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Ask the doctor: Is blood in my urine a reason to worry?

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For a few years I have experienced blood in my urine. Despite various scans and tests, no one has been able to find the cause of this. However, I was recently diagnosed with the bowel disorder diverticulosis — could this be causing the problems? My wife says I could be suffering from sugar intolerance.

Ian McDowell, Peterborough.

Blood in the urine (called haematuria) may be caused by an underlying disease

Though this symptom is no doubt alarming, blood in the urine without an obvious cause such as cystitis or a kidney stone is common.

I have one or two patients whom I have followed for years with this symptom (called haematuria), with no obvious cause.

However, it is unsettling when detailed investigations do not provide an accurate diagnosis and a chance to stop the problem.

The important point is to keep re-checking, at least annually, because in some cases the cause is eventually revealed.

The concern is that haematuria may be caused by an underlying disease, such as inflammation of the prostate, kidney stones and, in older patients, cancer in a kidney or somewhere in the urinary tract.

You tell me in your letter you have been fully and properly investigated, which is reassuring — the most important of these tests would have been a CT scan, cystoscopy (visual inspection of the bladder lining) and examination of the urine for cancer cells (cytology).  

These have found nothing sinister, and I assume that a follow-up with cytology and repeat imaging or even a cystoscopy will take place.

The suggestion that sugar intolerance — type 2 diabetes — is to blame can be dismissed. Though kidney damage is a feature of long-term diabetes, this would have been evident in your history and tests. But the other suggestion — diverticulosis — is worth considering.

CONTACT DR SCURR

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details.Dr Scurr cannot enter into personal correspondence.His replies cannot apply to individual cases and should be taken in a general context.

In this condition, small pouches or ‘blowouts’ form in the large intestines at weak points in the intestine wall — like the inner tube of a bike tyre popping out through a crack in the outer casing.

These ‘blowouts’ (known as diverticula) mostly occur at the bottom end of the colon, which is on the left side of the body — and which is why, if the condition causes pain, it occurs on that side.  

They are more common in older people — in one study, they were found in 60 per cent of those  aged 60.

The diverticula do not always cause problems. When they do not produce symptoms, as in your case, the condition is called diverticulosis (you tell me in your letter that your condition was diagnosed only after a camera inspection — colonoscopy — of the large intestine).

It’s only when debris from the large intestine collects in these pockets that there can be trouble.

The pouches can become inflamed, triggering characteristic symptoms such as pain, constipation, diarrhoea or bleeding. This is known as diverticulitis.

Because this condition affects the bowel, and not the bladder, the only possible way it could trigger the blood in the urine is if the inflamed pouches rub on the outside of the bladder wall, causing inflammation and bleeding.

This can happen in appendicitis, when the inflamed appendix rubs against the bladder lining. However, for this to occur in your case I would imagine that the outpouchings would need to become inflamed before they would impinge on the bladder — that is, your condition would have progressed to diverticulitis.

Further, I would have expected that at least a degree of bladder wall inflammation would have been identified during the cystoscopy, though it is possible the inspection was carried out at a time when inflammation was low.

Despite this, your idea that the diverticulosis is implicated is a worthy thought, and I would raise it — tell your urologist about the recent colonoscopy.

Many years ago, I suffered with depression and panic attacks. I was given electric shock therapy and antidepressants. I noticed an improvement, but over the past few years I’ve undergone a mastectomy and hysterectomy and have been diagnosed with osteoporosis and the eye condition age-related-macular degeneration. I now cannot walk unaided and the depression and anxiety have returned. What treatments can I try to ease these terrible episodes?

Name and address supplied.

No one could fail to be moved by your story — I feel saddened and only hope you have an interested and supportive GP, and relatives or friends who can give you care in your predicament.

Your depressive illness, which is manifested as panic attacks, is possibly the worst aspect of all that you have described, as it destroys optimism, narrows horizons, saps confidence — and has profound and negative effects on your general health.

The positive side is that in this era the medicines available are better than they have ever been, and most doctors are well versed in the choice and use.

It is rare to have to resort to the effective but rather daunting and complex treatment of electro-convulsive therapy.

You tell me you have previously tried the antidepressants known as selective serotonin reuptake inhibitors.

    More from Martin Scurr...   How can I get this heavy feeling off my chest? 03/06/13   Ask the doctor: Bad breath is ruining my self-confidence 27/05/13   Ask the doctor: Will my shingles pain ever go away? 20/05/13   Ask the doctor: Why am I seeing stars in my eyes? 07/05/13   Ask the doctor: What has caused my unbearable leg pain? 29/04/13   Ask the doctor: Why are my teeth starting to crumble? 22/04/13   Ask the doctor: Simple steps for easing a hormone headache 08/04/13   Ask the doctor: Why do my wife's hands bruise so easily? 01/04/13   VIEW FULL ARCHIVE  

These work by increasing the amount of the feel-good chemical serotonin in the brain, and there are a number of different types of these drugs — the advantage of this being that one may be effective where another fails. 

A recent development in psychiatry has been the practice of introducing ‘enhancing medicines’ to the primary anti-depressant, either one of the atypical antipsychotics (such as olanzapine or quetiapine) or stabilisng agents (such as pregabalin or lamotrigine).

It is also worth discussing with your GP the option of talking therapies — one in particular, called cognitive behavioural therapy, has been shown to help tackle panic attacks. 

There is every reason for optimism and every reason to hold on and be confident that you definitely can be helped.

By the way...Why A&E is on the critical listPlenty of people are concerned about the ever increasing pressure on A&E.

Even the College of Emergency Medicine, whose members have been remarkably resilient and tolerant as their workloads have risen, has stated a tipping point has been reached and expressed great fears that standards will slip.

The problem is too many people turn up at A&E for problems that really should be cared for in the community.

Overload: There are fears that standards will slip in A & E units due to demand for urgent care

This is not how it should be, and it pays to reflect on how we got in to this difficulty.  It’s easy to say changes in our culture — lower thresholds for anxiety and ever greater expectations about what is possible from the health service — are at the root of everyone pouring into A&E.

But I think greater awareness and involvement gives people more sense of personal responsibility and self-care, and less reason to consult for trivia — but is not the reason for the A&E overload. It must be that when there’s a problem — such as severe earache in a small child — there’s no other resource available out of hours.

The Royal College of GPs says this is nothing to do with the change of GP contract in 2004, when family doctors were able to opt out of their round-the-clock commitment to patients.

The gap was supposed to be filled by NHS Direct, a phone advisory service staffed by trained personnel who worked according to instructions (‘protocols’).

That service hasn’t measured up to what went before, when all you had to do was call up the GP practice and a doctor would call back and advise, or even visit.

Over the years, many groups of GPs had banded together to share the commitment and workload, not quite as ideal as there’s less chance the duty doctor would know the patient or their history, but viable all the same, and a good service. But whatever the doctors say, the change in the GP contract has brought about nothing for the public except for this major change in their experience of out-of-hours services.

And I suspect that most GPs, while relieved no longer to be working at nights or weekends, aren’t entirely happy about what’s happened because they don’t feel so close to their patients. (There are also some who see in the contract a devious government ploy to allow private companies into the NHS.)

So what now? I think it needs a revolution in thinking — by the profession. The genie is out of the bottle: there is no return to the old system. Maybe the time has come when each GP practice has to organise a rota to cover anti-social hours, as consultants are having to  do as they contemplate seven-day working in hospitals. I don’t think there’s a choice.


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