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Seeing red
Urine that looks bloody should be investigated as it can suggest cancer or infection. Most cases, however, tend not to have a serious cause.
PATIENTS. AT THE HE RT OF ALL WE DO?*
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THERE WAS A STUDY DONE WHERE A COHORT OF PATIENTS WERE LABELLED AS IDIOPATHIC AND THEN FOLLOWED UP. WITHIN THE NEXT ONE OR TWO YEARS, ABOUT 10 PER CENT OF THEM EVENTUALLY DO TURN UP TO HAVE SOMETHING.
ASSOC PROF CHONG TSUNG WEN SENIOR CONSULTANT DEPARTMENT OF UROLOGY, SOH**
Don't panic if your urine looks bloody. It can suggest a deadly medical condition, although in many instances, bloody urine isn’t caused by anything serious. Still, the condition shouldn't be taken lightly and anyone who sees blood in their urine should consult a specialist to rule out a serious cause, said Assoc Prof Chong Tsung Wen, Senior Consultant, Department of Urology, Singapore General Hospital.
“Principally we are worried about things like cancer (of the bladder or kidney), sometimes infection or kidney stones. So anybody who has macroscopic haematuria (when the urine looks bloody) requires a urology consult," said Assoc Prof Chong.
Patients will be asked about their medical background, in particular if they have a family history of kidney stones or cancer. X-ray or CT scan images will be taken of the kidneys and urethra. In case the scans fail to detect small growths In the bladder, a cystoscopy may be scheduled.
In this procedure, an endoscope - a fibre optic scope with a camera attached to the end - is inserted through the urethra to examine the inner lining of the bladder. “It’s a very safe procedure, but it’s a bit more uncomfortable for men than for women because anatomically, men have long urethras,” said Assoc Prof Chong, adding that the 5-10 minute procedure is commonly performed in a clinic.
As the incidence of bladder cancer is much higher among males and smokers, if a man over the age of 40 has a history of smoking and has macroscopic haematuria, “to us, he is deemed to have cancer until proven otherwise".
“That’s why we emphasise that anybody with macroscopic haematuria should always be referred to us, no exception,” he said. Up to a quarter of people who are seen for the condition will be diagnosed with a serious disease like cancer.
In macroscopic haematuria, the presence of blood clots in the urine would usually set off alarm bells, although a large amount of blood in the urine doesn’t always mean the underlying condition is more severe. Some large cancers don’t bleed at all, Assoc Prof Chong said.
Kidney stones and infections of the bladder or kidney are other common causes of the condition. Bloody urine can also be due to rare congenital causes such as disorders in the blood vessels.
When no known cause is found, patients are not discharged but are seen yearly for a couple of years. “There was a study done where a cohort of patients were labelled as idiopathic (no known cause) and then followed up. Within the next one or two years, about 10 per cent of them eventually do turn up to have something,” said Assoc Prof Chong.
Joggers sometimes get the condition too, although it’s not clear why it happens. “Some people believe the blood is caused by abrasions within the lining of the bladder. If the bladder isn’t completely filled, the front and back walls can rub against each other when the person is running. This causes a bruise or bleeding, so when the jogger passes urine, he sees blood,” said Assoc Prof Chong.
Drinking more water and resting usually lead to the condition resolving itself. The human kidney filters up to a million red blood cells a day, so everybody has traces of red blood cells in the urine. If you are dehydrated and you happen to do a urine test, you will pick up blood in the urine, but it doesn’t mean its anything abnormal,” Assoc Prof Chong said.
Just 1 per cent of such cases -known as microscopic haematuria when the blood cannot be seen by the naked eye - will be due to serious causes, he added. The low incidence is due in part to improper collection of urine samples.
The urine test must be properly conducted, especially for women. If the urine is not collected property, traces of blood can be picked up from the skin or around the surrounding areas, and that gives what is known as spurious or false haematuria,” said Assoc Prof Chong.
“So its not just a matter of passing urine. You want to collect the urine in the mid-stream (not the first 10-20 millilitres) and that it is collected straight from the urethra and not trickling down."
A rough guide to dehydration
The kidney filters up to a million red blood cells daily. For that reason, traces of red blood cells can often be detected in the urine especially when one is dehydrated.
But drinking at least eight glasses of water a day to ensure one isn't dehydrated is a bit of an urban legend. Too much water can lead to different problems, and a better way of telling if you are not drinking enough is look at the colour of your urine.
“If the colour of your urine is very darkly stained or yellow,
chances are you are dehydrated and need to drink more water,” said Assoc Prof Chong Tsung Wen, Senior Consultant, Department of Urology, Singapore General Hospital.
Another is the number of times you go to the toilet. “If you haven’t gone to the toilet for three to four hours, or if you don't feel the urge, you are probably not drinking enough," he said, adding that this rough guide is based on the amount of urine a person produces and the amount the bladder can hold before it sends signals to go to toilet.
SingHealth
www.singhealth.com.sg SingHealth is Singapore’s largest healthcare group providing quality care across 4 hospitals, 5 national specialty centres and a network of primary care clinics. With over 40 medical specialties and a faculty of close to 4,000 doctors, it is recognised for the high quality of its healthcare services. An academic medical centre, Singapore institutions are recognised centres of excellence, integrating clinical care with research and education to transform care for its patients.
The Singapore General Hospital, one of the tertiary hospitals of the SingHealth Group, is Singapore's largest hospital. It offers multidisciplinary and seamless integrated care over a comprehensive range of clinical specialties. As a testament to its standard of quality and safety, SGH is accredited by the Joint Commission International. SGH also accounts for about one-fifth of acute beds in Singapore.y