Painless Hematuria: Causes and Concerns for Travelers

Asymptomatic hematuria?

Hello Doctor, I am currently working abroad.
I smoke and drink alcohol in moderation, and my routine is normal.
Last Saturday afternoon, I noticed dark red urine (throughout the stream).
The next day, I immediately went to a local hospital funded by Taiwanese businesses for a consultation.
They performed a urinalysis, ultrasound, and secretion tests.
Aside from the hematuria and a BLD value that exceeded the normal range at 300 Ery/uL, no abnormalities were found.
The doctor suspected an infection (through translation) and prescribed me a week's worth of medication, one of which contained a blue dye that turned all my urine blue.
However, upon closer inspection, it seems there are small traces of blood floating in the urine.
I do not have any significant discomfort, pain, itching, or lower back pain, and I wonder if this is psychological.
The more others mention it, the more I scrutinize my body's subtle discomforts, which increases my anxiety.
I continued taking the medication until last night.
After drinking plenty of water, today my urine appears light blue with a hint of red and yellow.
I am unsure if I have expelled all the dye, but there are still small blood clots appearing (about once a day), mostly in thin strands, with a few in small clumps.
I do not feel any unusual sensations.
There is still a week until I return to Taiwan, and I am very worried every time I go to the bathroom.
Even though I feel fine physically, I am concerned about tumors or cancer.
I have searched online, but there seems to be no concrete cause.
I kindly ask the doctor to clarify whether this condition is serious and if I can wait until my return to Taiwan for a consultation, as I still trust the quality of healthcare in Taiwan.
Thank you for your reassurance.

V Nan, 20~29 year old female. Ask Date: 2018/12/30

Dr. Liu Mingyue reply Urology

If there are currently no obvious discomforts and the hematuria has improved, it is recommended to return to Taiwan and visit a urology outpatient clinic for a detailed examination.

Reply Date: 2018/12/30

More Info

Painless hematuria, or the presence of blood in urine without accompanying pain, can be a concerning symptom, especially for someone traveling abroad. Your situation, where you have experienced dark red urine and have undergone initial testing without any definitive diagnosis, raises several important considerations.

Firstly, it is essential to understand that painless hematuria can have various causes, some of which may be benign while others could be more serious. Common causes include urinary tract infections (UTIs), kidney stones, benign prostatic hyperplasia (in men), and, in some cases, tumors in the urinary tract, including bladder cancer. Given that your initial tests indicated a possible infection, it is plausible that this could be the cause of your symptoms. However, the presence of blood, even in small amounts, should not be overlooked.

The fact that you are experiencing anxiety about your condition is understandable. Anxiety can exacerbate physical symptoms and may lead to a heightened perception of discomfort. It is crucial to manage this anxiety, as stress can impact your overall health. Engaging in relaxation techniques, such as deep breathing exercises, mindfulness, or gentle physical activity, may help alleviate some of your concerns.

Regarding your current situation, it is advisable to continue monitoring your symptoms closely. If you notice any changes, such as an increase in the amount of blood, the appearance of pain, or any other unusual symptoms, it would be prudent to seek medical attention sooner rather than later. While it is possible to wait until your return to Taiwan for further evaluation, it is essential to remain vigilant about any changes in your condition.

In terms of the medications you received, it is not uncommon for certain medications to temporarily alter urine color. The blue pigment you mentioned is likely a harmless side effect of the medication. However, if you continue to see blood in your urine after the medication has been cleared from your system, this warrants further investigation.

When you return to Taiwan, I recommend scheduling an appointment with a urologist, who can perform a more comprehensive evaluation, including a possible cystoscopy (a procedure to look inside the bladder) and additional imaging studies if necessary. These tests can help rule out any serious conditions and provide peace of mind.

In summary, while your symptoms may not indicate an immediate crisis, it is essential to remain aware of any changes and to seek medical advice if your condition worsens. Managing your anxiety and focusing on your well-being during this time is equally important. Trust in the medical system back home, and ensure you follow up with a healthcare professional upon your return.

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