Blood in Urine in Older Men: Causes, Warning Signs and Tests
Blood in urine in an older man should be assessed even if it happens only once and then stops. Common causes include infection, stones, benign prostate enlargement, recent urinary instrumentation and blood-thinning medicines. However, visible blood in urine can also be the first sign of a urinary tract cancer, especially bladder cancer and sometimes kidney or upper-tract cancer. Blood thinners may make bleeding more noticeable, but they do not remove the need to look for an underlying urinary cause. Depending on your risk factors, evaluation may include urine tests, kidney-function tests, upper-tract imaging and cystoscopy to inspect the bladder.
What does blood in urine mean?
Blood in urine is called hematuria.
There are two main types:
Visible hematuria
This means you can see blood in the urine. The urine may look pink, red, brown, tea-coloured or cola-coloured. Some men may also pass blood clots.
Microscopic hematuria
This means the urine looks normal, but red blood cells are seen on urine microscopy or urinalysis.
Both types can be important. NIDDK explains that hematuria may be visible or microscopic, and can be associated with causes such as infection, stones, enlarged prostate, medicines and urinary tract cancers.
Quick guide: can it wait or is it urgent?
| Symptom or situation | What to do |
|---|---|
| Visible blood in urine, even once | Book early urology evaluation, especially if you are above 45-50 years |
| Painless red urine | Do not ignore; bladder and kidney causes may need to be ruled out |
| Blood in urine with burning and fever | Same-day medical evaluation; urine culture may be needed |
| Blood with severe stone-type side pain | Same-day evaluation, especially if pain is severe or vomiting is present |
| Blood clots or inability to pass urine | Emergency care |
| Blood in urine while on blood thinners | Do not stop medicines yourself; consult your doctor and urologist |
| Repeated microscopic blood in urine | Risk-based evaluation with urine tests, imaging and sometimes cystoscopy |
Blood in urine in older men: why it should not be ignored
In older men, blood in urine has a wider range of causes. Some are simple. Some need urgent attention.
Common causes include urinary infection, kidney stones, enlarged prostate, recent urinary procedure and blood-thinning medicines. More serious causes include bladder cancer, kidney cancer, upper urinary tract cancer and prostate-related disease.
The most important rule is:
Never assume blood in urine is “just prostate” or “just blood thinner” until proper evaluation is done.
NICE recommends suspected cancer referral for people aged 45 and above with unexplained visible hematuria without urinary infection, or visible hematuria that persists or recurs after treatment of infection.
Common causes of blood in urine in older men
1. Urinary tract infection
A urinary infection can cause burning urination, fever, frequency, urgency, foul-smelling urine, cloudy urine or lower abdominal discomfort.
In older men, infection often has a reason behind it, such as prostate enlargement, incomplete bladder emptying, stone disease, catheter use or diabetes. Repeated antibiotics without finding the cause can delay diagnosis.
2. Kidney or ureteric stone
A kidney stone or ureteric stone can cause blood in urine with severe side pain, back pain, groin pain, nausea or vomiting.
Some stones cause only mild discomfort or microscopic blood. If stone pain is associated with fever, chills or vomiting, it may be an emergency because infection behind a blocked kidney can become serious.
3. Enlarged prostate
Benign prostatic hyperplasia, or BPH, can cause weak urine stream, straining, frequent urination, night-time urination, incomplete emptying and sometimes bleeding.
But prostate enlargement is common in older men. So even if the prostate is enlarged on ultrasound, it should not automatically be blamed for bleeding. The bladder and kidneys may still need evaluation.
4. Bladder cancer
Painless visible blood in urine is one of the most important warning symptoms of bladder cancer. The bleeding may stop and return later.
This is why even one episode of painless red urine should be taken seriously. The EAU non-muscle-invasive bladder cancer guideline highlights cystoscopy as part of the primary assessment when bladder cancer is suspected.
5. Kidney cancer or upper urinary tract cancer
Bleeding may also come from the kidney or ureter. This may happen without pain in the early stage.
Depending on the case, your urologist may advise ultrasound, CT KUB, CT urography or other imaging to check the kidney, ureter and bladder lining.
6. Blood thinners and antiplatelet medicines
Medicines such as aspirin, clopidogrel, warfarin, apixaban, rivaroxaban and dabigatran can make bleeding more visible.
But blood thinners should not be used as the final explanation. They may reveal an underlying stone, tumour, infection or prostate bleeding. Do not stop heart or blood-thinning medicines on your own. Speak to your physician/cardiologist and urologist.
7. Recent catheter, stent or urinary surgery
Mild bleeding can occur after catheterisation, cystoscopy, ureteroscopy, prostate surgery, stone surgery or DJ stent placement.
But heavy bleeding, clots, fever, severe pain or inability to pass urine is not normal and needs urgent medical attention.
When should an older man see a urologist?
See a urologist if you have:
- visible blood in urine, even once
- painless blood in urine
- blood clots in urine
- blood in urine with smoking history
- repeated microscopic blood in urine
- blood in urine while taking blood thinners
- recurrent urinary infection
- weak urine stream or incomplete bladder emptying
- fever with stone pain
- unexplained weight loss or appetite loss
- previous bladder, kidney or prostate cancer
Do not wait for urine to become red again. Many important causes of hematuria bleed intermittently.
