Bladder cancer

Blood in the urine, once, painlessly, is enough to be investigated. It is the symptom people most often dismiss because it goes away.

What it is

Cancer of the lining of the bladder. More common in men, and strongly linked to smoking, which accounts for around half of cases, and to some industrial chemical exposures in dye, rubber and textile work.

The defining feature is how it announces itself: visible blood in the urine, usually painless, often just once, and then apparently gone. People wait, it does not happen again, and they decide it was nothing. It was not nothing, and a single episode of visible blood in the urine in an adult warrants urgent investigation regardless of whether it recurs.

Most bladder cancers are found while still confined to the lining, which is treatable, but they have a strong tendency to come back. That is why follow-up involves repeated cystoscopy over years, which is burdensome and is the part people give up on.

Urinary tract infection is the great confounder: blood in the urine is put down to infection, treated with antibiotics, and never investigated further. Blood that persists after an infection has been treated needs looking into.

Signs you might notice

Blood in the urine: pink, red or brown, usually without pain. Even once.

Needing to pass urine more often, urgently, or a burning feeling, when infection has been ruled out or has not settled with treatment.

Later: pelvic or bone pain, weight loss, swelling of the legs.

An adult with visible blood in the urine should be referred on an urgent suspected cancer pathway. Being on blood thinners does not explain it away.

How it can affect day-to-day life

Repeated cystoscopy is uncomfortable and undignified, and dropping out of surveillance is common and dangerous. Knowing that the discomfort is short and the alternative is a cancer found late helps some people; better preparation and pain relief helps more.

Treatment with BCG or chemotherapy into the bladder means frequent hospital visits over months, with real effects on work and travel.

For people who need the bladder removed, life with a urostomy is a major adjustment and is done well by many thousands of people. See stoma care.

Smoking cessation after diagnosis reduces the chance of recurrence, and is one of the few things the person themselves controls.

Supporting someone well

Blood in the urine, once, painless: go to the GP and ask for urgent referral. Do not wait to see if it comes back.

If an infection was treated, get a repeat urine test to confirm the blood has gone. Persisting blood needs investigation.

Do not accept anticoagulation as the explanation.

Keep every surveillance appointment, and say if the procedure was badly painful so it can be done differently next time.

Stop smoking; it lowers the recurrence risk as well as the risk of everything else.

For anybody with a urostomy, get the stoma nurse's number and use it early rather than struggling on with a leaking appliance.

Where to get help

A GP practice urgently for blood in the urine.

The urology clinical nurse specialist once under a team.

Fight Bladder Cancer run a support community and clear patient information.

Macmillan Cancer Support on 0808 808 00 00.