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A question for Canadian Health Care workers (or anyone who knows)

Raisin

Veteran

For any of you ladies working in the Canadian Health Care system, I have a quick question. If someone were to go to the emergency room because they were urinating blood, and the more benign things like UTI and yeast infection were ruled out, would they normally do a scope there to look in the bladder, or just refer that person to a specialist to follow up later? Also assuming they did an x-ray or ultrasound and kidney stones and anything else was ruled out. I'm just wondering how far they would go at the ER, or would it have to be a specialist referral and a few months wait.

THANKS!!!

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19 replies

Latest reply was from Glory

lyn*

(website)

Veteran

Given I don't know your specific clinical situation, if someone was peeing blood, I'd definitely scan them - CT/US to start; or an MRI. Sometimes if someone wasn't losing a lot of blood, we ask patients to come back the next day (i.e.: if it was a weekend) for an urgent scan.

If the scans come back negative, and there were other signs we were concerned about for possible bladder cancer, we'd scope them probably within a week... or two. I think I had one patient we got in for a scan within a week.

I'm not an ER/Family resident, so, my experience is limited, and I do live in a big city. I'd definitely do a urology consult in the ER though, especially if there was change in the blood work or there were secondary signs that something more sinister was brewing. Usually we do a pelvic exam too (in ladies) just to make sure it's not coming from there. And look at the rectum. Sometimes the specialist hears the story and asks us to book the patient in for urgent clinic, so you (the patient) may not see the specialist in the ER - but they are advising us as your primary physician.

I have never heard of anyone having to wait for months when you can visibly see blood in the urine (macroscopic hematuria). I'm guessing there is no obvious cause of the blood - i.e.: kidney stones; or like it's your period. And any doc can order a bladder scan here - but it's usually not someone like me (psychiatry!)

Raisin

Veteran

Thanks Lyn!

Well to be more specific, I had an episode where I urinated blood a few years ago. Had all the bloodwork and scans, saw the urologist, nothing came up and he said it was not unusual. Don't worry about it basically. So now fast forward a few years. Been urinating blood off an on for the past month. Saw my family doctor about it. It has happened ONLY after I run. But these are not vigorous runs. Like 1/2 hour moderate treadmill runs. Still to me it seemed like at least it probably was connected and he did bloodwork and no UTI, yeast infection, no kidney problems. He said though that even marathon runners usually only have microscopic blood and mine is like MACROscopic. I usually have to stop and make sure it's not aunt flo time, cause it could resemble that (Sorry). Referral to the urologist again and now am waiting.

However, today has been bleeding all day and NO running at all. So I am freaked a bit. My so called "connection" is gone and I don't feel so good about the issue now. Also the past 2 weeks I have had to skip many runs because I have the urge to pee so bad, even right after going, that I cannot even run. Today I have bloody urine, no physical activity and a sore back.

Anyway, my only issue was I don't want to waste time at the ER knowing already it's not likely a UTI, yeast infection or stones, and if they then just have me wait for the urologist, well I'm already waiting on that anyway. But if they would look into it further like a cystoscopy right there, then I would be happy to know right now it's not something super serious. I just don't know if that's normal ER procedure or not, and I don't want to go if it's not. Cause I already know it's not the "usual" stuff.

lyn*

(website)

Veteran

WTF. That doesn't sound normal at all.

You're right - runners usually have microscopic hematurea.

Depending on your centre, they may not be able to do a cystoscopy right then and there, but you should be seen on an urgent basis. If you're bleeding enough that you think it might be period blood, I'd be concerned.

Is your GP not willing/able to get you an urgent urology appointment or at least a cystoscopy? Some of the urologists have resident clinics that you can get in to see sooner.

I don't know what advice I can give you since I can't assess you and I'm a psychiatry resident. Maybe we have some other docs who can weigh in here - I don't really deal much with bodily fluids.

Raisin

Veteran

Well I don't think I'd be urgent at the ER cause when I went in a month ago I waited 6 hours and had to leave due to an urgent work call. At least when I left an ambulance was coming in so I didn't feel so bad, I knew it would be a few more hours at least.

My doctor said when he made the referral to call him if it kept occurring and he would see what he could do to speed it up. So I did let him know a couple weeks ago. I called him today but he's off till Monday. I have no idea what the normal wait time for this is, I can't remember how long I waited to see him last time.

I think since it's the weekend I probably won't get anything done at the ER, so if I wait and call him Monday then maybe he can make it an urgent call since now it's happening even without running. I don't know what we have for urgent urology visits, but I guess I will have to find out Monday. I think, based on my last visit, it would just be a waste of time sitting around the ER over the weekend.

I should say though it's always after running where it looks similar to AF. But that lasts one pee, then maybe the next and it's gone. Today it's been red, but not like AF. Still very obviously blood though. So it wouldn't look AS crazy, but then again I didn't even run or anything, and it's happened for at least 3-4 pees now.

