Hematuria: Causes, Symptoms, and Treatment

Seeing blood in your urine can be alarming. Sometimes it happens because of something relatively simple, such as a urinary tract infection or kidney stone. In other cases, it can be a sign of kidney disease, prostate problems or, less commonly, cancer.

The medical term for blood in the urine is hematuria or haematuria. It is not a disease by itself. Instead, it is a symptom that can have many different causes.

Blood may be obvious when you urinate, or it may be present in such a small amount that it can only be detected through a urine test. Either way, unexplained blood in the urine should not simply be ignored.

What is hematuria?

Hematuria means that red blood cells are present in the urine. It can originate anywhere along the urinary system, including the kidneys, ureters, bladder or urethra.

There are two main clinical forms:

• Gross or visible hematuria: Blood can be seen in the urine, which may appear pink, red or dark brown.
• Microscopic hematuria: The amount of blood is too small to see with the naked eye and is detected through urine testing.

A urine dipstick may also detect blood, but a positive dipstick does not automatically prove that red blood cells are present. Further urine examination may be needed.

Only a small amount of blood can make urine look red or pink, so the colour of the urine does not reliably tell you how much bleeding is occurring.

What is the main cause of hematuria?

There is no single cause that applies to everyone. Urinary tract infections, kidney or bladder stones, prostate enlargement and kidney disorders are among the common causes.

In many people, the cause is treatable and not life-threatening. However, blood in the urine can sometimes be an early warning sign of bladder, kidney or prostate cancer, particularly in older adults. This is why visible hematuria deserves medical assessment even if it happens only once.

What are the most common causes of hematuria?

Several conditions can cause blood to leak into the urine.

Urinary tract infections

A UTI can irritate the lining of the urinary tract and cause bleeding. Blood may occur along with burning while urinating, frequent urination, urgency, cloudy or strong-smelling urine and lower abdominal discomfort.

Most bacterial bladder infections are caused by Escherichia coli (E. coli), although other bacteria can also cause UTIs.

Kidney infections

A kidney infection can cause hematuria along with fever, chills, painful urination and pain in the back or side. Kidney infections need prompt treatment because an untreated infection can become serious.

Kidney and bladder stones

Stones form when minerals in urine crystallise. As a stone moves through the urinary tract, it can irritate or injure the lining and cause bleeding.

Kidney stones can cause severe pain in the side, back or groin, although some stones may cause little or no pain.

Enlarged prostate

In men, an enlarged prostate can contribute to hematuria, particularly with increasing age. It may also cause difficulty starting urination, a weak urine stream, frequent urination or waking several times during the night to urinate.

Kidney disease

Certain kidney conditions, including glomerulonephritis, can cause blood to enter the urine. Kidney disease may sometimes be accompanied by protein in the urine, swelling, high blood pressure or changes in kidney function.

Injury

An injury to the kidneys or urinary tract can cause blood in the urine. This may happen after an accident, fall, contact sport or other significant trauma.

Intense exercise

Strenuous exercise, particularly prolonged endurance exercise, can occasionally be associated with hematuria. The bleeding is often temporary, but persistent or recurrent blood should still be evaluated rather than automatically attributed to exercise.

Certain medicines

Some medications, including certain blood thinners and pain-relieving medicines, may increase the likelihood of urinary bleeding. However, medication use should not be assumed to be the explanation without appropriate assessment.

Cancer

Bladder, kidney and prostate cancers can cause hematuria. Blood in the urine may be an early symptom, and cancer-related bleeding may occur without pain.

This does not mean that every episode of hematuria is cancer. In fact, many cases have other explanations. But unexplained visible blood should be investigated because early detection of urinary cancers can improve treatment options.

What are the risk factors for hematuria?

Hematuria can occur at any age, but certain factors make it more likely. These include:

• Increasing age
• Previous urinary tract infections
• Kidney stones
• A family history of kidney disease or stones
• Certain medications
• Strenuous exercise
• Previous urinary tract problems
• Smoking, which is an important risk factor for bladder cancer
• A history of urinary tract or kidney disease

Some people may have microscopic hematuria without experiencing any symptoms at all.

What are the three types of hematuria?

There is no universally accepted classification that defines exactly three types of hematuria. Clinically, doctors most commonly distinguish between visible (gross) hematuria and microscopic hematuria.

A third term people sometimes encounter is dipstick-positive hematuria, where a urine dipstick detects blood. This is technically a test finding rather than a separate type of hematuria, because the result may need confirmation under a microscope.

Hematuria can also be classified according to where the bleeding originates. For example, doctors may distinguish glomerular hematuria, which originates from the kidney’s filtering units, from nonglomerular hematuria, which comes from elsewhere in the urinary tract.

Is hematuria a kidney problem?

Not necessarily.

