Hematuria (Blood in the Urine)
Blood in the urine can be visible to the eye or detected only on urine testing. Although some causes are minor, hematuria can also be an early sign of important bladder, kidney, ureteric, or prostate problems and should be assessed properly.
Key points
- Visible blood in the urine should always be investigated.
- Microscopic blood in the urine may still need specialist assessment.
- Assessment usually includes urine tests, imaging, and often cystoscopy.
- Prompt diagnosis helps identify both benign and serious causes early.
What is hematuria?
Hematuria simply means the presence of blood in the urine. It may occur once, come and go, or persist. Some patients notice red, pink, or brown urine, while others are told that blood has been found only on a urine dipstick or laboratory test.
Hematuria is not a diagnosis by itself. It is a symptom or sign that needs a cause to be identified. The source of the bleeding can arise anywhere in the urinary tract, including the kidneys, ureters, bladder, prostate, or urethra.
Two main types
- Visible hematuria — blood can be seen in the urine.
- Non-visible hematuria — blood is detected only on urine testing.
How hematuria may present
The pattern of bleeding, associated symptoms, and your age or background risk factors all help guide the assessment.
Visible hematuria
The urine may appear pink, red, rust-coloured, or cola-coloured. Sometimes the bleeding is painless. In other cases it is associated with urinary infection, stone pain, or clots.
Non-visible hematuria
Blood is found on dipstick or microscopy even though the urine looks normal. This may be discovered during routine testing or when investigating urinary symptoms.
Associated symptoms
Some patients also have burning when passing urine, urinary frequency, urgency, loin pain, lower abdominal discomfort, reduced urinary flow, fever, or passage of clots.
Who particularly needs assessment?
Adults over 40, smokers, those with recurrent urinary symptoms, previous stones, prostate symptoms, occupational chemical exposure, or a family history of urinary tract disease may need especially careful evaluation.
What can cause blood in the urine?
There are many possible explanations. Some are straightforward and treatable, while others require urgent exclusion.
Urinary infection
Infection of the bladder or kidneys can cause bleeding, often with burning, frequency, urgency, and discomfort.
Kidney or bladder stones
Stones may irritate the urinary tract lining and cause bleeding, sometimes with severe pain or episodes of urinary blockage.
Prostate-related bleeding
Enlargement of the prostate, inflammation, or increased vascularity within the prostate can sometimes lead to hematuria in men.
Bladder, kidney, or upper tract tumours
One important reason to investigate hematuria is to exclude cancer affecting the bladder, kidneys, ureters, or other parts of the urinary tract.
Inflammation or kidney disease
Some forms of kidney inflammation or medical renal disease can cause microscopic or visible blood in the urine, sometimes with protein loss or abnormal kidney function.
Other causes
Trauma, vigorous exercise, blood-thinning medication, recent procedures, or urethral causes may also contribute in selected cases.
How hematuria is assessed and diagnosed
The aim is to identify the cause of bleeding and to exclude serious pathology in a structured way.
The pattern of bleeding, pain, clots, urinary symptoms, infections, smoking history, medications, and previous stone or prostate problems are reviewed carefully.
Urine dipstick, microscopy, culture, and sometimes urine cytology may be used depending on the presentation.
Kidney function and other relevant blood tests may be performed, particularly if there is concern about renal causes.
Ultrasound or CT imaging may be used to assess the kidneys, ureters, bladder, and prostate, depending on the clinical picture.
A flexible camera inspection of the bladder is often an important part of assessment, especially in visible hematuria or persistent unexplained non-visible hematuria.
Why the pathway may differ
Visible hematuria
Visible bleeding is generally treated more urgently, even when it happens only once. This is because the chance of significant underlying pathology is higher.
Non-visible hematuria
Microscopic bleeding is interpreted in context. The need for cystoscopy and imaging depends on age, persistence, symptoms, kidney findings, and other risk factors.
Painful hematuria
When hematuria is associated with pain, infection or stones may be more likely, although proper assessment is still important.
Painless hematuria
Painless visible hematuria is particularly important not to ignore, as bladder or upper tract pathology can sometimes present this way.
Treatment depends on the underlying cause
Hematuria itself is a sign. Management is directed at the condition responsible for the bleeding.
Treating infection
Urinary infections are treated with appropriate antibiotics and follow-up testing where needed.
Managing stones
Stones may be managed conservatively, with medical treatment, or with intervention depending on size, location, pain, and obstruction.
Prostate-related treatment
Where prostate enlargement or inflammation is contributing, treatment may include medication, further assessment, or prostate procedures if indicated.
Bladder or upper tract findings
If cystoscopy or imaging identifies suspicious lesions, a further specialist pathway and appropriate treatment plan will be arranged promptly.
Kidney-related causes
If the pattern suggests medical renal disease rather than a urological cause, onward nephrology assessment may be appropriate.
Reassurance when appropriate
In some cases the assessment is reassuring and no serious abnormality is found. Even then, a proper evaluation is important before reassurance is given.
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Arrange a specialist hematuria assessment
If you have had visible blood in the urine, persistent microscopic blood in the urine, or urinary symptoms that need proper investigation, an early consultant-led assessment can help provide clarity and the right next steps.