Red alert

The presence of fresh blood in the urine should raise the red alert immediately! 

Annus horribilis is a Latin phrase meaning “horrible year”. This phrase was brought to prominence by Queen Elizabeth II in a speech to the Guildhall in 1992 marking the 40th anniversary of her accession.

“1992 is not a year on which I shall look back with undiluted pleasure. In the words of one of my more sympathetic correspondents, it has turned out to be an Annus Horribilis”

Undeniably, 2014 has already been an extremely difficult year for us plagued by yet another aviation tragedy. Indeed, such misfortunes often remind us of how fragile life can be. 

I recently received a letter from a reader. 

“Dear Dr G, 

I am a 46-year-old woman and hope you can help me.

I am overall healthy, but have a lifetime bad habit of smoking.

I have been rather bothered by some toilet issues.

I have encountered blood in the urine in the past three months.

The bleeding is mixed with the urine and occasionally, I also noted some clots.

The good news is the blood in the urine is not associated with any pain.

I was hoping the bleeding would go away after it stopped one month ago, unfortunately, the bleeding started again lately.

Should I be worried?


The presence of fresh blood in the urine should raise the red alert immediately! In medical schools, most of us were taught: “Painless blood in the urine is equal cancer unless proven otherwise!”

Ironically, most sufferers would assume the lack of pain is a blessing.

On the contrary, painful urination is commonly associated with benign causes such as stones or infections; and the painless bloody urine is usually associated with cancers.

The presence of blood in the urine is called haematuria.

Although the presence of redness in the urine can be frightening; occasionally, the causes may be non-bleeding related etiologies such as food dyes, medications or foodstuff like beetroots or rhubarb.

The verification of blood in the urine is important before further investigations. This can be carried out with microscopy or dipstix of the urine.

Bloody urine can be classified as microscopic or frank haematuria.

The vast majority of cases of blood in the urine are benign, including bloody enlarged prostate or even strenuous exercise.

Serious causes of blood in the urine can be caused by kidney damage or cancer arising from the bladder, kidneys or prostate.

The investigation of the blood in the urine is quite standardised. This involves the analysis of the urine, imaging and endoscopy.

Imaging tests such as ultrasound scans or CT scan can also delineate the source of the bleeding with clarity.

The most definitive mode of investigation is cystoscopy. This involves the insertion of a flexible digital camera (Small one, of course!) in to the urethra.

The examination is rather straightforward to the ladies but can bring tears to a gentleman’s eyes when done under local anesthesia (OUCH!!).

Such investigation can determine the presence of the commonest malignant cause of painless haematuria: bladder cancer. 

In 2011, nearly 70,000 people were diagnosed in the USA with bladder cancer and almost 15,000 will die from the disease. Without a doubt, cigarette smoking is the most important risk factor for bladder cancer.

Recent research had also estimated that smoking is now responsible for about half of female bladder cancers. Previous studies had actually demonstrated only 20 to 30% of bladder cancer cases in women were smoking related. 

The research also found stronger association between smoking and bladder cancers than previously reported.

Former smokers were twice likely to develop bladder cancer as those who never smoked, and current smokers were four times more likely. As with many smoking-related diseases, cessation is associated with reduced cancer risks. 

The late Robin Gibbs from Bee Gees once said: “I don't take things for granted, because everything feels more fragile. It has made me wonder about mortality and how long you have got in the world”.

On that note, Jenny, get your haematuria checked out and its time to quit smoking!

> The views expressed are entirely the writer’s own. 


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