Haematuria is the presence of red blood cells in the urine. In microscopic haematuria the urine appears normal, but examination under a microscope shows the blood cells. This is why people are asked to supply a urine sample when having a general medical check-up, so certain problems can be discounted. It is macroscopic haematuria which can be seen with the naked eye. The amount of blood in the urine does not indicate the seriousness of the underlying problem, one ml (0.03 oz) of blood will turn urine red. If you spot anything suspicious¹ collect a urine sample and take it along to your medical practitioner for testing.

Collecting a Urine Sample

Perhaps not everybody would know how to go about this. It is best to pass some urine, stop, collect the next bit², then let the rest go down the toilet. It is not necessary to fill the beaker! The reason that you don't just shoot straight into the beaker is to flood out any bacteria that might have settled in the urethra, (the duct leading from the bladder to the point of exit), which may falsify the results of the lab tests.

Of course, if the doctor hasn't given you a sealed beaker to collect it in beforehand, or if you are producing a sample at home to take along just in case, you will need to find a sealable container for your sample. A jam-jar with a screw-on lid, or a small, wide-topped bottle will do. You shouldn't wash the receptacle out with soap, but sterilise it the best you can by rinsing several times with boiling water (but do not use boiling water in glass, use baby equipment sterilising tablets instead, then they should subsequently be rinsed out with generous amounts of very hot water.) Label your bottle with your name and the date.

The sample should be as fresh as possible - producing it while at the doctor's surgery would give the freshest of all and saves all the hassle of finding and preparing containers.

Causes of Haematuria

Haematuria can be caused by just overdoing your normal exercise routine. 'Joggers haematuria' results from repeated jarring of the bladder during long-distance running or even just normal running and jogging; or it may be indicative of something more serious. With a kidney infection, typical symptoms may include haematuria, pain in the side of the abdomen, fever, feeling nauseous, vomiting and diarrhoea. Other possible causes for haematuria are:

• Accident (trauma) and excessive exercise can cause bruised kidneys or bladder damage.
• Cyst(s).
• Testicular disorders.
• Cystitis: Infection of the urinary system (tract).
• Cancer (bladder, kidney, prostate).
• Kidney stones.

Personal Experience of Kidney Stones

Having been through the kidney stone scenario about 15 years ago I have experienced haematuria, blood in the urine was the 'minor' part. Trying to pass kidney stones was, well, indescribable. In the end I had keyhole surgery - they removed seven kidney stones from the right kidney, measuring between 2mm and up to 5mm.

- An h2g2 Researcher.

The 'Plumbing'

As you would expect, the male plumbing system is vastly different from that of the female:

Male

Situated inside the scrotum is the vas deferens, the tube which carries the sperm from the testicles to the prostate gland, which is located between the bladder and the penis, and surrounds the urethra. Prostate glands tend to grow with age and eventually obstruct the flow of urine. The 'upper' urethra from the bladder also enters the prostate. The prostate secretes semen for the sperm and is also a switching valve between the urinary and ejaculatory functions. (Both can't happen at the same time.) The 'lower' urethra leaves the prostate with the appropriate cargo to the penis. Some semen is thought to clean the urethra before ejaculation and act as a lubricant during sex, which is why the 'withdrawal' method of contraception is unreliable.

The prostate gland can be removed with the use of a surgeon's electric knife. The same technique is used for cystectomy (removing cancers of the bladder).

Female

The female urethra is much shorter than that of the male. On the whole, women suffer more urinary tract infections, which can cause haematuria, than men. By the age of 30, more than one in five women will have required treatment for a yeast infection such as thrush, which is caused by Candida albicans, sometimes known as 'monilia'. If either partner suffers from this infection, their sexual partner/s should also be treated, even if they are showing no symptoms, to prevent recurrence.

The presence of blood in the urine of a pregnant woman is treated very seriously. This is why all expectant mothers should attend regular ante-natal clinic appointments and remember to take a urine sample along for checking. While the foetus is growing inside the womb, the mother's organs are working at more than twice their normal rate; for example her kidneys are expelling the baby's waste as well.

Haematuria in a pregnant woman could be an indication that she is struggling to maintain her pregnancy, or that there may be something wrong with the baby. If the condition is noticed between clinic appointments, it's serious enough to warrant immediate medical attention and the woman should seek the advice of her care provider, midwife or GP.

Cystoscopy

Obviously your doctor will want to find out the reason why there's blood in your urine. After he has taken account of your lifestyle and discounted possible benign causes like yesterday's corned beef and beetroot sandwich, the next step is arranging for you to have a cystoscopy. This procedure involves a tiny camera and fibre-optic cable which, under local anaesthetic, is inserted into the urethra. This is one of the few things that are worse for men than for women, because the distance is greater! The doctor can then take a peek inside your bladder.

The only way to get through a cystoscopy (or any other kind of painful treatment or examination) is:

• Rule One: Ask thorough questions and find out exactly what is going on. You will then find the subject (especially as it is you) so interesting, it takes your mind off the actual painful part.
• Rule Two: Relax - this is obvious; contracted muscles make the job much more difficult for the doctor. If the doctor doesn't start talking to you about your holiday or hobbies to distract you, then start up a conversation yourself.
• Rule Three: Meditate. Remember what it was like not to be in pain, think about this state, and look forward to enjoying it again afterwards.

You will be administered a local anaesthetic (possibly gel) to numb the area. You will be a little uncomfortable afterwards, and pain on passing urine is possible, but don't be tempted to stop drinking fluids to decrease the need to urinate. Try to drink more water, to flush your system through and get things back into full working order as soon as possible.

Get your partner to pamper you or treat you - you deserve it.

