About this symptom
Gross/ visible hematuria: a symptom that basically means the presence of blood in urine.
Microscopic/ non-visible hematuria: red blood cells are only visible upon microscopic examination of urine sample.
If your urine appears pink, red, brownish-red or tea-like in colour, this may indicate the presence of blood in your urine. Doctors term this as gross/visible haematuria. Sometimes, the presence of blood in urine is not visible when red blood cells in a urine sample can be seen under a microscope. Doctors term this as microscopic/non-visible haematuria. Since the causes of hematuria may be benign or malignant, investigations should be done to ascertain its cause.
According to existing literature, 18.9% of patients with visible hematuria were diagnosed with urinary cancer after investigation; whereas only 4.8% of patients with non-visible hematuria were diagnosed with urinary cancer after urological investigations.
Reference：Edwards et al, BJUI 2006 Feb;97(2):301-5; discussion 305.
Possible causes:
There are abundant causes for hematuria. Those more specific to urology include:-
- Infection of the urinary system
- Urinary stones – kidney stones or ureteric stones
- Cancer – kidney, bladder cancer, or prostate cancer
- Cystic disease - kidney cysts, polycystic kidney disease
Other causes:
- Medications such as blood thinners (heparin, warfarin, aspirin)
- Kidney injury resulting from an accident
Your urine may also appear pinkish red because of red pigments from your daily intake, such as medication (e.g. pyridium, rifampicin) or food (e.g. beetroot). However, of note, this is only pseudo-hematuria.
Is it kidney pain or back pain?
Kidney pain, also termed ‘loin pain’, is often characterised by a constant ache that can be felt at the back under the rib cage. Kidney pain can often be mistaken for muscular back pain. There are some characteristics of kidney pain that can help differentiate from back pain. The definitive cause is determined by appropriate investigations.
Kidneys, each about the size of a fist, are located at the back below the rib cage on both sides of the spine. Pain can usually be felt on one side, occasionally on both sides.
Depending on the cause, loin pain can also be sharp and severe, radiating to the groin and abdomen. For example, if pain is caused by urinary stones, pain can be severe and comes in waves.
Back pain, on the other hand, is often persistent and associated with movement and relieved with rest.
It is important to also look out for any signs of infection (fever, painful urination, foul smelling urine) and other urinary symptoms such as haematuria .
Possible causes:
- Infection of the kidney (pyelonephritis)
- Urinary stones – kidney stones or ureteric stones
- Cancer – kidney cancer, upper tract urothelial carcinoma
- Cystic disease - kidney cysts, polycystic kidney disease
Symptom description:
This is a lower urinary tract voiding symptom. It may be associated with hesitancy, intermittency, straining and sense of incomplete emptying. Lower urinary tract symptoms are not exclusive to men, it can affect both men and women of all ages. Although it may be a result of an underlying disease, it can also be physiological - the speed of urine flow decreases as one ages.
Possible causes:
The bladder functions as both a reservoir and pump for urination. The urethra acts as a tube that connects the bladder to an external opening, allowing urine to leave the body during urination. In male, the urethra passes through the prostate.
The bladder muscle is either in a relaxed state, allowing urine to fill the bladder; or under contraction, where urine is being actively pumped out of the bladder. The switch between urinary storage and voiding is under tight regulation by an intact neurological system.
Weak stream may be caused by:-
- Disease that cause ineffective pumping of urine out of the bladder
- Disease that cause blockage in the outlet of the bladder
- Disease affecting the neurological system that governs the urination
Due to anatomical differences between genders, there are different organs in the pelvis that might compress onto the outlet and block the outflow of urine.
In men, a common cause is an enlarged prostate, termed benign prostatic hyperplasia, an outlet obstruction of urine from the bladder.
SYMPTOM DESCRIPTION:
Urgency describes a sudden strong sensation that urges you to urinate and is difficult to control. This may be accompanied by increased frequency as the sensation makes you feel like you need to pass urine more frequently, up to 8 or more times in 24 hours.
You may also experience an unintentional loss of urine, as well as the need to wake up during the night to urinate.
POSSIBLE CAUSES:
Think of the bladder being a balloon, when it is being filled by urine produced from the kidneys, it becomes stretched. Whenever the bladder is stretched, a nerve signal is sent to the brain to tell the brain that the bladder is reaching its maximum volume. As a result, you feel the sensation of urgency, and you have to pass urine in order to relieve your bladder.
