Blood in Urine: Causes and When to See a Doctor

Blood in urine may be caused by a urinary infection, kidney or ureteric stones, prostate problems, kidney inflammation, an injury or a recent urinary procedure. Sometimes red or brown urine is caused by food, medicine or another source of bleeding rather than blood from the urinary tract. Because appearance alone cannot confirm the cause, visible blood should be medically assessed even when it happens once or does not cause pain. Patients in and around New BEL Road can consult the urology team at Shirdi Sai Hospital for an evaluation based on their symptoms, medical history and test results. 

What Does Blood in Urine Mean?

Blood in urine is medically called hematuria. It happens when red blood cells enter the urine from somewhere in the urinary system.

The urinary system includes:

• The kidneys, which produce urine
• The ureters, which carry urine to the bladder
• The bladder, which stores urine
• The urethra, through which urine leaves the body

In men, bleeding may also be associated with a condition affecting the prostate.

There are two main types of hematuria:

Visible hematuria: The urine may look pink, red, rust-coloured, brown or tea-coloured.

Microscopic hematuria: The urine appears normal, but red blood cells are detected during a urine test or examination under a microscope.

Both types may occur without pain. Microscopic hematuria usually causes no visible change in urine, while visible hematuria may appear suddenly and then stop. 

At a Glance

• Blood in urine is a symptom, not a diagnosis.
• It can occur with an infection, urinary stone, prostate condition or kidney problem.
• Painless blood in urine still needs evaluation.
• Blood clots, difficulty urinating, fever or severe pain need prompt medical attention.
• Tests are selected according to symptoms, examination findings and individual risk.

When Is Blood in Urine an Emergency?

Visible blood should be assessed by a doctor, but some accompanying symptoms require more immediate care.

Seek urgent medical attention if blood in urine occurs with:

• An inability to pass urine
• Blood clots that interrupt urine flow
• Heavy or continuing bleeding
• Severe pain in the side, back, lower abdomen or groin
• Fever, chills or marked weakness
• Repeated vomiting
• Reduced urine output
• Blood in urine after a fall, accident or injury
• Confusion, fainting or difficulty staying alert

Blood clots may sometimes block urine flow. In addition, fever and back or side pain may occur with a kidney infection or an infected urinary obstruction. These situations should not be managed only with home remedies or leftover medicines.  

For severe symptoms, patients can seek assessment through the hospital’s emergency medicine service.

Common Blood in Urine Causes

The cause depends on factors such as age, associated symptoms, previous urinary conditions, medicines and whether the bleeding is visible or detected during testing.

Urinary tract infection

A urinary tract infection can irritate the lining of the bladder, urethra or kidneys and may lead to blood in the urine.

Other symptoms may include:

• Burning or pain while urinating
• Frequent urination
• A sudden urge to urinate
• Cloudy or strong-smelling urine
• Lower abdominal discomfort

When an infection affects the kidneys, fever, chills, nausea and pain in the side or back may also occur.

However, blood in urine should not automatically be treated as a UTI. A urine test, and sometimes a urine culture, may be needed to determine whether an infection is present.  

Kidney or ureteric stones

A stone can irritate the urinary tract and cause visible or microscopic bleeding.

Depending on its size and location, a stone may also cause:

• Sharp pain in the side or back
• Pain moving towards the abdomen or groin
• Nausea or vomiting
• Burning while urinating
• Frequent urination
• Difficulty passing urine

Some stones cause intense pain, while others are discovered during an investigation for blood in urine. Stone size, location, obstruction and infection risk help determine the next step.  

Enlarged prostate

Benign prostatic hyperplasia, commonly called an enlarged prostate, can affect urinary flow and may sometimes be associated with bleeding.

Men may also notice:

• A weak urine stream
• Difficulty starting urination
• Straining to empty the bladder
• Frequent night-time urination
• A feeling that the bladder has not emptied
• A sudden or difficult-to-control urge to urinate

These symptoms may also occur with infection, stones or other urinary problems. Therefore, the cause should be evaluated rather than assumed from symptoms alone.  

Prostate inflammation

Inflammation or infection of the prostate may cause painful urination, pelvic discomfort, urinary difficulty, fever or blood in the urine.

The evaluation may include a symptom review, examination, urine testing and further investigations when clinically appropriate.

Kidney inflammation or kidney disease

Conditions affecting the kidney’s filtering structures can allow red blood cells to enter the urine.

Possible accompanying findings include:

• Protein in the urine
• Swelling of the feet, ankles or face
• High blood pressure
• Changes in kidney-function tests
• Dark or cola-coloured urine

When test results suggest that the problem may involve kidney tissue rather than the urinary passages, care may involve both urology and nephrology evaluation.  

