Painless Hematuria: What You Need to Know

Q: Painless Hematuria: What You Need to Know

Hello： If there is painless visible hematuria, it is recommended to conduct a thorough examination based on age. <br>Clinically, I generally suggest starting at age 45. <br>If active testing is required, urine cytology may only serve as a reference, as it has a higher false-negat

Hematuria issues

Hello, doctor.
Last night after exercising, I noticed painless hematuria, but my exercise was not intense, and I did not experience any trauma.
Today, I went to see a doctor, who tested my urine and took an X-ray, then told me there was no blood and asked me to leave, suggesting I observe if it persists.
Before the test, the doctor asked if I had eaten anything in the morning, and I said no, but I forgot to mention that I had some water.
Could drinking water affect the urine test results for hematuria? Is it possible that cancer might not always show up in tests for hematuria? If it’s not visible to the naked eye, what should I do? I thought painless hematuria should strongly rule out cancer concerns.
Do I need to undergo any further tests? Should I have more urine tests? The doctor only had me do one test and did not perform any cell cultures.
Thank you.

Ling, 30~39 year old female. Ask Date: 2019/01/24

Dr. Du Shixi reply Urology

Hello: If there is painless visible hematuria, it is recommended to conduct a thorough examination based on age.
Clinically, I generally suggest starting at age 45.
If active testing is required, urine cytology may only serve as a reference, as it has a higher false-negative rate.
Additionally, ultrasound, cystoscopy, intravenous pyelography, and computed tomography can all be considered.
To confirm that the bladder is free of issues, cystoscopy is necessary, as other tests may miss problems below a certain size.
If there is a recurrence of visible hematuria (although some food dyes can cause urine to appear red), I personally recommend that individuals of an older age with painless hematuria should definitely undergo cystoscopy.
However, a significant proportion of cases may not reveal a cause, resulting in idiopathic hematuria.
Regular follow-up and monitoring of various tests are advised.
Wishing you good health.

Reply Date: 2019/01/24

More Info

Painless hematuria, or the presence of blood in urine without accompanying pain, can be a concerning symptom, and it is understandable that you are seeking clarity on this issue. The first thing to note is that painless hematuria can arise from a variety of causes, some benign and others more serious, including urinary tract infections, kidney stones, or even malignancies such as bladder or kidney cancer.

When you experienced painless hematuria after exercise, it is important to consider several factors. First, while vigorous exercise can sometimes lead to transient hematuria due to physical stress on the kidneys or bladder, your description suggests that the exercise was not particularly intense. Therefore, it is less likely that this was the cause.
Regarding the urine test you underwent, it is possible that hydration levels can affect the detection of blood in urine. If you consumed a significant amount of water before the test, it could dilute the urine, potentially leading to a false negative result. However, it is also important to note that not all cases of hematuria are detectable in a single urine sample. Blood may not be present in every sample, especially if it is intermittent.

Your concern about the possibility of cancer is valid, as painless hematuria can indeed be a symptom of malignancy. However, it is also essential to remember that many other conditions can cause this symptom. The fact that your doctor did not find blood in the initial tests is a positive sign, but it does not entirely rule out the need for further investigation.

Given your situation, it may be prudent to follow up with your healthcare provider. You might want to discuss the following options:
1. Repeat Urinalysis: Requesting additional urine tests, especially if you continue to notice blood in your urine, can help clarify the situation. It is often recommended to perform multiple tests over time to catch intermittent hematuria.

2. Urine Culture: If there is any suspicion of a urinary tract infection, a urine culture can help identify any underlying infection that may not have been evident in the initial tests.

3. Imaging Studies: If hematuria persists, imaging studies such as an ultrasound or CT scan of the abdomen and pelvis may be warranted to visualize the kidneys, bladder, and urinary tract for any abnormalities.

4. Cystoscopy: In cases where there is a strong suspicion of bladder pathology, a cystoscopy (a procedure where a thin tube with a camera is inserted into the bladder) may be recommended to directly visualize the bladder lining.

5. Monitoring Symptoms: Keep a close watch on any additional symptoms you may experience, such as changes in urination patterns, pain, or any other unusual signs, and report these to your doctor.

In summary, while your initial tests did not show blood, it is essential to remain vigilant. If you continue to have concerns or if symptoms change, do not hesitate to seek further medical evaluation. Early detection and diagnosis are crucial in addressing any potential underlying issues effectively.

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