Seeing blood in the urine can be frightening.
The medical term for blood in urine is hematuria.
Blood may be clearly visible, known as gross hematuria, or it may only be detected during urine testing, known as microscopic hematuria.
Although many causes are benign and treatable, blood in urine should never automatically be ignored.
What causes blood in urine?
Possible causes include:
- Urinary tract infection
- Kidney or ureteric stones
- Prostate problems
- Kidney disease
- Trauma
- Certain medications
- Vigorous exercise
- Bladder or kidney tumors
- Prostate cancer
- Other urinary tract conditions
The cause cannot be determined simply from the appearance of the urine.
Is red urine always blood?
No.
Some foods and medications can change urine colour.
For this reason, proper urine testing is important.
The AUA/SUFU guideline defines microhematuria based on microscopic examination rather than a positive dipstick alone.
Blood in urine and cancer
One of the important reasons to evaluate hematuria is to exclude urinary tract malignancy.
This does not mean that blood in urine automatically means cancer.
However, particularly in adults with visible blood in urine, appropriate evaluation is important because urinary tract cancers can sometimes present with hematuria before other symptoms appear.
What evaluation may be required?
Depending on age, symptoms and risk factors, your urologist may recommend:
Urine examination: To look for blood, infection and other abnormalities.
Blood tests: Kidney function and other tests may be required.
Ultrasound: Can assess the kidneys and bladder.
CT scan: May be recommended in selected patients, particularly when stones or other urinary tract abnormalities are suspected.
Cystoscopy: A small camera is passed through the urethra to examine the bladder.
Not every patient requires every test. Evaluation should be individualized according to risk.
What if I take blood thinners?
Patients sometimes assume that blood in urine is simply due to anticoagulant or antiplatelet medication.
However, medication use does not necessarily eliminate the need for appropriate evaluation. The AUA guideline states that patients taking antiplatelet or anticoagulant medications should undergo the same hematuria evaluation framework as other patients.
When is hematuria an emergency?
Seek urgent medical attention if blood in urine is accompanied by:
- Inability to urinate
- Large blood clots
- Severe flank pain
- Fever or chills
- Severe weakness or dizziness
- Significant bleeding
Final message
Blood in urine has many possible causes, ranging from infection and stones to more serious urinary tract disease.
Do not panic, but do not ignore it.
A timely urological evaluation can identify the cause and allow appropriate treatment.