Although kidney disorders can cause hematuria, blood can come from anywhere in the urinary tract. The bladder, ureters, urethra and prostate can all be involved.

For example, a bladder infection can cause blood in urine without there being a primary kidney problem. Similarly, a bladder stone or enlarged prostate can cause hematuria.

The location of the bleeding is determined through the patient’s symptoms, urine tests, blood tests and, when necessary, imaging or specialist investigations.

Is hematuria life-threatening?

Hematuria itself is not necessarily life-threatening. Many underlying causes are treatable and relatively straightforward.

However, some causes can be serious. Significant bleeding may lead to blood clots that interfere with urine flow, while kidney infections, severe urinary obstruction, major trauma and some cancers require prompt medical attention.

The important point is that you cannot determine the seriousness of hematuria simply by looking at the urine. Even a small amount of visible blood can warrant investigation.

What are the red flags for hematuria?

Seek prompt medical attention if you have blood in your urine, particularly if it is unexplained or recurrent.

Red flags include:

• Visible blood in the urine
• Repeated episodes of hematuria
• Blood that continues after treatment for a suspected UTI
• Blood clots in the urine
• Difficulty or inability to pass urine
• Severe pain in the back, side or groin
• Fever or chills
• Significant weakness or dizziness
• Unexplained weight loss
• Persistent urinary symptoms
• Hematuria in an older adult
• A history of smoking or urinary tract cancer

Blood in the urine accompanied by fever, chills, severe pain or difficulty passing urine deserves particularly prompt assessment.

How much blood in urine is worrying?

There is no simple amount that can be considered “safe.”

Even a small amount of blood can turn urine pink or red, while the visible appearance does not tell you exactly how much blood has been lost.

For this reason, any unexplained visible blood in urine should be checked by a healthcare professional, even if it occurs only once or disappears quickly.

Can blood in urine be nothing serious?

Yes.

Hematuria can result from conditions such as a UTI, kidney stone, strenuous exercise or other non-cancerous causes.

However, it is important not to assume that blood in the urine is harmless simply because there is no pain or because it disappears. Some important conditions, including certain urinary cancers, can cause painless hematuria.

That is why evaluation is recommended even when you otherwise feel well.

Can blood in urine be cancerous?

Yes, blood in urine can be associated with cancer of the bladder, kidney or prostate.

But hematuria does not mean you have cancer. Infection, stones and many other conditions are considerably more common explanations.

One reason doctors take visible hematuria seriously is that urinary cancers can sometimes cause bleeding before other noticeable symptoms develop.

Does drinking water stop hematuria?

Drinking water does not treat the underlying cause of hematuria.

Staying adequately hydrated is generally good for urinary health and may help prevent dehydration. However, water cannot eliminate a tumour, dissolve every type of kidney stone, cure a bacterial infection or treat kidney disease.

If blood appears in your urine, drinking extra water should not be used as a substitute for medical evaluation.

How long does hematuria last?

There is no fixed duration.

The length of time depends entirely on the underlying cause. Hematuria caused by a temporary problem may resolve quickly once the cause is addressed. Bleeding related to stones, infection, kidney disease or another ongoing condition may persist or return until the underlying problem is treated.

If blood continues, comes back or appears without an obvious explanation, further investigation is important.

Can hematuria come and go?

Yes.

Hematuria can be intermittent. A person may notice blood one day and have completely normal-looking urine the next.

This does not necessarily mean the underlying problem has disappeared. Conditions such as stones, prostate problems and some urinary tract cancers can cause bleeding that comes and goes.

Recurrent or unexplained hematuria should therefore be assessed rather than monitored indefinitely at home.

Can you recover from hematuria?

In many cases, yes.

Hematuria is a symptom rather than a disease, so recovery depends on treating its cause. A person with a UTI may recover after appropriate treatment, while someone with a kidney stone may recover once the stone passes or is treated.

If hematuria is caused by a chronic kidney condition, long-term management may be necessary.

The earlier the cause is identified, the sooner appropriate treatment can begin.

What will a urologist do for blood in urine?

A urologist will first try to determine where the bleeding is coming from and why it is happening.

The evaluation may include:

1. Medical history and physical examination – The doctor may ask when the bleeding started, whether it comes and goes, whether there is pain, urinary difficulty, fever or other symptoms, and which medications you take.
2. Urine testing – A urine sample can look for red blood cells, infection and other abnormalities. Urine culture may be used when infection is suspected.
3. Blood tests – These may assess kidney function, blood counts and other relevant factors.
4. Ultrasound or other imaging – Imaging can help identify stones, kidney abnormalities, bladder problems or other structural causes.
5. Cystoscopy – In selected patients, a thin flexible instrument is passed through the urethra to examine the inside of the bladder.

