Usually, you begin by seeing your family doctor (GP). They will ask for a sample of your urine. This will be tested in the surgery to find out if you have any blood in it. Your GP may then carry out an internal examination of your back passage (rectum) and (in women) your vagina. This is because the rectum and vagina are very close to the bladder, and it allows the doctor to feel for any obvious changes.

Your urine sample will be sent to a laboratory to be checked under a microscope for any abnormal cells. It will also be checked for infection. Your GP may also arrange for further tests or x-rays. They will need to refer you to hospital for these tests, and for expert advice and treatment from a urologist (specialist doctor who treats bladder and kidney problems).

Some people who have blood in their urine (haematuria) may be referred to a ‘one-stop’ haematuria clinic. At this kind of clinic, all the tests needed to make a diagnosis can often be carried out on the same day. You may be asked not to eat or drink anything for up to eight hours before your appointment.

At the hospital

The urologist will ask you about your symptoms and general health. You will also be asked if you have any other health problems. The doctor will examine you by feeling your abdomen and bladder and you may have another internal examination.  They will probably ask you to give another urine sample and take a blood sample for testing.

Some of the following tests will then be arranged for you:

Blood tests

Samples of your blood will be taken to check your general health, the number of cells in your blood (blood count), and to see how well your kidneys and liver are working.

Cystoscopy

The most important test is a cystoscopy. This is where a doctor uses a thin, flexible fibre-optic tube with a light on the end (cystoscope) to look at the inside of the bladder.

It’s usually done first under a local anaesthetic, because this is the quickest and simplest way. Some people may have a sedative to help them relax.  A jelly, which contains anaesthetic is squeezed into the opening of your urethra (tip of the penis or outside of the vagina). The anaesthetic will start to work after a few minutes.

The doctor will then gently pass the cystoscope into your urethra. This allows the doctor to look at the whole lining of the bladder and urethra. The whole test takes a few minutes and you can usually go home straight afterwards. You may have some soreness or mild pain when you pass urine for the first time after the test.  You may notice a little blood in your urine for the first couple of days. There are not usually any other after effects.

If any abnormal area that could be bladder cancer is seen, you will be asked to come back for a cystoscopy and a biopsy (removal of a piece of tissue) on another day.

Cystoscopy and biopsy

This is sometimes done as a day-case under a general anaesthetic but you may need to stay in hospital overnight. You will be given instructions on how to prepare for the test. Under the anaesthetic, the doctor can closely examine the inside of the bladder and can take samples (tissue biopsies) of any abnormal areas. Any small growths can be removed, as they could be cancer. You can usually go home the same day. The tissue samples are sent to a pathologist (an expert who identifies diseases by looking at cells) who examines them under a microscope. If the biopsy shows that you have cancer of the bladder, you will be asked to go back to the hospital to have the cancer removed.