Microscopic Haematuria

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).

Microscopic Haematuria can be caused by:

• 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)

You may have no complaints apart from an incidental finding of blood in the urine at your routine medical or insurance check up. Other symptoms include:

• A burning feeling during 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)

Your doctor may find one or more of the following upon examination:​

• 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)

The following tests may be used to diagnose Microscopic Haematuria:

• 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.

The following are the treatment options for the various causes of Microscopic Haematuria:

• UTI: Treat with the appropriate antibiotic.
• Kidney / Bladder stone / Kidney / Bladder tumour / Foreign body in bladder / Radiation cystitis: Referral to a Urologist.
• Painful bladder syndrome (Interstitial cystitis) - Referral to Urogynaecologist for cystoscopy, bladder biopsies, and treatment.
• Urogenital syndrome (Atrophic genitalia & bladder): Treat with topical Premarin cream & Tab Vagifem twice a week.