Injury or a recent urinary procedure

Blood may appear after an injury involving the back, abdomen, pelvis or urinary organs. Temporary bleeding can also occur after procedures involving a catheter, cystoscopy, urinary stone treatment or prostate surgery.

The expected amount and duration depend on the procedure. Heavy bleeding, large clots, fever, worsening pain or difficulty urinating should be reported promptly.

Medicines that affect bleeding

Blood-thinning medicines and some other medications may be associated with urinary bleeding. However, the medicine should not automatically be assumed to be the only cause.

Do not stop or change a prescribed blood thinner without speaking to the clinician who prescribed it. A urinary evaluation may still be required.  

Strenuous exercise

Prolonged or intense physical activity can occasionally be followed by temporary blood in the urine. Even so, repeated or persistent hematuria should be assessed, especially when it occurs with pain, urinary difficulty or other symptoms.  

A growth in the urinary tract

Less commonly, hematuria may be associated with a growth in the bladder, kidney, ureter or prostate. It may occur without pain.

Blood in urine does not automatically mean cancer. Still, painless or recurring visible bleeding should not be ignored because appearance and symptoms alone cannot rule out a significant condition.  

Is Red or Brown Urine Always Blood?

No. Urine may sometimes change colour even when red blood cells are not present.

Possible explanations include:

• Beetroot or strong food colouring
• Certain medicines
• Menstrual blood entering the urine sample
• Vaginal or rectal bleeding
• Very concentrated urine

Because these causes may be difficult to distinguish at home, a urine test can help confirm whether blood cells are present. A woman who provides a sample during menstruation may sometimes be advised to repeat the test after the period ends.  

What Can Associated Symptoms Indicate?

Other symptoms may help guide the evaluation, although they cannot confirm the diagnosis by themselves.

This comparison is intended to explain possible clinical patterns. It should not be used to diagnose the cause at home.  

Can Blood in Urine Occur Without Pain?

Yes. Visible and microscopic hematuria may occur without discomfort.

Painless blood in urine can be associated with prostate enlargement, certain kidney conditions, medicines, strenuous exercise, a previous procedure or a urinary tract growth. Since there may be few other clues, the absence of pain should not be treated as reassurance that evaluation is unnecessary.  

Blood in Urine in Women

In women, it is sometimes necessary to confirm whether the blood is coming from the urinary tract, vagina or rectum. Menstruation or vaginal bleeding may occasionally enter a urine sample.

Urinary causes can include infection, stones, kidney inflammation, injury and other conditions affecting the urinary system. The timing of bleeding, menstrual history and accompanying urinary symptoms help guide the investigation.

Women should arrange an evaluation when blood appears during urination, occurs between periods, returns repeatedly or is accompanied by pain, fever or urinary difficulty.  

Blood in Urine in Men

In men, urinary bleeding may arise from the kidneys, ureters, bladder, urethra or prostate.

Possible causes include infection, urinary stones, prostate enlargement, prostate inflammation, injury, a recent procedure, kidney disease or a urinary tract growth.

During the consultation, the doctor may ask about changes in urine flow, night-time urination, previous stones, smoking history, regular medicines and earlier urinary procedures.

How Does a Doctor Evaluate Blood in Urine?

Not every patient requires every available test. The investigation is selected according to the type of hematuria, accompanying symptoms, examination findings and individual risk.

Medical history

The doctor may ask:

• When did the bleeding begin?
• Did it happen once or several times?
• Was the urine pink, red, brown or tea-coloured?
• Were there blood clots?
• Was there pain, burning, fever or difficulty urinating?
• Is there a history of stones, infection or prostate symptoms?
• Has there been a recent injury or urinary procedure?
• Is the patient taking blood thinners?
• Could menstrual or vaginal bleeding have entered the sample?

Urine testing

A urinalysis can confirm whether red blood cells are present. It may also identify findings such as white blood cells, protein or other abnormalities.

Depending on the situation, the doctor may advise:

• Microscopic urine examination
• Repeat urinalysis
• Urine culture when infection is suspected
• Additional urine tests when clinically indicated

A repeat sample may be needed if the initial result could have been affected by menstruation or another source of contamination.  

Blood tests

Blood tests may be used to assess kidney function, blood counts, signs of infection or other findings relevant to the suspected cause.

Ultrasound or other imaging

Imaging may be advised to examine the kidneys, ureters and bladder.

Depending on the clinical situation, this may include:

• Ultrasound
• CT imaging
• MRI
• Other urinary tract investigations

The choice depends on symptoms, age, kidney function, pregnancy status and the suspected condition.  

Cystoscopy

Cystoscopy uses a thin instrument with a camera to examine the urethra and bladder. It may be considered when the urologist needs to look directly for a source of bleeding or another bladder or urethral problem.  

