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Hematuria is another name for blood in the urine, and painless hematuria refers to blood being found without any accompanying symptoms of pain or discomfort in or around the bladder and kidneys, or when urinating. Urinary blood may be visible by the eye or only apparent under a microscope. As 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 into 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 the presence of visible blood in urine, in the absence of other symptoms, can often indicate a bladder tumor, if the blood is only visible under a microscope there are more possible causes, especially in younger people. These causes of microscopic painless hematuria include some kidney problems, the use of certain drugs such as some antibiotics and anti-inflammatory medicines, and enlargement of the prostate. Occasionally, strenuous exercise may also lead to blood in the urine. Where blood appears to be visible in the urine it is important to rule out other factors that can cause a red coloring, such as beet consumption and the use of certain medicines.
Laboratory studies of urine, known as urinalysis, are generally carried out in cases of painless hematuria. Other investigations may be performed, including ultrasound scans of the urinary system, abdominal X-rays and cystoscopy, where an instrument like a telescope is inserted into the bladder. If a bladder tumor is found using a cystoscope it may be possible to take a sample of the tissue at the same time, or even to remove the growth.
When investigation of painless hematuria leads to the discovery of bladder cancer, the treatment and outlook will depend upon the type of cancer and the extent to which it has spread. If a cancer has not spread beyond the lining of the bladder, a cure may be possible. In cases where the muscle of the bladder wall has been invaded, a cure is less likely, and treatment is aimed at slowing the progression of the disease and improving symptoms.
Treatment options for bladder cancer may include surgery to remove the tumor or the whole bladder. Chemotherapy, where drugs are used to destroy tumor cells, may be given before or after surgery. If radiotherapy, where radiation is directed at cancer cells, is used, 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.