Blood in the Urine (Haematuria): Causes, Tests & When to Worry

Seeing blood in your urine can be frightening. Most of the time the cause turns out to be something simple and treatable, such as an infection or a kidney stone. But blood in the urine (doctors call it haematuria) should never be ignored, because in a small number of people it is the first sign of a more serious problem, such as a bladder or kidney tumour, which is far easier to treat when found early.

Two types of haematuria

Visible haematuria

• You can see the blood yourself: the urine may look pink, red, brown or "cola-coloured"

• There may be small clots

• It may happen once and then stop – it should still be checked, even if it goes away

Non-visible (microscopic) haematuria

• The blood can only be seen on a urine dipstick test or under the microscope

• It is often found by chance, for example at a GP check-up or insurance medical

• It is common and usually less worrying, but some people still need tests

Is it really blood?

Some things can turn urine red without any blood being present:

• Beetroot, blackberries or rhubarb

• Some medicines, such as the antibiotic rifampicin

• Heavy exercise or dehydration can make urine very dark

A simple urine test in clinic will confirm whether blood is truly there.

What causes blood in the urine?

Common causes:

• Urine infection (cystitis) – often with burning, frequency and urgency

• Kidney or ureteric stones – often with pain in the side, back or groin

• Enlarged prostate – the surface of the prostate has many small blood vessels that can bleed

• Inflammation of the bladder, prostate or urethra

• Recent catheter, procedure or injury

• Very strenuous exercise, such as long-distance running

Less common but important causes:

• Bladder cancer

• Kidney cancer

• Cancer of the ureter or prostate

• Kidney diseases that affect the filters of the kidney (these are usually looked after by kidney specialists)

What about blood thinners?

If you take a blood thinner (such as warfarin, apixaban, rivaroxaban, clopidogrel or aspirin), you may bleed more easily. However, blood thinners usually reveal a problem rather than cause it, so you still need the same tests. Do not stop a blood thinner on your own – speak to your doctor.

Who is at higher risk of a serious cause?

• Age over 45

• Smoking, now or in the past – the most important risk factor for bladder cancer

• Exposure to certain industrial chemicals (for example in the dye, rubber, leather or printing industries)

• Previous pelvic radiotherapy

• Visible blood with no sign of infection, or blood that continues after an infection is treated

When should I seek help?

Please seek medical advice if:

• You see blood in your urine, even once, even if it is painless and settles

• Blood is found on a urine test and you have urinary symptoms

• You have been told you have blood in your urine and it has not been investigated

Seek help urgently (A&E or your out-of-hours service) if:

• You are passing clots and cannot pass urine

• You have heavy bleeding, feel faint or dizzy

• You have blood in the urine with a high temperature and pain in your side

What tests will I need?

The aim of the tests is to look at the whole urinary tract – kidneys, ureters, bladder and prostate – to find the source of the bleeding.

1. Urine tests

• A dipstick test to confirm blood

• A sample sent to the laboratory to check for infection

• In some cases, a urine test looking for abnormal cells

2. Blood tests

• Kidney function

• Full blood count

• PSA (a prostate blood test) in men, where appropriate and after discussion

3. Scans of the kidneys and ureters

• CT urogram – a detailed CT scan with dye, usually the best test after visible haematuria

• Ultrasound – used for younger people, those at lower risk or when CT is not suitable

4. Looking inside the bladder (flexible cystoscopy)

The bladder lining is best examined directly with a camera, because small tumours do not always show up on scans.

• A thin, flexible telescope is passed into the bladder through the urethra

• Done under local anaesthetic gel – you are awake and can watch on the screen if you wish

• Takes around 5 minutes

• Most people describe it as uncomfortable rather than painful

• You can go home straight afterwards

• You may notice some stinging or a little blood when you pass urine for a day or two

What happens next?

• If an infection is found, it will be treated and the urine rechecked

• If a stone is found, we will discuss whether it needs treatment

• If the prostate is the cause, there are effective tablets and procedures to reduce bleeding

• If a tumour is found, it will usually be removed through a telescope procedure (TURBT for the bladder), and you will be guided through the next steps quickly

• In many people, no cause is found – which is reassuring. You may be advised to have a repeat urine test later, and to come back if you see blood again

Why see a urologist promptly?

Most causes of blood in the urine are benign. But if something serious is present, finding it early makes a real difference to the outcome. A consultant urologist can arrange all the tests quickly, often within days, and explain the results to you clearly.

At OX Urology, Mr Sarp Keskin offers prompt private assessment of blood in the urine in Oxford and Banbury, with fast access to urine tests, CT scanning and flexible cystoscopy.