What is microscopic haematuria? What tests need to be done?

Microscopic haematuria is the presence of blood in the urine which cannot be detected by the naked eye, but only picked up by a urine test where the urine is studied under the microscope for red blood cells (RBCs), white blood cells (WBCs), epithelial cells (ECs) [vaginal cells] and bacteria (germs).

What is microscopic haematuria?

What causes it?

  • Menses
  • Urinary tract infection (UTI)
  • Kidney and/or bladder stone/s
  • Kidney and/or bladder tumour which may be benign or malignant (non-cancerous or cancerous).
  • Foreign body in the bladder, e.g., suture, tape or mesh
  • Radiation cystitis (radiation treatment to the bladder or pelvis)
  • Interstitial cystitis: a type of chronic cystitis; now known as painful bladder syndrome
  • Urogenital syndrome: post menopausal changes to the urinary tract and female genital organs, i.e., thinning and dryness caused by the decreased blood flow because of the very low female hormone, oestrogen, after the menopause
  • Pyelonephritis (inflammation of the kidneys)

What would you complain of?

  • You may have no complains apart from an incidental finding of blood in the urine at your routine medical or insurance check up.
  • Burning urination, feeling the desperate need to pass urine very often, passing small amounts of urine and feeling that you have not voided completely (typical of urinary tract infection)
  • Severe sharp pain starting from usually one loin and radiating down to your groin (strongly suggestive of kidney stone passing down your ureter, the tube connecting your kidney to your bladder)
  • Previous radiation treatment to your bladder or pelvis for cancer (can present as radiation cystitis even years later)
  • Previous pelvic surgery, operation for pelvic organ prolapse or for stress incontinence of urine followed by recurrent or repeated urinary tract infection (UTI) and/or blood in the urine (should suspect a foreign body in the bladder; a rare complication)
  • Vaginal dryness, painful sex after the menopause (very likely to be urogenital syndrome)

What would your doctor find?

  • Nothing
  • Tenderness over your bladder and/or urethra (urine pipe) [lower tummy and/or top of your vagina]
  • Tenderness over your loin and groin
  • Vaginal dryness, thinning and pallor (paler colour)

What tests need to be done?

  • Urine tests to look for pus cells, red blood cells, bacteria, cancer cells
  • Kidney and bladder ultrasound scan
  • Cystoscopy: Using a medical telescope to look into your bladder and urine pipe: Typical features of Interstitial cystitis are shown in the bottom 2 photos during cystoscopy; when the bladder is drained of its filling fluid it starts to bleed like a water fall. The top 2 photos show that during initial filling the bladder is normal.

How will your doctor treat you?

UTI: Treat with the appropriate antibiotic.

Kidney/bladder stone /Kidney/bladder tumour / Foreign body in bladder / Radiation cystitis: Please refer to our Urology colleagues.

Painful bladder syndrome [Interstitial cystitis]: Please refer to Urogynaecology clinic for cystoscopy & bladder biopsies & treatment.

Urogenital syndrome (Atrophic genitalia & bladder): Treat with topical Premarin cream & Tab Vagifem twice /week for maintenance.

Pyelonephritis: Please refer to our Renal Physician colleagues

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