What is Blood in Urine (Hematuria) | Symptoms and causes

Blood in urine, medically known as hematuria, can be a concerning symptom that ranges from harmless to potentially serious. While it may sometimes go unnoticed, visible changes in urine colour or associated symptoms should never be ignored. Understanding its causes, types, and when to seek medical care is essential for timely diagnosis and effective treatment.

What is Blood in Urine?

Blood in Urine otherwise Hematuria is the medical term used to describe the presence of blood cells in urine. Blood in urine is common. In many cases, you may not even realise its presence. It doesn’t always cause your urine to appear pink or red. 

Sometimes, the amount of blood is so small that it’s invisible to the naked eye and is only detected when a healthcare provider performs a urine test.

However, if you notice your urine appears pink or red, or if you experience other symptoms related to hematuria, it may indicate an underlying issue. In such situations, it’s important to contact a doctor.

Types of Hematuria

Healthcare providers classify blood in urine into the following types:

• Gross Hematuria: Gross hematuria occurs when there is enough blood in the urine to be seen without any testing. It may cause the urine or toilet water to appear light pink or bright red.
• Microscopic Hematuria: Microscopic hematuria (also called microhematuria) refers to blood in the urine that cannot be seen with the naked eye. A microscope is required to detect it.
• Dipstick Hematuria: Dipstick hematuria happens when a urine dipstick changes colour due to oxidation (exposure to oxygen). Dipsticks are narrow plastic or paper strips that are coated with chemicals. They react and change colour when certain substances are present in urine.

Dipstick tests can produce false-positive results, meaning they may indicate the presence of blood in the urine when none is actually present. Because of this, healthcare providers must confirm dipstick findings with a microscopic urinalysis.

How Common Is Blood in Urine?

Hematuria is a frequent finding. Medical experts estimate that over 20% of people evaluated by a urologist are found to have blood in their urine. Microscopic hematuria affects approximately 2% to 31% of the population and occurs more often than visible (gross) hematuria.

Symptoms of Hematuria

In many cases, hematuria causes no symptoms other than the presence of blood in urine. When this occurs, healthcare providers may describe the condition as asymptomatic. If symptoms are present, they may include:

• Urge to urinate more often than usual (frequent urination)
• Pain or a burning sensation during urination (dysuria)
• A sudden and intense urge to urinate (urinary urgency)

Additional symptoms that may accompany hematuria include:

• Nausea and vomiting
• Fever
• Chills
• Pain in the lower back
• Abdominal pain
• Pain on one or both sides of the lower back, just above the hips (flank pain)

The presence of blood in urine does not always indicate a serious medical condition. However, it can serve as an important warning sign. It should never be ignored, and you should seek medical advice as soon as blood is noticed in your urine.

What is the main cause of Hematuria?

Hematuria can occur for many reasons, ranging from mild to serious. Some of the more serious causes include:

• Urinary stone disease refers to the formation of mineral or substance deposits within the urinary system, including kidney stones, bladder stones, and ureteral stones.
• Urinary tract infection (UTI): A bacterial infection affecting any part of the urinary system.
• Kidney infection (pyelonephritis): An infection that spreads to one or both kidneys.
• Bladder inflammation (cystitis): Inflammation of the bladder, which may be caused by infection or noninfectious factors.
• Certain cancers can also result in blood in the urine.

Additional conditions that may lead to hematuria include:

• Enlarged prostate (benign prostatic hypertrophy or BPH): A condition in which the prostate gland, which produces semen, becomes enlarged.
• Injury to the urinary system: This may result from blunt trauma such as falls, car accidents, or sports injuries, or from penetrating injuries like knife wounds or gunshot wounds.
• Menstruation: Blood may appear in urine during a menstrual period.
• Endometriosis: A condition where tissue similar to the uterine lining grows outside the uterus.
• Chronic kidney disease (CKD): A long-term condition that affects the function of the kidneys.
• Sickle cell disease: An inherited condition that affects red blood cells.

What cancers can cause Hematuria?

Several types of cancer can cause blood in the urine. These include:

• Prostate cancer
• Kidney cancer
• Ureteral cancer
• Bladder cancer
• Urethral cancer

Is Hematuria Contagious?

