Blood in Urine: Causes, Tests and Treatment
Blood in urine should always be taken seriously, even if it happens only once or there is no pain. Most causes are treatable, such as urinary infection, kidney stone, prostate enlargement or recent urinary procedure. But painless visible blood in urine can sometimes be an early warning sign of bladder, kidney or prostate cancer. The right treatment depends on finding the source of bleeding. A urologist may advise urine tests, blood tests, ultrasound, CT scan and sometimes cystoscopy depending on your age, symptoms and risk factors.
What does blood in urine mean?
Blood in urine is medically called hematuria or haematuria. It means red blood cells are present in the urine.
| Type | Meaning |
|---|---|
| Visible hematuria | You can see pink, red, brown, tea-coloured or cola-coloured urine. |
| Microscopic hematuria | Urine looks normal, but blood is found on urine testing. |
A urine test may need to be repeated to confirm hematuria, especially if there is a chance of menstrual contamination in women. Diagnosis usually starts with medical history, physical examination and urinalysis, followed by additional tests when needed.
Blood in Urine: When Is It Serious?
Blood in urine needs timely assessment when it is visible, painless, recurrent or associated with clots. For microscopic haematuria, the need for cystoscopy and imaging is based on factors such as age, smoking history, the degree and persistence of blood, and other urinary cancer risk factors rather than one age cut-off. Blood in urine is also important when it occurs with fever, stone pain or difficulty passing urine.
Most patients with blood in urine do not have cancer. However, cancer must be ruled out in the right patient, especially when visible bleeding is painless or continues after treating a urine infection.
Common causes of blood in urine
1. Urinary tract infection
A urinary tract infection can cause burning urination, frequent urination, urgency, lower abdominal pain, cloudy urine, foul-smelling urine and sometimes blood in urine.
If infection reaches the kidney, symptoms may include fever, chills, flank pain, vomiting or weakness. Blood in urine due to infection should improve after proper treatment. If bleeding continues after infection treatment, further urology evaluation is needed.
2. Kidney stone or ureteric stone
Kidney stones and ureteric stones commonly cause blood in urine. Pain may be severe, come in waves, and move from the side of the back towards the lower abdomen or groin.
Some patients have only mild pain or burning. Others may have vomiting, fever or reduced urine output. A stone with fever or kidney blockage needs urgent care.
3. Prostate enlargement
In men, benign prostate enlargement can cause slow urine stream, straining, incomplete emptying, frequent night urination and sometimes blood in urine.
But blood in urine should not automatically be blamed on the prostate. A urologist may still need to check the bladder, kidneys and ureters, especially in older men or smokers.
4. Bladder, kidney or prostate cancer
Painless visible blood in urine is an important warning symptom. It does not always mean cancer, but it should not be ignored.
Bladder and kidney cancers may cause bleeding before they cause pain. Prostate cancer less commonly causes visible blood in urine, but prostate evaluation may be needed in selected men.
5. Kidney medical disease
Some kidney-related medical conditions can cause microscopic blood in urine. Clues may include protein in urine, swelling of feet or face, high blood pressure, abnormal creatinine or reduced kidney function.
In such cases, a nephrologist may be involved along with a urologist.
6. Blood thinners and bleeding-risk medicines
Aspirin, clopidogrel, warfarin, rivaroxaban, apixaban and other blood thinners can make bleeding more noticeable. But blood thinners should not be considered the only reason without evaluation. They may reveal bleeding from a stone, prostate, bladder lesion or tumour.
Do not stop blood thinners without advice from your doctor, physician or cardiologist.
7. Recent procedure, catheter or injury
Blood may occur after catheterisation, cystoscopy, prostate surgery, stone surgery, urinary tract injury or trauma. Mild bleeding after a procedure may be expected, but heavy bleeding, clots, fever or inability to pass urine needs urgent review.
