When men pee blood

By Dr Pius Musau

The sight of blood in urine is gross and a reason for many poeple to freak out.

For a male patient, to pee blood also medically referred to as haematuria, is an indicator of an underlying problem, which will need exhaustive evaluation and appropriate Intervention.

The causes of haematuria may range from rare to the obvious. It could be due to medical disorders or complications of drug therapy one maybe taking.

But, the most common causes may be medical or surgical and will have a bearing on the underlying problem and mode of treatment.

Medical: These are predominantly infections of the urinary tract, particularly the kidneys and bladder. They are likely to present as microscopic, painful haematuria, but may also be gross in severe cases. Of special mention is the infection in swampy areas called bilharzia, that if not treated properly, can lead to bladder cancer later in life.

Surgical causes:

• Trauma of the urinary tract right from the kidneys down to the urethra is usually dramatic and evident in the history given. There may be associated rupture of the bladder.

The urethra is particularly prone to trauma from pavement projections, manhole covers, astride falls and kicks to the perineum. There will be blood at the urethral opening and a stricture may follow the urethral injury.

• Urinary stones may be in any part of the tract, but are commonly found in the kidneys, ureters and bladder.

The ureteric stones cause crampy pain that makes the patient pace around restlessly, while a bladder stone will result in discomfort experienced at the tip of the penis.

• Tumours, whether benign or malignant, affect the kidneys, bladder and the accessory gland called the prostate. These are among the causes of haematuria and require early detection and accompanying decisive action.

The rare causes of haematuria include medical disorders, which affect the clotting mechanism. Note: Some drugs and foods may make the urine appear bloody in colour.

Evaluation: A haematuric patient requires a comprehensive history aimed at finding out the cause for the bloody urine.

Physical examination may reveal masses in the abdomen or an enlarged prostate.

There may also be tell-tale signs of possible complications of the cause or disease progression and its effect on the tract. The investigations will include laboratory and imaging tests as well as diagnostic procedures.

Treatment: The interventions will depend on the type and underlying cause of haematuria. While some patients will be given medicine, others whose problem is of urological nature, will have to undergo surgery.