A 52 year old female came in because of dysuria (painful urination) and hypogastric pain. Urinalysis showed pyuria(pus in the urine) and hematuria (blood in the urine). I gave her antibiotic and treated her as a case of urinary tract infection with strict advice to follow up after one week with a repeat urinalysis. She never came back.
After 1 month though, she came back with her new urinalysis results, this time, blood was +4, sugar +2, red blood cells 20-25/hpf and a normal white blood cell count. She said she never came back because her symptoms disappeared after 3 days of antibiotic treatment.
There may be 3 possible reasons for the presence of blood in the urine. Infection with pathologic bacteria such as E. Coli may cause hematuria. The bacteria can invade the bladder tissues and cause inflammation. This can sometimes produce minute rupture of small blood vessels producing blood in the urine. Another is the presence of a stone. Stone formation may be due to calcium or uric acid crystals. Presence of stones anywhere in the urinary tract may cause hematuria as it can cause abrasion of the inner lining of these structures. Blood in the urine may also be indicative of malignancy. For female patients, it is necessary to check for presence of gynaecologic pathologies.
In such cases, I also advise patients to drink a lot of fluids and observe proper perineal hygiene. Cleansing with water should be done from the front to back as contamination of the perineal area by anal bacteria is possible. Use of tissue or cloth may be used to damp excess urine or water but never rub the area.
An ultrasound of the kidneys and the urinary bladder is warranted to confirm diagnosis of a stone. I also sent her to a gynaecologist for a Pap smear. A word of advise: always see your doctor when she tells you to follow up. She wouldn’t ask you to do so for no reason at all.
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