8. Red urine that is not blood
Not every red-coloured urine sample contains blood. Beetroot, food colour and some medicines can change urine colour, while concentrated urine is usually darker rather than truly bloody. A urine test can confirm whether red blood cells are actually present.
Symptoms to notice before you visit a urologist
Try to observe the pattern of bleeding. It helps your doctor decide the next tests.
- Is the urine pink, red, brown or cola-coloured?
- Is there pain or no pain?
- Are there blood clots?
- Is blood seen at the start, throughout, or at the end of urination?
- Is there burning, fever, urgency or frequent urination?
- Is there side/flank pain suggesting stone?
- Are you passing less urine?
- Are you on blood thinners?
- Did bleeding happen after exercise, catheterisation or surgery?
- In women, could the sample be mixed with menstrual blood?
When should you see a urologist?
You should see a urologist if you have:
- Any visible blood in urine
- Painless blood in urine
- Blood clots in urine
- Repeated microscopic blood in urine
- Persistent or recurrent blood in urine, particularly with smoking or other urinary cancer risk factors
- Blood in urine with smoking history
- Blood in urine with kidney stone pain
- Blood in urine while taking blood thinners
- Blood that continues after UTI treatment
- Blood in urine with prostate symptoms
A one-time trace blood report may sometimes need repeat urine testing, but visible blood should not be dismissed.
Emergency signs: seek urgent medical care
Go to emergency care urgently if you have:
- Inability to pass urine
- Blood clots blocking urine flow
- Fever with chills and flank pain
- Severe kidney stone-like pain
- Vomiting and dehydration
- Heavy bleeding or dizziness
- Blood in urine after injury
- Pregnancy with blood in urine
- Single kidney with pain, fever or reduced urine
These situations may need urgent tests, IV medicines, catheterisation, DJ stenting, nephrostomy or admission depending on the cause.
Tests for blood in urine
The main goal of testing is to answer three questions:
- Is it truly blood?
- Where is the bleeding coming from?
- Is there a serious cause that needs early treatment?
Urine routine and microscopy
This confirms red blood cells in urine and checks for pus cells, protein, crystals and infection signs. Microscopy is important because dipstick tests can sometimes be misleading.
Urine culture
If infection is suspected, urine culture helps identify bacteria and guides antibiotic selection.
Blood tests
Common blood tests include:
- CBC to check infection or anaemia
- Creatinine and eGFR to check kidney function
- Blood sugar if infection risk is high
- Coagulation profile if bleeding tendency is suspected
- PSA in selected men, depending on age and prostate findings
Ultrasound KUB
Ultrasound KUB checks the kidneys, ureters when visible, bladder, prostate size and post-void residual urine. It may detect stones, swelling of the kidney, bladder clots, prostate enlargement or some masses.
CT KUB or CT urography
CT KUB is useful when stone is suspected. CT urography gives more detailed information about the kidneys, ureters and bladder when unexplained bleeding needs evaluation.
The type of CT scan depends on kidney function, contrast allergy history, age, symptoms and the suspected diagnosis.
Cystoscopy
Cystoscopy is a camera test used to look inside the urethra and bladder. It is especially useful in painless visible bleeding, recurrent hematuria, suspected bladder tumour or high-risk microscopic hematuria.
Urine cytology
Urine cytology checks urine for abnormal cells. It may be advised in selected patients when bladder or upper urinary tract cancer is suspected.
Treatment for blood in urine
Treatment should start after identifying the likely source of bleeding. Antibiotics, painkillers or stopping blood thinners without evaluation can delay the correct diagnosis.
| Cause | Possible treatment |
|---|---|
| Urinary infection | Urine culture-guided antibiotics, hydration, repeat urine test if needed |
| Kidney or ureteric stone | Pain control, observation, medical expulsive therapy, URSL, RIRS, PCNL or ESWL depending on stone |
| Prostate enlargement | Medicines, catheter if retention, TURP or HoLEP in selected patients |
| Bladder tumour | Cystoscopy-guided biopsy/removal, biopsy-based cancer treatment plan |
| Kidney tumour | CT/MRI staging, partial nephrectomy, radical nephrectomy or other treatment depending on stage |
| Blood thinner-associated bleeding | Find the bleeding source; coordinate medicine changes with physician/cardiologist |
| Kidney medical disease | BP control, kidney function monitoring, nephrology evaluation, sometimes kidney biopsy |
Can blood in urine come back?
