Blood in the urine, medically known as hematuria, is a common clinical finding that can signal a range of health issues1 . It may be visible to the naked eye or only detectable under a microscope, and its presence often prompts medical evaluation to identify the underlying cause2 . While some causes are benign and transient, others may indicate serious conditions such as infections, stones, or cancer3 . Early detection and proper diagnosis are essential for effective treatment and better outcomes4 .
Signs and Symptoms of Hematuria
Hematuria is classified into two main types based on visibility: gross hematuria and microscopic hematuria5 . Gross hematuria occurs when blood is visible in the urine, causing it to appear pink, red, or dark brown6 . In contrast, microscopic hematuria is not visible to the naked eye and is detected only through urine microscopy or dipstick testing7 . The color change in urine depends on the amount of blood and how long it has mixed with urine, with darker urine indicating longer contact time8 .
Symptoms accompanying hematuria vary depending on the cause and may include urinary frequency, pain or burning during urination, and passing blood clots9 5. Some patients may experience additional symptoms such as nausea, vomiting, fever, chills, or abdominal and back pain, especially if an infection or inflammation is present10 6. Microscopic hematuria is often asymptomatic and found incidentally during routine urine tests11 .
Medical evaluation is recommended for any visible blood in urine or persistent urinary symptoms to rule out serious underlying conditions1 12.
- Visible blood in urine causing pink, red, or tea-colored urine6
- Passing blood clots during urination5
- Increased urinary frequency or urgency9
- Pain or burning sensation when urinating10
- Abdominal, flank, or back pain in some cases6
💡 Did You Know?
Blood in urine is called hematuria. Gross hematuria is when blood is visible to the naked eye2 .
Common Causes of Hematuria
Hematuria has a broad range of causes, from benign to serious conditions11 . The most frequent causes include urinary tract infections (UTIs), kidney stones, trauma, and prostate disorders9 . UTIs, which are bacterial infections affecting the urinary tract, are especially common in women and often cause hematuria along with symptoms like dysuria and urgency4 9. Kidney stones cause hematuria by irritating and obstructing the urinary tract lining13 .
Prostate diseases, including benign prostatic hyperplasia, are significant causes of hematuria in men, particularly older adults14 5. Trauma to the urinary system, whether external or internal, can also result in blood appearing in the urine4 . Strenuous physical activity may cause transient hematuria due to minor bladder or kidney injury4 6.
Less common but serious causes include hematologic disorders such as sickle cell disease, which can cause renal papillary necrosis leading to hematuria, and malignancies of the urinary tract like bladder, kidney, or prostate cancer14 43. These cancers often present with gross hematuria and require urgent evaluation3 .
- Urinary tract infections (especially in women) 9
- Kidney stones causing mucosal injury and obstruction13
- Prostate disorders in men, including benign prostatic hyperplasia14
- Trauma to urinary organs4
- Hematologic diseases such as sickle cell disease14
- Urinary tract malignancies (bladder, kidney, prostate) 4
How Hematuria Is Diagnosed
Diagnosing hematuria involves confirming the presence of red blood cells in urine and identifying the underlying cause1 . The initial step is urinalysis, which screens for red blood cells and other abnormalities9 . Microscopic examination of urine sediment confirms hematuria and helps differentiate between glomerular and non-glomerular sources11 15. Automated urine sediment analyzers and phase contrast microscopy enhance detection accuracy15 16.
If gross hematuria or persistent microscopic hematuria is present, further evaluation with cystoscopy is recommended to inspect the bladder and lower urinary tract17 13. Imaging studies such as ultrasound and computed tomography (CT) scans are used to detect stones, tumors, or anatomical abnormalities in the urinary tract13 . Kidney biopsy may be performed if glomerular disease is suspected18 .
Physical examination, including digital rectal exam in men and pelvic exam in women, assists in assessing prostate or gynecologic causes1 14. Blood tests may help identify systemic or renal diseases contributing to hematuria14 .
What to Expect From the Test
- Urinalysis: A urine sample is analyzed for red blood cells, protein, and signs of infection9 .
- Microscopy: Urine sediment is examined under a microscope to confirm red blood cells and assess their shape11 .
- Cystoscopy: A thin camera is inserted into the bladder to visualize the lining and detect abnormalities17 .
- Imaging: Ultrasound or CT scans provide detailed images of kidneys, ureters, and bladder to identify stones or tumors13 .
- Blood Tests: Assess kidney function and detect systemic causes14 .
Understanding Your Results
- Microscopic hematuria: Red blood cells detected only under microscope; may be benign or indicate early disease7 .
- Gross hematuria: Visible blood in urine; requires thorough evaluation due to higher risk of serious causes4 .
- Dysmorphic red blood cells: Suggest glomerular (kidney) origin of bleeding16 .
- Normal RBC count: Less than 3 red blood cells per high power field is considered normal6 .
- Additional findings: Presence of protein, white blood cells, or bacteria may indicate infection or inflammation9 .
If you have gross hematuria, your doctor will typically perform a cystoscopy and CT scan to inspect the urinary tract and find the cause. A CT scan will take images to look for any masses in your urinary tract. A cystoscopy allows the doctor to fully examine your bladder and its lining. Both tests should be done to properly diagnose the condition causing blood in your urine.
— Thomas Smith, M.D., MD Anderson Cancer Center19
Treatment Options for Hematuria
Treatment of hematuria focuses on addressing the underlying cause rather than the presence of blood itself18 4. Many benign causes, such as exercise-induced hematuria, resolve without specific intervention20 . Infections require antibiotics, while kidney stones may be managed with pain control, hydration, or procedures to remove or break up stones4 13.
Prostate-related hematuria may need medications or surgery depending on the severity14 . Malignancies require specialized cancer treatment including surgery, chemotherapy, or radiation4 . Rare causes like hematologic diseases or glomerular kidney diseases may require referral to specialists such as nephrologists or hematologists18 14.
Management usually follows a stepwise approach starting with history, physical exam, and basic tests, progressing to more advanced diagnostics as needed4 .
- Urinary tract infections: Antibiotics to clear infection4
- Kidney stones: Pain management, hydration, lithotripsy, or surgery13
- Prostate disorders: Medications or surgery14
- Malignancies: Cancer-directed therapies4
- Benign causes (e.g., exercise-induced): Usually self-limited, no treatment needed20
Many people believe that drinking a lot of water can stop blood in the urine. While drinking water will help wash the blood out of your system as the body makes more urine, it won't fix the underlying cause of the hematuria. So, you'd be treating the symptom but not the actual cause.
— Thomas Smith, M.D., MD Anderson Cancer Center19
Key Takeaways
- Hematuria is the presence of red blood cells in urine, either visible (gross) or microscopic5 .
- Common causes include urinary tract infections, kidney stones, prostate disorders, trauma, and malignancies4 .
- Diagnosis begins with urinalysis and may include cystoscopy, imaging, and blood tests to identify the source11 .
- Treatment targets the underlying cause, ranging from antibiotics for infections to surgery for cancers or stones18 .
- Any visible blood in urine should prompt timely medical evaluation to exclude serious conditions3 .