Can a person have endometriosis INSIDE the bladder? Cause lately I've been wondering if it could be that. I will have to ask my OB about that. That would suck, but of the other options I can think of at the moment, it's probably not so bad.

lyn*

(website)

Veteran

I guess technically you can have endometriosis anywhere ... the thing to rule out for mysterious bladder bleeds would be bladder cancer.

ETA: I'll leave you with the Patient (Beyond the Basics) article for hematuria in adults: http://www.uptodate.com/conten.....source=sea

Raisin

Veteran

For sure. And I was ok waiting on the urologist so far cause honestly I just assumed the bleeding was from running. It just really freaked me out today that it happened for no "reason", so to speak. Well I talked to the nurse hotline and reading between the lines and all she pretty much confirmed the ER won't do a cystoscopy unless super urgent. I don't feel they will see me as super urgent so I will just harass my doctor on Monday to get me in. Thanks for listening to me freak out!

lyn*

(website)

Veteran

Good luck No problems!

Beth Ann

Veteran

Not Canadian. Not a Doctor, but I'm sending my thoughts and prayers for peace and good rest this weekend while you wait to get some answers. Our bodies are amazing, but oh so complicated and intricate! I'm sure you'll find excellent help, just don't be afraid to press for it!

Deborah

Veteran

Not a doctor or a Canadian but like Beth Ann you are in my thoughts and prayers My GP always encourages me that most times things are not serious. But this does need to be followed up. Silly question but you are sure you are weeing the blood? Some of what you describe is similar to when I was diagnoses with a large fibroid in my uterous. Not sinister but I did need to do something about it. I also had a virus about three years ago which caused some blood in my urine. That was quite stressful for me but it appears it was viral and I was and have been fine. Here in Australia this would be treated as a matter of urgency. You may have to be proactive and really push to get some immediate attention.

Nicole D

Veteran

I would call the urologist that you saw before and report that your symptoms have changed/become more worrisome - maybe they can fit you in sooner since they saw you before. Although if it has been a few years, they may insist on your family MD getting involved. Calling your OB is not a bad idea either. May annoy your family MD that you are calling specialists directly, but if you are worried, you have to intervene. Call your family MD on Monday and let him know you are having back pain and urgency (that have to pee feeling). You should go back to ER no matter what if you get other symptoms that worry you - dizziness, heavy bleeding, more pain, whatever. Don't mess around - if you are worried you need to do what it takes to get this dealt with.

Raisin

Veteran

Thank you all. Thankfully the blood stopped today. It was still going up till 3am but I'm happy it's stopped now. Also my back pain went away. I am hoping maybe it was a kidney stone. I have passed 2 before, only while pregnant. They never caused me to bleed, but maybe this time was different. Though the pain was nothing like the last one I passed! Although, I guess a kidney stone wouldn't really make sense that I've been bleeding off an on for a month.

Here, if we haven't see a specialist in over a year we have to be referred again. Which is why I have to wait to see my urologist again. I will definitely be bugging my doctor on Monday to speed this consult up though, I was super worried last night thinking of all the very bad possibilities, and I'd just like to know it's not something super serious!

I shall keep you updated, if/when I find something out!

Suz

(website)

Veteran

Rae, I just read this and although I have no great advice I wanted to say I am concerned for you and I definitely think you should be seen. Huge hugs. It must be worrying.

Glory

Veteran

Rae I am glad that the pain has diminished. I am not a doctor but am a fellow Canadian. I think you are on the right track calling your GP first thing and pressing your urgency. Sending (((HUGS)).

catgirl

Veteran

Sending a hug - am having some issues myself and know that feeling of stress). Keep us posted please.

L'Abeille

Veteran

Here in NB you aren't likely to have a scope same day in the ER. They would speed up the imaging though, especially since it's been over a year and this sounds different. Hope you get it all sorted out soon!

Neelie

Veteran

Are you in Toronto? If so I can recommend a gyno/urologist (same person) at Mount Sinai that I have seen. If you see her as a patient even for a consult she will do the cystoscopy right away if she feels it is recimmended, no additional appointment or wait time and she is excellent. PM me if you would like this information and best of luck. Urinary issues are a real pain!

Raisin

Veteran

Thanks Neelie, but unfortunately I'm not in Toronto. In NB and L'Abeille just confirmed what I suspected which is they would not do it at the ER. Fingers crossed my doc can get this process sped up! Calling him today.

Inge

(website)

I am sorry you are going through this, Rae, and I really hope you can get this sorted out as quickly as possible. Please do keep us posted? I am thinking of you!

Glory

Veteran

Rae thinking about you today and hoping you had some success with your primary doctor!