There are conditions which makes you feel the sensation more frequently or more difficult to control, for example:
- Faster rate or increased volume of urine produced that increases the filling of bladder
- Certain medications that increases in urine production or increases thirst and fluid intake
- Excess consumption of caffeine or alcohol
- Poorly controlled diabetes where you start to excrete sugar in urine causing the urine volume to increase as more water is required to dilute the urine
- External pressure added onto the bladder, causing it to stretch
- Obesity
- Enlarged prostate in males
- Uterine prolapse in women
- Storage volume of bladder is reduced
- Incomplete bladder emptying, leaving a residual volume in the bladder after urination
- Bladder tumour or bladder stone
- Neurological condition
- Stroke
- Multiple sclerosis
- Declining cognitive function due to ageing
Other common causes include urinary tract infections, postmenopausal hormonal change in women.
Illustration by @bowlful.of.rice
SYMPTOM DESCRIPTION:
The need to wake up at night to urinate. This is common as you age, it also depends on the timing of your fluid intake.
POSSIBLE CAUSES:
Think of the bladder being a balloon, when it is being filled by urine produced from the kidneys, it becomes stretched. Whenever the bladder is stretched, a nerve signal is sent to the brain to tell the brain that the bladder is reaching its maximum volume. As a result, you feel the sensation of urgency, and you have to pass urine in order to relieve your bladder.
There are conditions which makes you feel the sensation more frequently at night and you feel the need to wake up for urination, for example:
- Related to urology:
-
- Faster rate or increased volume of urine produced that increases the filling of bladder
- Certain medications that increases in urine production or increases thirst and fluid intake, especially taking them late in the evenings.
- Excess consumption of caffeine or alcohol
- Poorly controlled diabetes where you start to excrete sugar in urine causing the urine volume to increase as more water will be drawn into the urine
- Drinking too much fluid before going to bed.
- Storage volume of bladder is reduced
- Incomplete bladder emptying, leaving a residual volume in the bladder after urination
- Bladder tumour or bladder stone
- Infection of the urinary tract
- Related to neurological conditions:
-
- Stroke
- Multiple sclerosis
- Declining cognitive function due to ageing
- Related to cardiovascular conditions:
-
- Swollen ankles and legs with excess fluid. At night when you lie down this excess fluid is reabsorbed into the blood stream and the kidneys then produce more urine.
- Heart failure
Illustration by @bowlful.of.rice
SYMPTOM DESCRIPTION:
Leaks of urine when you don’t intend to pass urine.
There are different types of urinary incontinence:
- Stress incontinence. Urine leaks upon exertion of pressure on your bladder due to movements such as coughing or sneezing.
- Urge incontinence. This type of incontinence is associated with other symptoms such as increased urinary urgency and frequency as well as nocturia. Urge incontinence may be caused by a minor condition, such as infection, or a more-severe condition such as a neurologic disorder or diabetes.
- Overflow incontinence. You experience frequent or constant dribbling of urine due to incomplete emptying of urinary bladder.
POSSIBLE CAUSES:
Related to urology
- Stress incontinence
This type of incontinence may be a result of damage or weakened control of pelvic floor muscles or urethral sphincter, which are both structures that control the exit of urine from the bladder.
Problems with these muscles may be caused by:
- damage during childbirth, especially if your baby was born not by caesarean section
- increased pressure on your abdomen due to obesity or pregnancy
- damage during previous surgery, such as the removal of the womb in women, or prostate gland in men
- neurological conditions such as Parkinson's disease or Multiple sclerosis
- connective tissue disorders such as Ehlers-Danlos syndrome
- drugs such as ACE inhibitors, diuretics, antidepressants or sedatives
- Urge incontinence
This type of incontinence is likely to be a result of a problem with the detrusor muscle, a muscle that controls the relaxation and contraction of your bladder.
Possible causes can be:
- excessive caffeine or alcohol consumption
- insufficient fluid intake, creating urine too concentrated that irritates the bladder wall and causes symptoms of urgency
- urinary tract infection
- constipation
- neurological conditions
- drugs such as ACE inhibitors, diuretics, antidepressants or sedatives
- Overflow incontinence
This type of incontinence is likely to be associated with incomplete urinary bladder emptying, possibly due to an obstruction or insufficient detrusor muscle contraction
Causes can be:
- for men, enlarged prostate gland
- bladder stones
- neurological condition
- drugs such as ACE inhibitors, diuretics, antidepressants or sedatives
SYMPTOM DESCRIPTION:
Dysuria describes painful urination.
POSSIBLE CAUSES:
Related to urology
- Bladder or kidney stones
- Urinary tract infection, including sexually transmitted diseases (STDs)
- prostate problems in men
- a recent invasive urinary tract procedure