Hematuria itself is not contagious. However, one of the most common causes of hematuria is a urinary tract infection (UTI). Healthcare providers do not classify UTIs as transmissible. Still, the bacteria responsible for UTIs can sometimes be passed to a partner during sexual activity.

Who is affected by Hematuria?

Blood in urine can occur in people of any age. However, certain factors may increase the likelihood of developing hematuria, including:

• Having a urinary tract infection
• Having a congenital abnormality of the urinary system
• Being 50 years of age or older
• Having a biological family history of urinary system conditions, such as chronic kidney disease (CKD) or kidney stones
• Taking certain medications, including anticoagulants (blood thinners), nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics
• Smoking and not drinking enough fluids can lead to dehydration.
• Exposure to specific chemicals and/or radiation in the workplace
• Working around metals, fumes, dyes, or rubber materials
• Participating in contact sports such as hockey, soccer, boxing, or football
• Running long distances or engaging in intense or prolonged exercise (exercise-induced hematuria)
• Having vigorous sexual intercourse

Complications associated with Blood in Urine

Some might experience side effects related to treatments for hematuria, including medical procedures. These effects vary depending on the treatment used, and a healthcare provider will discuss the risks prior.

If hematuria is left untreated, it can result in more serious complications, particularly when the primary cause is significant. Any conditions that are responsible for blood in the urine should be properly treated. Early identification of a seriousness of the condition allows treatment to begin sooner. It improves the likelihood of a successful outcome.

How is Hematuria diagnosed?

Diagnosing hematuria will begin by reviewing your medical history and asking about any additional symptoms you may be experiencing. They will also carry out a physical examination. It may involve a pelvic or a digital rectal examination. In many cases, further tests are recommended to confirm the diagnosis of hematuria.

What is the best treatment for Hematuria?

The treatment for hematuria depends entirely on its underlying cause. A doctor determines the most appropriate treatment by reviewing your medical history, performing a physical examination, and analysing the results of any diagnostic tests. To help determine the cause of blood in urine, a healthcare provider may suggest one or more of the following tests:

• Urine culture
  A urine sample is collected and tested to identify any signs of infection.
• Urinalysis
  Provide a urine sample in a special container, which is then examined for its appearance and analysed for indicators of conditions that may cause hematuria.
• Urine cytology
  A urine sample is examined to identify abnormal-looking cells.
• Cystoscopy
  A healthcare provider inserts a thin tube with a camera, called a cystoscope, through the urethra into the bladder to closely inspect the urethra and bladder.
• Imaging tests
  Noninvasive imaging studies, such as ultrasound scans, CT scans, and MRI scans, are used to create images of the urinary system as well as surrounding organs and structures.

Can Hematuria be prevented?

Not all causes of hematuria can be avoided. However, certain steps may help reduce the risk of some underlying causes, including:

• Drinking an adequate amount of water each day
• Urinating both before and after sexual intercourse
• Wiping the vagina from front to back after bowel movements to reduce the spread of bacteria
• Keeping your body weight within a healthy range for you
• Reducing intake of foods high in sugar, sodium (salt), and animal-based proteins
• Stopping smoking, minimising exposure to harmful substances or chemical hazards

Conclusion 

Blood in urine, also known as hematuria, is a relatively common finding and may occur with or without noticeable symptoms. In many cases, it is detected during routine urine testing, but visible changes in urine colour should never be ignored. Hematuria can arise from a wide range of causes, including infections, urinary stones, chronic kidney disease and cancers affecting the urinary tract. While some causes are mild, others may be serious, making early recognition and medical evaluation essential. 

Proper diagnosis involves a careful review of medical history, physical examination, and targeted tests such as urinalysis, imaging, or cystoscopy. Treatment depends entirely on the underlying cause and may include medications, monitoring, or more advanced therapies. Although not all causes are preventable, adopting healthy habits such as adequate hydration, avoiding smoking, and reducing exposure to harmful substances may lower risk. Proper evaluation and management significantly improve outcomes.

FAQs