Yes. Blood in urine can recur if the underlying cause recurs or remains untreated.
Kidney stones may recur if hydration, diet and metabolic risk factors are not addressed. UTIs may recur in people with diabetes, stones, poor bladder emptying or obstruction. Prostate-related bleeding may recur if prostate enlargement is significant. Cancer-related bleeding needs structured follow-up based on biopsy and stage.
If your initial tests are normal but bleeding returns, inform your doctor. Repeat evaluation may be needed.
Consultation checklist: what to bring
Bring these to your urology consultation:
- Urine routine/microscopy report
- Urine culture report, if done
- Ultrasound KUB report and images
- CT KUB or CT urography films, if done
- Creatinine/eGFR report
- CBC report
- PSA report, if done
- Current medicine list, especially blood thinners
- Diabetes and BP records
- Previous stone, prostate or cancer treatment records
- Catheter or discharge summary, if applicable
- Notes about when bleeding started, pain, fever and clots
FAQs
Is blood in urine always dangerous?
No. Many causes are treatable, such as UTI or kidney stone. But visible blood in urine should be evaluated because serious causes, including bladder or kidney cancer, need to be ruled out.
Can blood in urine happen without pain?
Yes. Painless blood in urine can happen with prostate bleeding, stones, infection or tumours. Painless visible bleeding should be checked by a urologist.
Can kidney stones cause blood in urine?
Yes. Kidney and ureteric stones commonly cause microscopic or visible blood in urine. Pain may be severe and may move from the back to the groin.
Can UTI cause blood in urine?
Yes. UTI can cause burning, urgency, frequent urination and blood in urine. If bleeding continues after infection treatment, further evaluation is needed.
What if I see blood clots in urine?
Blood clots need timely evaluation. If clots block urine flow or you cannot pass urine, seek emergency care.
Can blood thinners cause blood in urine?
Blood thinners can worsen bleeding, but they may also uncover an underlying problem. Do not stop them on your own. Speak to your doctor.
Which test is best for blood in urine?
There is no single best test for everyone. Urine microscopy confirms blood. Ultrasound, CT scan, cystoscopy and urine cytology are chosen based on age, symptoms, kidney function and risk factors.
Which doctor should I see for blood in urine?
A urologist evaluates bleeding from the kidney, ureter, bladder, prostate and urethra. If kidney medical disease is suspected, a nephrologist may also be involved.
Related reading
- What Does a Urologist Treat?
- When Should You Visit a Urologist?
- Urologist vs Nephrologist: What Is the Difference?
- Kidney Stone Symptoms You Should Not Ignore
- Frequent Urination: Causes and Treatment
- Prostate Enlargement: Symptoms, Tests and Treatment
- Cystoscopy: What to Expect
- Bladder Cancer: Symptoms, Diagnosis and Treatment
- Urologist in Latur
References
- 1. American Urological Association/SUFU. Microhematuria Guideline, 2025 update https://www.auanet.org/guidelines-and-quality/guidelines/microhematuria
- 2. NIDDK. Hematuria: Blood in the Urine https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine
- 3. British Association of Urological Surgeons. Blood in the urine – haematuria, updated March 2024 https://www.baus.org.uk/patients/conditions/2/blood_in_the_urine_haematuria/
- 4. NICE. Suspected cancer pathway referral for visible haematuria, updated 2026 https://www.nice.org.uk/guidance/qs215/chapter/Quality-statement-1-Suspected-cancer-pathway-referral