Emergency signs: seek urgent medical care
Go to the emergency department or contact a doctor urgently if you have:
- inability to pass urine
- blood clots blocking urine flow
- heavy bleeding with weakness, dizziness or fainting
- fever with chills
- severe flank pain with vomiting
- very low urine output
- blood in urine after a fall or injury
- severe pain in a patient with a single kidney or known kidney disease
These symptoms may suggest clot retention, obstructing stone, severe infection or significant bleeding.
Tests used to find the cause
The tests depend on your age, symptoms, smoking history, kidney function, medicines and whether the bleeding is visible or microscopic.
Urine routine and microscopy
This confirms red blood cells and checks for pus cells, protein, crystals and other clues.
Urine culture
This is important if infection is suspected. It helps identify the bacteria and choose the correct antibiotic.
Blood tests
Common tests include CBC, serum creatinine, blood sugar and coagulation profile when needed. PSA may be advised in selected older men after clinical evaluation.
Ultrasound KUB with prostate and post-void residue
Ultrasound can check the kidneys, bladder, prostate size, bladder stones, retained urine and swelling of the kidney.
It is a useful first test, but it may miss small bladder lesions. A normal ultrasound does not always rule out bladder disease.
CT KUB or CT urography
CT KUB is useful when stone disease is suspected.
CT urography gives a more detailed view of the kidneys, ureters and bladder lining when cancer risk is higher and kidney function allows contrast. The AUA/SUFU microhematuria guideline recommends risk-based evaluation, and high-risk patients may need cystoscopy with axial upper tract imaging.
Cystoscopy
Cystoscopy is a camera test that looks inside the bladder and prostate channel.
It is especially important for painless visible bleeding because small bladder tumours may be missed on ultrasound. Flexible cystoscopy is usually done with local anaesthetic gel. It is short and generally well tolerated.
Urine cytology
Urine cytology checks for abnormal cancer-like cells in urine. It may be useful in selected high-risk cases, especially when high-grade bladder cancer is suspected.
It is an additional test. It does not replace cystoscopy.
Treatment depends on the cause
Treatment is different for each patient.
If infection is confirmed, antibiotics are given based on culture. If a stone is found, treatment may include observation, medicines, URSL, RIRS or PCNL depending on stone size and location.
If prostate enlargement is causing bleeding or obstruction, medicines or prostate surgery may be advised.
If a bladder tumour is seen, the usual next step is TURBT – transurethral resection of bladder tumour. In this procedure, the tumour is removed through the urinary passage and sent for biopsy. The biopsy report then decides the next treatment.
Blood in urine should be evaluated systematically rather than repeatedly treated with antibiotics without confirming the cause.
What to bring for consultation
- urine routine/microscopy report
- urine culture report, if done
- ultrasound KUB/prostate report
- CT KUB or CT urography films and report
- PSA report, if done
- creatinine and CBC reports
- list of blood thinners, heart medicines and diabetes medicines
- catheter, stent or discharge summary
- previous stone, prostate or cancer treatment records
- photo of urine colour, if available
FAQs
Is blood in urine in older men always cancer?
No. Infection, stones, benign prostate enlargement, recent instrumentation and medicines are common causes. But visible or persistent blood in urine still needs proper evaluation, especially when it is painless, recurrent or occurs in a smoker, because bladder and upper urinary tract cancers must be excluded.
Can prostate enlargement cause blood in urine?
Yes, enlarged prostate can cause bleeding. But older men should not assume the prostate is the only cause until the bladder, kidneys and urine tests are properly checked.
I had blood in urine once and then it stopped. Should I still see a doctor?
Yes. One episode of visible blood in urine can be important. Bladder and kidney causes may bleed on and off.
Can blood thinners cause blood in urine?
Blood thinners can make bleeding more obvious, but they may uncover an underlying stone, tumour, infection or prostate bleeding. Evaluation is still needed.
Which is the most important test for painless blood in urine?
Cystoscopy is very important because it directly checks the bladder lining. Imaging such as ultrasound or CT urography may also be needed.
Is cystoscopy painful?
Flexible cystoscopy is usually tolerable. Local anaesthetic gel is used. You may feel mild pressure or burning for a short time.
When is blood in urine an emergency?
It is urgent if there are clots, inability to pass urine, fever, severe flank pain, weakness, dizziness, trauma or reduced urine output.
Related reading
- Enlarged Prostate: Symptoms, Causes and Treatment
- Blood in Urine: Is It Bladder Cancer?
- Bladder Cancer: Symptoms, Tests and Treatment
- Kidney Stone Symptoms, Causes and Treatment
- Cystoscopy: What to Expect
- Sudden Inability to Pass Urine
- When Should a Man See a Urologist for Prostate Symptoms?
- Urine Dribbling After Passing Urine: Causes and Treatment
- Enlarged Prostate / BPH Treatment
- Kidney Stone Evaluation and Treatment
- Urologist in Latur
References
- NIDDK. Hematuria – Blood in the Urine https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine
- NICE. Urological cancers – recognition and referral https://cks.nice.org.uk/topics/urological-cancers-recognition-referral/
- American Urological Association/SUFU. Microhematuria Guideline, 2025 https://www.auanet.org/guidelines-and-quality/guidelines/microhematuria
- European Association of Urology. Non-muscle-invasive Bladder Cancer Guidelines, 2026 https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer