Painless hematuria, or blood in urine without pain or discomfort, is a common sign of bladder cancer in adults and requires urgent investigation. Visible blood may indicate bladder cancer, while blood only visible under a microscope may have other causes. Treatment options for bladder cancer include surgery, chemotherapy, and radiation therapy.
Hematuria is another name for blood in the urine, and painless hematuria refers to blood that is found without any symptoms of pain or discomfort in or around the bladder and kidneys, or when urinating. Urine blood may be visible to the naked eye or only apparent under a microscope. Since painless hematuria in adults is a common sign of bladder cancer, it is usually investigated urgently, especially if the blood is visible without a microscope. Where abnormal bleeding in the urinary tract is associated with pain, it is more likely to be benign or non-cancerous, as is the case with kidney stones and urinary tract infections.
While visible blood in the urine, in the absence of other symptoms, can often indicate bladder cancer, if the blood is only visible under a microscope, there are more possible causes, especially in younger people. These causes of painless microscopic hematuria include certain kidney problems, the use of certain medications such as certain antibiotics and anti-inflammatory drugs, and an enlarged prostate. Occasionally, strenuous exercise can also lead to blood in the urine. Where blood appears to be visible in the urine it is important to rule out other factors which may cause a red discolouration, such as beetroot consumption and the use of certain medicines.
Laboratory studies of urine, known as urinalysis, are usually done if you have painless hematuria. Other investigations may be done, including ultrasounds of the urinary system, abdominal x-rays, and cystoscopy, in which an instrument such as a telescope is inserted into the bladder. If bladder cancer is found using a cystoscope, it may be possible to take a sample of tissue at once or even remove the growth.
When investigation of painless hematuria leads to the discovery of bladder cancer, treatment and outlook will depend on the type of cancer and how far it has spread. If a cancer hasn’t spread beyond the lining of the bladder, a cure may be possible. In cases where the bladder wall muscle has been invaded, a cure is less likely and treatment aims to slow the progression of the disease and improve symptoms.
Treatment options for bladder cancer may include surgery to remove the tumor or the entire bladder. Chemotherapy, in which drugs are used to destroy cancer cells, can be given before or after surgery. If radiation therapy is used, in which radiation is directed at the cancer cells, this may also be preceded by a course of chemotherapy. Combining therapies in this way is thought to be more beneficial than using them individually.
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