Blood in urine

Seeing blood in your urine can be alarming and needs to be checked by your doctor, but in most cases, it's not a sign of a serious problem.

The medical name for blood in urine is haematuria. If blood in urine can be seen by the naked eye it is known as visible or macroscopic haematuria. If it can only be detected by laboratory testing it is known as non-visible or microscopic haematuria.

Blood found in urine will have come from somewhere within the urinary tract, such as the kidneys, bladder or the tubes the urine passes through.

If you notice bright red blood in your urine, or if your urine has turned pinkish or reddish brown because it has blood in it, make an appointment to see your doctor.

Are you sure you have blood in your urine?

Other factors can cause your urine to change colour. Before you read further, it is worth considering if any other things could be causing the colour change, such as:

  • Certain foods including beetroot which can turn your urine pinkish.
  • Some medicines, such as the antibiotics nitrofurantoin and rifampicin, which can turn your urine red or brown.
  • Menstrual blood mixing with urine which can cause it to turn pinkish.

If you are uncertain of the cause of the change of colour of your urine, see your doctor. 

Causes of blood in urine

In haematuria, blood cells from certain parts of the urinary tract leak into your urine. 

The most common cause of blood in the urine are urinary tract infections (cystitis) and other infections of the urogenital region such as kidney infection (pyelonephritis) or prostate infection (prostatitis).

These conditions will normally also cause a persistent urge to urinate and a burning pain when urinating. Kidney and prostate infections are also likely to include fever and low back pain.

Other common causes include:

  • Kidney stones – which can be painless but can sometimes block one of the tubes coming from your kidneys, causing severe tummy pain.
  • Enlarged prostate – a common condition in older men, the enlarged prostate gland can press on the bladder and cause problems such as difficulty urinating or frequent urge to urinate.  

Less common causes include:

  • Kidney disease – symptoms may include weakness, high blood pressure and body swelling including puffiness around the eyes. Fairly uncommon cause; found in approximately 2 to 3 out of 100 people with non-visible blood in urine
  • Cancer of some part of the urinary system. Approximately 15 out of 100 people with visible blood in urine, and 1 out of every 200 people with non-visible blood in urine, will have some type of cancer of the urinary system.² The risk of cancer increases in people aged over 40 and in smokers.

Haematuria may also be caused by strenuous exercise or trauma (ie, a hit or a blow). Whatever the cause, contact your doctor right away if you have blood in your urine. 

Seeing your doctor

To determine the cause of blood in your urine, your doctor will ask you questions about your symptoms (such as pain and discomfort) and will ask for a urine sample. They may also arrange blood tests to look for signs of infection.

If they consider it likely that you have an infection, you may be prescribed antibiotics before the results of the tests arrive. If there is no sign of infection in the results you may be referred to a specialist. In some instances, your doctor may do a physical examination. For men, this will may involve a rectal examination and women may have a vaginal examination.  

Specialist referral

Your doctor may refer you to a specialist if you have any of the following symptoms:

  • Visible blood in urine with no pain and no sign of infection.
  • A combination of non-visible haematuria (blood in urine) and proteinuria (protein in the urine).
  • You are over 40 years of age and get repeated urinary tract infections and blood in urine
  • You are over 40 years of age and a urine test picks up unexplained blood in urine.

You will be referred to a hospital urology or nephrology department for further tests to identify the cause of your symptoms.

These tests may include more blood and urine tests, an ultrasound scan, a CT urogram (an imaging exam which uses X-rays to generate a very detailed 2-D image of the urinary system) and a cystoscopy (a procedure used to look closely at the inside of the bladder, using an instrument called a cystoscope).

Learn more

Blood in urine (hematuria) MayoClinic, US
Blood in urine (haematuria) NHS Choices, UK 

References

  1. Interpreting urine dipstick tests in adults – a reference guide for primary care BPAC, NZ, June 2013
  2. Hematuria: Definition and screening test methods International Journal of Urology. 2008