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
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
Presentation
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.
Possible Causes
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.
Clinical history
The pattern of bleeding, pain, clots, urinary symptoms, infections, smoking history, medications, and previous stone or prostate problems are reviewed carefully.
Examination and urine testing
Urine dipstick, microscopy, culture, and sometimes urine cytology may be used depending on the presentation.
Blood tests and kidney assessment
Kidney function and other relevant blood tests may be performed, particularly if there is concern about renal causes.
Imaging
Ultrasound or CT imaging may be used to assess the kidneys, ureters, bladder, and prostate, depending on the clinical picture.
Flexible cystoscopy
A flexible camera inspection of the bladder is often an important part of assessment, especially in visible hematuria or persistent unexplained non-visible hematuria.
Visible and Non-Visible Hematuria
Why the pathway may differ
Treatment
Treatment depends on the underlying cause
Hematuria itself is a sign. Management is directed at the condition responsible for the bleeding.
Struggling with this condition?
If you have persistent symptoms, repeated infections, or have not found answers so far, a specialist assessment can help clarify the diagnosis and guide treatment.