Blood in urine (hematuria): What causes it and what to do about it

It can be scary to see blood in your urine. While there is cause for concern, you shouldn’t panic. There can be many reasons for blood in the urine, also known as hematuria.

Here, I’ll share common causes of hematuria, who’s at risk and when you should see your doctor versus going to the emergency room.

Many things can cause blood in your urine

Some common medical reasons for blood in urine are:

• Infection: This could be either inflammatory infections in the bladder, like a urinary tract infection (UTI), or a kidney infection.
• Stones: These are small, hard mineral deposits in the kidneys or ureters.
• Kidney disease
• Cancer in the bladder, kidney or prostate  

Sometimes, it can look like blood in your urine when it’s just discoloration. For example, eating beets or consuming certain vitamins may make your urine appear orange or bright yellow, but it contains no red blood cells.

Still, when in doubt, it’s best to get checked out.

You have a higher chance of having blood in your urine if you have:

• History of smoking
• Family history of any urologic cancer
• Been exposed to certain dyes and chemicals as part of your job

See a doctor sooner rather than later for hematuria

There are two types of hematuria:

• Gross hematuria: blood that you can see in the urine
• Microscopic hematuria: blood cells in the urine that can only be seen under a microscope

The only way to know for sure what’s causing blood in your urine is to see a doctor. My advice is not to wait – the sooner the better. Make an appointment with your doctor as soon as you notice any blood in your urine.

If you have gross hematuria, your doctor will typically perform a cystoscopy and CT scan to inspect the urinary tract and find the cause. A CT scan will take images to look for any masses in your urinary tract. A cystoscopy allows the doctor to fully examine your bladder and its lining. Both tests should be done to properly diagnose the condition causing blood in your urine.

Sometimes, you may have gross hematuria along with the following symptoms:

• Several blood clots in the urine
• Inability to urinate
• Fever
• Chills
• Nausea or vomiting

If you experience any of these symptoms with blood in your urine, this could indicate an obstruction in your urinary tract or a serious infection. To be safe, it’s important that you go to the emergency room right away.

Pay attention to what the blood looks like

You can help your doctor diagnose the problem by describing what the blood in your urine looks like. It can also help them determine how serious the condition may be.  

Pay attention to the color and consistency of the blood. It’s probably not an emergency if you see just:

• one or two small blood clots,
• discoloration (like pinkish or reddish)
• and the blood is still thin where you can see through the urine

However, it’s more concerning if:

• there are several blood clots or
• the blood becomes thick enough to where you can’t see through it.

Get your annual physical

You could have blood in your urine but not be able to see it. That’s why annual checkups with your doctor are important.

You should get a urinalysis as part of your physical exam every year. This is when your doctor asks you for a urine sample and runs tests on your urine that can help diagnose many different conditions. Make sure your doctor orders a microscopic exam and not a dipstick urine analysis.

A dipstick urine analysis uses a chemical strip dipped into the urine to look for abnormalities. During a microscopic exam, your doctor will look at your urine under a microscope. If your doctor sees microscopic hematuria, they may be able to catch and treat conditions you wouldn’t have known about otherwise.

Don’t dismiss your symptom, even if it only happens once

It can be easy to dismiss symptoms like blood in the urine, especially if you only notice it one time. Blood in the urine may go away on its own, but it could still indicate something serious is going on in your body. For example, a small tumor may cause blood in the urine just one time.

Many people believe that drinking a lot of water can stop blood in the urine. While drinking water will help wash the blood out of your system as the body makes more urine, it won’t fix the underlying cause of the hematuria. So, you’d be treating the symptom but not the actual cause.  

Treatment depends on what’s causing blood in your urine

Your doctor will determine the best treatment for hematuria based on what’s causing it. Treatment may include:

• Medications or medical procedures to help break up a stone and help you pass it
• Antibiotics to clear infections, like UTIs
• Cancer treatment, which may involve surgery to remove a tumor

The bottom line: see a doctor if you have blood in your urine and don’t know the cause. They can diagnose the condition and select the best treatment to help you get better.

Thomas Smith, M.D., is a urologic surgeon specializing in treating cancer and other conditions of the urinary tract and reproductive system.

Request an appointment at MD Anderson online or call 1-877-632-6789.