The exact investigation depends on age, symptoms, risk factors and the characteristics of the hematuria.

How do doctors treat hematuria?

Doctors treat the cause, rather than hematuria itself.

Treatment may include:

• Antibiotics for an appropriate bacterial urinary infection
• Treatment to help a kidney stone pass or procedures to remove it
• Medication or other treatment for an enlarged prostate
• Treatment of kidney disease
• Management of medication-related bleeding where appropriate
• Procedures or specialist treatment for structural problems
• Cancer treatment when a tumour is identified

For example, antibiotics may be prescribed when a bacterial UTI is diagnosed, but antibiotics are not appropriate for hematuria caused by a kidney stone or cancer.

What is the first-line treatment for hematuria?

There is no single first-line treatment for hematuria because it is a symptom with many possible causes.

The first step is generally to confirm the blood and identify its source. Once the cause is established, treatment can be directed appropriately.

For example, a bacterial UTI may require antibiotics, while a stone may require pain management, observation or a procedure depending on its size and location.

Which bacteria cause hematuria?

Several bacteria can cause urinary tract infections that result in hematuria.

The most common is E. coli, which is responsible for many bladder infections. Other bacteria can also cause UTIs, and the specific organism can sometimes be identified through a urine culture.

It is therefore important not to assume that every case of blood in urine is an infection. A urine test can help determine whether bacteria are present.

When should you see a doctor for hematuria?

You should arrange a medical evaluation whenever you notice unexplained blood in your urine.

This is especially important if:

• It is the first time you have noticed blood.
• The bleeding is painless.
• It happens repeatedly.
• You are over 45.
• You have urinary symptoms.
• You have a history of smoking.
• You have kidney disease or kidney stones.
• The blood persists after treatment for a UTI.

Visible hematuria should not be dismissed simply because it stops on its own. NHS guidance specifically recommends medical assessment even after a single episode of visible blood in the urine.

Frequently asked questions about hematuria

What is the main cause of hematuria?

There is no single cause. UTIs, kidney and bladder stones, prostate enlargement, kidney disease, injury, certain medications and urinary tract cancers can all cause hematuria.

Is haematuria life threatening?

Usually, hematuria itself is not life-threatening. However, its underlying cause can sometimes be serious, so unexplained blood in urine should be investigated.

How long does haematuria last?

There is no standard duration. It may disappear quickly or continue until the underlying cause is treated. Recurrent or persistent hematuria requires medical assessment.

How do you know if hematuria is serious?

Visible blood, recurrent bleeding, blood clots, inability to urinate, severe pain, fever, unexplained weight loss or persistent urinary symptoms are warning signs. However, the absence of these symptoms does not completely rule out a serious cause.

Can hematuria come and go?

Yes. Some conditions cause intermittent bleeding. Blood disappearing temporarily does not necessarily mean the underlying problem has resolved.

Is hematuria a kidney problem?

Not always. Hematuria can originate in the kidneys, ureters, bladder, prostate or urethra.

Can drinking water stop hematuria?

No. Adequate hydration supports urinary health but does not treat the underlying cause of hematuria.

Can blood in urine be nothing serious?

Yes. UTIs, stones, strenuous exercise and other non-cancerous conditions can cause blood in urine. Nevertheless, unexplained visible blood should be checked.

Can blood in urine be cancerous?

Yes. Bladder, kidney and prostate cancers can cause hematuria. Most cases are not necessarily cancer, but unexplained bleeding needs evaluation.

What will an urologist do for blood in urine?

A urologist may arrange urine and blood tests, imaging such as ultrasound or CT when appropriate, and cystoscopy to examine the bladder, depending on the patient’s age, symptoms and risk factors.

What are the three types of hematuria?

The two main clinical types are visible/gross hematuria and microscopic hematuria. Dipstick-positive blood is a test finding rather than a distinct third type.

What is the most common reason for hematuria?

UTIs are a common cause, particularly when hematuria occurs with burning urination, frequency and urgency. Kidney or bladder stones are another common cause. The most likely cause varies according to age, sex, symptoms and medical history.

Final takeaway

Hematuria can have a simple explanation, but it should never be diagnosed by appearance alone. A UTI, kidney stone or enlarged prostate may be responsible, but kidney disease and urinary tract cancers are also possible.

Drinking more water may support hydration, but it will not treat the underlying cause. Similarly, the fact that bleeding stops does not necessarily mean the problem has gone away.

If you notice blood in your urine, particularly if it is unexplained, recurrent or painless, speak with a healthcare professional. A urine test and, when appropriate, blood tests, imaging or urological evaluation can help identify the cause and ensure that an important condition is not missed.

To consult a Nephrologist or a Urologist at Sparsh Diagnostic Centre for treatment of Emphysema, call our helpline number 9830117733.

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