

Roach column: Numerous causes for blood in urine

6:30 PM, Feb. 24, 2014  |  Comments
Keith Roach
Keith Roach
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Dear Dr. Roach: I am a female, 50 years of age and I smoke less than half a pack of cigarettes a day. I recently found out that I have blood in my urine. It is not noticeable with the naked eye, but under a microscope. I drink up to five bottles of water daily, along with green tea. My doctor said that I could have a kidney stone or some kind of infection. I have an appointment with a urologist next month. What should I expect? - R.C.

Answer: Hematuria (blood in the urine) is a common finding and usually does not mean serious disease. Your doctor is quite right that kidney stones and infection are common causes. Normally, a urine culture would be done immediately to look for infection. However, you have two risk factors for cancer of the urinary tract, being 50 years old and with a smoking history. Your risk is still low (a few percent), but high enough that your urologist is likely to recommend a CT scan of the urinary tract, from the kidneys through the bladder. This certainly will identify stones if present, and is the best test to be sure you don't have a tumor. The urologist also may recommend a cystoscopy, the passage of a small, lighted tube to examine the lining of the urethra (which carries urine from the bladder to the outside of the body) and bladder. Odds are that everything will be fine, but your urologist is likely to make sure.

This is a good opportunity to quit smoking.

Dear Dr. Roach: I am a young woman who has had extreme gas and belching for years, and I am desperate for help. I have tried many things, including watching my intake of greasy and starchy foods, as well as others that can cause gas, but to no avail. Also, I have bouts of diarrhea and constipation, sometimes on alternate days. I often feel very good for several hours after a bowel movement. Could parasites be part of my problem? - A.

Answer: You have a classic presentation of irritable bowel syndrome. While IBS is common, it is highly variable from one person to another, and I feel that its severity and ability to disrupt work and especially social life is often underappreciated by those who aren't affected by it.

It is important to know that IBS doesn't predispose a person to cancer or worsen life expectancy. However, there are serious conditions that may look like IBS, so a visit with a gastroenterologist or internist familiar with IBS is important. Bacterial and parasite infections (especially Giardia) occasionally can cause some symptoms of IBS; however, most cases are not caused by infection. Celiac disease and lactose intolerance often are misdiagnosed as IBS and may be worth testing for. Inflammatory bowel disease, Crohn's disease and ulcerative colitis are serious GI conditions that should be looked for in people with a family history or warning signs, such as bleeding and weight loss. Even ovarian cancer has been misdiagnosed as IBS in women and should be considered.

I have written before about the benefits of a low-FODMAP diet. Some foods and many artificial sweeteners should be avoided on this diet, and it has been helpful in 75 percent of people with IBS. More information about this is available from a nutritionist, and there is an introduction to the diet at Many readers have written to me about the value of probiotics, which can be very helpful, even life-changing, for some people.

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