Blood in the urine or hematuria is a common problem experienced by many women. Hematuria can occur in isolation or in conjunction with bladder pain, urinary frequency or urgency. Most cases of hematuria are caused by reversible issues like bladder infections, kidney stones, menstrual bleeding or vaginal infections and resolves after the underlying problem is treated. In very rare cases, blood in the urine may be a sign of abnormal cells in the bladder or cancer. Most times, blood discovered in the urine is a harmless problem with no known cause.
Am I at risk for cancer?
In general, women are at a lower risk for bladder cancer when compared to men. Your risk of cancer in the bladder is increased if you smoke or are older than 60 years of age. Your likelihood of cancer is also increased if large amounts of blood are seen in your urine.
Should I be evaluated if I have blood in my urine?
The first step in evaluating blood in the urine is to collect a clean sample of urine. Your doctor will first dip the urine to look for signs of infection. If you do not have a bladder infection, then your urine is examined further by looking under a microscope and counting the number of red blood cells present in your sample. If more than three red blood cells are present by microscopic evaluation, your doctor will recommend referral to specialist called a Urologist.
A Urologist is a specialized doctor who treats problems related to the kidneys and bladder. As part of your evaluation for hematuria your Urologist will recommend a procedure called a cystoscopy. A cystoscopy is an in-office procedure done by inserting a small camera into your urethra while filling your bladder with water. This camera helps inspect the bladder walls for abnormal growths or bladder stones. A cystoscopy is not usually a painful procedure and takes about ten minutes, anesthesia is not usually necessary. Another study such as an ultrasound of the kidneys or CAT scan is often necessary to complete your evaluation.
Should I be worried if my testing is normal?
Usually, no additional testing is needed if your cystoscopy, renal ultrasound and/or CAT scan are normal. Your doctor may recommend repeating your urine testing yearly if the blood in your urine is persistent, however if hematuria resolves then no additional work up is necessary. Remember, hematuria is a common issue seen in women and without risk factors your chances of cancer are very low. Take a deep breath and talk to your doctor if you have concerns about blood in your urine.
I am board certified in Obsetrics and Gynecology (OBGYN) and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). I currently serve as the Medical Director of Female Pelvic Medicine for the Crozer Health Medical Group in the greater Philadelphia area. I obtained my residency training in OBGYN at the Los Angeles County+ University of Southern California Medical Center and fellowship training in FPMRS at Johns Hopkins. I am passionate about the field of Women’s Health and the treatment of pelvic floor disorders like urinary incontinence and pelvic organ prolapse.