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Blood in urine 

Written by Healthwords's team of doctors and pharmacists based in UK | Updated: 23.02.2023 | 3 min read

Blood in the urine is also known as hematuria. Blood seen by the naked eye is referred to as macroscopic hematuria, whereas blood found only through testing your urine, is referred to as microscopic hematuria.

Both of these can indicate a cause for concern and require discussion with a doctor and possibly more investigations.

Blood in the urine can occur alone with no other symptoms, but it can also occur with pain on peeing or the passage of clots. You may get other urine symptoms such as passing urine very frequently, needing to rush to the bathroom or the urine having a bad smell. The color can vary from rose-colored to Coca-Cola-colored.

What causes blood in the urine?

There are a number of causes for blood in the urine – some common, some serious, and some not so serious, like eating beetroot, which makes it turn a purple color. Strenuous exercise may also cause it.

Urinary infections stemming from the bladder or one of the kidneys are the most common cause. There are some common bacteria that account for this, often originating from the gut (the anatomy is quite close together in that area). Bacteria then enters the sensitive urinary tract and can travel to the bladder and upwards to a kidney. You might experience other symptoms like pain passing urine, difficulty or urgency when urinating, and going more often. 

Stones originating from the kidney may be large and hard, causing bleeding when passing urine as it blocks the urinary tubes. You will likely be in excruciating pain and it may cause an infection. If you manage to pass the stone, there will then be a relief from the pain, but you may still have blood in the urine, as the tube has been traumatized.

An enlarged prostate is a common problem in older men. Its size means it can press on the tubes causing the flow of urine to be blocked and leading to difficulty urinating and possibly blood in the urine.

Cancer is a worrying cause of blood in the urine, and can indicate a more advanced stage of cancer in the prostate, kidney or bladder. Painless blood in the urine is a strong cause of concern, especially in those over 40, and should prompt you to prioritize seeing your doctor. 

Certain drugs can cause blood in the urine, like blood thinners such as warfarin or aspirin, and particular chemotherapy (anti-cancer) drugs. 

If one of your two kidneys gets injured, for example from a direct blow or trauma, or from an inflammation process such as glomerulonephritis, this can cause bleeding from high up in the urinary system.

When should I worry?

If you have blood in your urine, it is always advised to discuss it with your doctor. It is more concerning when you have blood in your urine and the cause is unknown, or it is occurring without pain. If you have blood in your urine and you are experiencing night sweats, weight loss, a change in appetite or increased fatigue, you must speak to your doctor as soon as possible.

What will my doctor do?

Your doctor will ask you about your symptoms, any relevant medical conditions and any medications or supplements you take. They will ensure the blood is not coming from the vagina or rectum, which may involve an examination. They will ask for a sample of your urine and have tests they can do there and then, and tests that the lab can do when it’s sent off.

They will conduct blood tests. They may also request an ultrasound or CT scan of your kidneys, ureters and bladder for greater detail.

If you have painless blood in your urine and are aged over 40, and you have no signs of infection, your doctor will likely refer you urgently to a hospital specialist.  

How is it treated?

Most cases of hematuria are from a urine infection, and this is treated with antibiotics that are prescribed by your doctor.

Specialist input is needed for most of the other causes of blood in the urine. A urologist, a specialist in the urine and kidney system, will organize further investigations. One of these may be a cystoscopy, where a tiny camera on a long cable is inserted into your urinary system. It can clearly visualize what is happening in your bladder.

A stone can be treated through a number of different methods, from seeing if it resolves naturally to surgical management.

Cancer will be managed quickly to treat, prevent further damage and prevent any spread. 

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