Personal Experience of a Cystoscopy

Have you had one of those flexible cystoscopies? No? Really, you should try one! Well perhaps that's going a bit far, but as a procedure it's not a trauma either. I was given an appointment for mine after a single episode of painless haematuria. The appointment was for 2pm, so I arrived about five minutes beforehand, was given a hospital gown and shown to a changing room. The ribbons at the back of those gowns are impossible to tie yourself, so after a fight, I ended up tying them first and climbing into the gown afterwards!

I waited for about 20 minutes before I was called and then walked with a nurse to the examination room. I hopped onto the table with a comfortable pillow and the table was raised to working height. My consultant came in and told me exactly what he was going to do. He also explained to me that at various points in the procedure he would ask me to assess my discomfort/pain level on a scale of 0 to 10.

The Nitty Gritty

First the pubic area was doused with a cleansing solution and the consultant told me he was about to squeeze the local anaesthetic gel into my penis. This was an odd sensation – no discomfort at all (score zero on my pain scale) – a bit like peeing in reverse. I expected a delay for the anaesthetic to take effect, but no, he started straight away and inserted the tube into the tip of the penis – score 0.5, no problem. Both of us satisfied, he continued to thread the fibre optic and wash tube into the bladder – score one, mild discomfort, nothing more. There was no real sensation whilst he peered around, occasionally spraying lukewarm water to check whether a couple of very small particles were adhering to the bladder wall. Examination over, the tube was withdrawn – score about 1.5. Total time in the examination room, about 10-12 minutes.

I walked back to the changing room, dressed and went home – in and out in less than an hour. There was a mild soreness for about half an hour afterwards, and some mild discomfort for the first couple of trips to the loo, but other than that, no after-effects. Apart from those couple of fragments of what were probably stones, the consultant was happy that there was nothing amiss with me. The worst bit? – definitely my imagination whilst waiting for the appointment. If you get called for a cystoscopy, don't panic; as a procedure, there is nothing to be worried about.

- An h2g2 Researcher.

Cystitis: Cause, Prevention and Cure

Typical symptoms of cystitis are haematuria, pain when you pass urine, passing urine more frequently than normal, pain in your lower abdomen, and fever. Candida can cause cystitis. Having thrush can make life miserable for the sufferer, but treatment is simple, in most cases. Pessaries and creams can be purchased over the counter in chemist shops.

A catheter inserted after an operation, or for whatever other reason, can often, despite all precautions, import bacteria into the bladder or urethra and cause an infection. The medical staff may be just leaving the catheter in place because they don't have time to help you to the toilet, or because they've just forgotten about it! So it may be worth asking if you can have it removed if you feel up to going to the toilet yourself, or using a bed pan.

Helpful Drinks

Rooibos (Redbush) tea eases the painful symptoms of urinary system diseases such as prostatitis (inflammation of the prostate gland) and cystitis, due to its high content of the anti-inflammatory antioxidant quercetin, which has been shown in clinical trials to relieve the symptoms of prostatitis.

Cranberry juice is supposed to be good for the urinary system, but it is either so high in added sugar³ content for flavouring⁴ that it can make things worse, but don't worry, you can take more palatable sugar-free cranberry tablets instead. Pomegranate juice is good. Make sure these are 100% pressed/whole juice and not a 'drink' or 'from concentrate'. Concentrates are full of sugar even though it does not say so on the pack. They are made by adding sugar, but, if listed as an ingredient, 'concentrate' means dehydrated juice and sugar.

Fluids include freshly-pressed apples, carrots, etc if you have a juicer at home. They are the best because they include the enzymes (packaged juices are irradiated or pasteurised, killing the enzymes). Or you can get the 'Innocent' smoothies which are made from whole fruit and nothing but fruit.

Warm drinks include mint tea, fennel, aniseed, etc - all of these can be bought in packets or (more beneficially) made from the seed/herb itself. The seeds will need crushing first then steeping, but herbs can infuse in just-boiled water (put a lid on the cup to catch the steam and drip the aromatic oils back into the liquid). The seeds and herbs can be found at Middle Eastern or Indian food/grocery or greengrocery shops.

Birch leaf tea is compiled with several other beneficial ingredients like Goldenrod and Horsetail herbs, Juniper berries, Spiny Restharrow roots and Orthosiphon (Java Tea) leaves, with different flavourings for taste; for example raspberry or peppermint leaves.

Bladder Cancer

Symptoms include:

• Loss of weight
• Loss of appetite
• Back pain (in the kidney region)
• Abdominal pain
• Haematuria
• Pain on urination
• Greater frequency of urination

Smokers have an increased risk for development of bladder cancer - two to three times that of a non-smoker. Tobacco use introduces carcinogenic polyaromatic hydrocarbons into the blood stream which are subsequently expelled via the bladder. Between 40 and 70% of all cases of cancer of the urinary tract reported in the western world are smokers.

Look After Yourself

If your doctor prescribes antibiotics, you must finish the course. It's also a good plan to eat some pro-biotic yogurts to ward off any potential thrush invasion.

• Stop smoking.

• Cutting down on alcohol during treatment may be helpful as it can irritate the urethra.

• Flush your system through with plenty of water but check whether you can take diuretics before you take them. Diuretics increase the amount of urine produced by the kidneys, but certain medication or medical conditions can render diuretics harmful to the patient.

• It's a good idea to get your partner to wash their hands thoroughly before any kind of foreplay/sexual contact. Wash after sex; women are also advised to urinate after having sex.

• Avoid spreading bacteria from the rectum to the vagina. After a bowel movement, wipe from front to back, away from the vagina.
  Clean the outer genital area thoroughly with unscented pH-balanced soap.

• Know your own body and its effluvia, note any changes and report any symptoms of potential illnesses. Better to put your mind at ease with an 'all clear' from your GP than cause yourself undue worry and stress which may ruin your peace of mind.