Blood in Your Urine: What It Can Mean and When to See a Urologist
By Dr. Christopher Vendryes, MD · Board-Certified Urologist · · 5 min read
Quick answer: Blood in the urine, called hematuria, can come from a urinary tract infection, kidney stones, an enlarged prostate, intense exercise, or certain medications. It can also be the first sign of bladder or kidney cancer. Visible blood in the urine should always be evaluated by a urologist, even if it happens once and goes away, and even without pain. Microscopic blood found on a urine test also needs follow-up, with the extent of testing based on your risk.
What are the two types of hematuria?
- Gross hematuria: blood you can see. Urine looks pink, red, or cola-colored.
- Microscopic hematuria: blood visible only under a microscope, usually found on a routine urine test.
What causes blood in the urine?
| Common causes | Less common but important |
|---|---|
| Urinary tract infection | Bladder cancer |
| Kidney or bladder stones | Kidney cancer |
| Enlarged prostate | Kidney disease |
| Vigorous exercise | Injury to the kidney or bladder |
| Recent urologic procedure | Certain inherited conditions |
Some foods, like beets, and some medications can turn urine red without any blood. A urine test tells the difference.
Why does painless blood matter so much?
Painless visible blood is the most common first sign of bladder cancer. Because it often comes and goes, people assume the problem resolved. It hasn't necessarily. Read Bladder Cancer Warning Signs.
Do blood thinners cause hematuria?
Blood thinners can make bleeding more likely, but they don't cause blood in the urine on their own. If you see blood while on a blood thinner, you still need an evaluation, because the medication may be revealing a problem that was already there.
Who is at higher risk of a serious cause?
- Smokers and former smokers
- Age over 50
- Men
- Workplace exposure to chemicals used in dyes, rubber, leather, paint, or textiles
- A history of pelvic radiation
- Visible blood rather than microscopic
What does the evaluation involve?
- Urine tests to confirm blood and check for infection.
- Imaging, often a CT scan or ultrasound, to look at the kidneys and ureters.
- Cystoscopy, a quick office procedure with a thin camera to look inside the bladder. See Cystoscopy: What to Expect.
The American Urological Association's guideline on microscopic hematuria sorts patients into low, intermediate, and high risk to decide how much testing is needed.
What if everything comes back normal?
That's a common and reassuring result. Your urologist may recommend a repeat urine test in the future, especially if you have risk factors.
Frequently Asked Questions
Talk to a Board-Certified Urologist
Dr. Vendryes sees patients in Plantation and across Broward and Palm Beach Counties for men's health, fertility, kidney stones, urologic cancers, and bladder problems.
References
- American Urological Association. Microhematuria: AUA/SUFU Guideline. 2020.
- Urology Care Foundation. Hematuria (Blood in the Urine).
- National Cancer Institute. Bladder Cancer: Symptoms.