can reduce the risk of obesity-related conditions that may lead to haematuria, such as diabetes or hypertension.
  • Limit alcohol consumption: excessive alcohol intake can irritate the urinary tract and may sometimes contribute to haematuria. 
  • Quit smoking: smoking is a risk factor for bladder cancer. Quitting smoking can significantly reduce this risk.
  • Practice safe sex: if sexual activity is associated with haematuria, taking precautions to prevent injuries or trauma during sex may be necessary.
  • Treat menopausal symptoms if all else are normal during urological investigations.

Make an appointment with Aare Urocare, where we cater to our patients’needs with accurate diagnosis and personalised treatment.

haematuria
Staying hydrated is vital to keep yourself healthy and prevent problems like haematuria.

Frequently asked questions

Bloody urine may be due to a problem in your kidneys or other parts of the urinary tract, such as bladder or kidney cancer. It may be a symptom of a serious condition, but in most cases, it is due to an infection or lifestyle habit that is easily treated.

Haematuria can worsen if not treated, leading to further problems with your urinary tract.  It can result in kidney failure and tumours developing from cancer, which can occur in your prostate, bladder, or kidneys.

Although seeing blood in the urine may be alarming, it is not life-threatening in most cases. Nevertheless, it is important to treat and find out the cause of haematuria in case it is a symptom of a serious condition or causes other problems. Medical intervention, such as antibiotics for a UTI, may also be required. 

If you or someone you know experiences haematuria, it is vital to seek medical evaluation to determine the underlying cause and get the appropriate treatment. A urologist can perform the necessary tests and examinations to diagnose and address the condition. Ignoring haematuria or assuming it will resolve on its own is not advisable, as the underlying condition may worsen if left untreated, especially if it persists or is associated with other symptoms such as pain, fever, or changes in urinary habits.

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Dr. Fiona Wu 2

Dr Fiona Wu
Consultant Urologist

MBBS (S'pore), MRCS (Edin), MMED (Surg),
MMED (Clinical Investigation),
FRCS (Urol) (RCPSG), FAMS (Urology)

Dr Fiona Wu is an experienced Consultant Urologist and is the Medical Director of Aare Urocare.

Prior to her private practice, she spent 15 years in public service. She was a Consultant in the Department of Urology at National University Hospital (NUH), Alexandra Hospital and Ng Teng Fong General Hospital.

She believes in treating urinary incontinence in a holistic way using minimally invasive methods – this ranges from laser treatment, neurotoxin injections, electromagnetic nerve stimulation to minimally invasive surgeries, etc. She worked closely with the gynaecology and colorectal departments to treat complex pelvic floor conditions and continues to do so in her own practice.

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