Risk-based evaluation

Current urology guidance recommends assessing microscopic hematuria according to factors such as age, degree and persistence of bleeding, smoking history, urinary symptoms and other risk factors.

As a result, two people with similar urine-test findings may not need the same investigations.  

How Is Blood in Urine Treated?

Hematuria does not have one standard treatment. Care is directed at the condition causing the bleeding.

Depending on the diagnosis, treatment may involve:

• Antibiotics for a confirmed bacterial infection
• Observation or pain management for selected urinary stones
• A stone procedure when clinically required
• Treatment for prostate-related urinary obstruction
• Care for kidney inflammation or kidney disease
• Management of an injury or procedure-related complication
• Further assessment and treatment of a urinary tract growth

Some people with microscopic hematuria may not require immediate treatment when the evaluation does not identify a condition needing intervention. Follow-up depends on the investigation results and individual risk.  

What Should You Do Before the Consultation?

A few practical steps can help the doctor understand the episode more clearly:

• Note when the urine changed colour.
• Record whether the bleeding happened once or repeatedly.
• Write down symptoms such as pain, fever, burning or reduced urine flow.
• Bring a list of regular medicines and supplements.
• Carry previous urine reports, scans and kidney-function results.
• Mention recent exercise, injury, catheter use or urinary procedures.
• Tell the doctor if menstruation or another source of bleeding is possible.

Avoid starting leftover antibiotics or stopping prescribed blood-thinning medicine without medical advice. These actions may complicate the assessment or delay appropriate care.

When Should You See a Urologist?

Arrange a medical consultation if:

• You see blood in the urine, even once
• Blood is found during a urine test without a clear explanation
• The bleeding returns after earlier treatment
• You have recurring urinary infections
• Blood appears with burning or frequent urination
• You have a history of kidney stones
• You notice changes in urinary flow
• You are taking blood-thinning medicine and develop urinary bleeding
• Red or brown urine continues without a clear food or medicine trigger

A urologist evaluates conditions affecting the kidneys, ureters, bladder, urethra and prostate. Depending on the findings, another specialist such as a nephrologist may also be involved.

Urology Evaluation on New BEL Road

Shirdi Sai Hospital provides urology care at its New BEL Road location. Its published urology services cover concerns including blood in urine, urinary infections, kidney stones and prostate-related symptoms. (shirdisaihospitalpvtltd.com)

Patients who need a non-emergency assessment can learn more about the hospital’s urology services. The consultation may begin with a medical history, symptom review and urine testing, followed by imaging or other investigations when clinically appropriate.

Shirdi Sai Hospital is located at No. 519, 2nd Main, Nethravathi Street, Devasandra, New BEL Road, Bengaluru, Karnataka 560054. (shirdisaihospitalpvtltd.com)

Frequently Asked Questions

Is blood in urine always serious?

No. It may occur with a urinary infection, stone, enlarged prostate, medicine, injury or recent procedure. However, some more significant urinary or kidney conditions can also cause it. Medical evaluation is needed to identify the reason.  

Should I see a doctor if blood appeared only once?

Yes. Visible blood should be assessed even if it happened once, there was only a small amount or no other symptoms were present.  

Can a UTI cause visible blood in urine?

Yes. A bladder or kidney infection may cause visible or microscopic blood. Burning urination, urgency, cloudy urine, lower abdominal pain, fever or back pain may also occur. A urine test can help determine whether infection is present.  

Can kidney stones cause blood in urine without severe pain?

Yes. A kidney or ureteric stone may cause microscopic or visible bleeding even when pain is mild or absent. Symptoms depend on the stone’s location, movement and whether it blocks urine flow.  

Is painless blood in urine dangerous?

Painless hematuria is not always caused by a dangerous condition, but it should not be ignored. Several urinary tract and kidney conditions can cause bleeding without discomfort, and investigations may be required to distinguish between them.  

Can dehydration cause blood in urine?

Dehydration may make urine darker and more concentrated, but it should not be assumed to explain confirmed blood in the urine. A urine test can help determine whether red blood cells are actually present.

Which doctor should I consult for blood in urine?

A urologist commonly evaluates unexplained or visible blood in urine because the bleeding may come from the kidneys, ureters, bladder, urethra or prostate. A nephrologist may also be involved when the findings suggest a condition affecting kidney tissue.

Arrange an Evaluation

Blood in urine may have a manageable explanation, but the cause should be identified rather than guessed from its colour or whether pain is present.

For non-emergency symptoms, patients can arrange a urology consultation at Shirdi Sai Hospital on New BEL Road.

Seek urgent medical care if you cannot pass urine, are passing blood clots, have heavy bleeding, severe pain, fever with chills, repeated vomiting or rapidly worsening symptoms.