Dr. CARLO A. BRAVI Urologist and Andrologist
What is Blood in the Urine?
Blood in the urine, also called hematuria, refers to the presence of red blood cells in your urine. Sometimes the blood is visible to the naked eye (gross hematuria), and other times it’s only found under a microscope (microscopic hematuria) during routine testing. While not always serious, blood in the urine can be a sign of an underlying condition that needs medical attention.
Common Causes of Hematuria
Blood in the urine can come from anywhere in the urinary tract – kidneys, ureters, bladder, prostate (in men), or urethra. Causes include:
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Urinary tract infections (UTIs): Often associated with burning during urination and increased urgency or frequency.
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Kidney stones: Can cause significant pain in the side or back, along with blood in the urine.
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Enlarged prostate (BPH): Common in older men, may cause urinary changes and occasional blood in the urine. More on this can be found here.
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Kidney or bladder tumors: Both benign and malignant growths can cause hematuria, especially in older adults.
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Trauma or injury: A blow to the kidneys or bladder may result in blood in the urine.
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Strenuous exercise: In rare cases, heavy exercise may trigger hematuria (known as “runner’s hematuria”).
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Glomerular disease: Kidney disorders affecting the filtering units may present with microscopic hematuria.
How Is Hematuria Diagnosed?
The evaluation of blood in the urine focuses first on identifying the cause—and importantly, ruling out serious conditions like cancer of the urinary tract (urothelial cancer). Even when the bleeding stops on its own, further evaluation is still needed to ensure a serious underlying condition is not missed.
Personalized Treatment Options
The first goal of testing is to exclude urothelial cancer, which can affect the lining of the bladder, ureters, or kidneys. To do this, your doctor will typically recommend:
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Flexible cystoscopy: A thin, flexible camera is inserted through the urethra to carefully examine the inside of the bladder and urethra. This is usually done in the office with local anesthesia and takes just a few minutes.
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Imaging of the upper urinary tract: This may include an abdominal ultrasound or a CT scan to check the kidneys and ureters for stones, tumors, or structural abnormalities.
These two tests—cystoscopy and upper tract imaging—are standard in evaluating patients with visible blood in the urine or persistent microscopic hematuria, especially for those over the age of 35 or with risk factors like smoking.
Additional tests may include:
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Urinalysis and urine culture: To check for infection or signs of kidney disease.
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Urine cytology: A lab test to look for abnormal cells in the urine.
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Blood tests: To assess kidney function or rule out other systemic causes.
This comprehensive approach helps ensure that any serious issues are identified early and that benign causes are not overlooked.
When to See a Doctor
Even if you only see blood once, you should contact your healthcare provider. Blood in the urine is not a normal finding and should be evaluated—especially if it’s accompanied by pain, fever, difficulty urinating, or unexplained weight loss.
Bottom Line
Hematuria is a symptom—not a diagnosis. Finding and addressing the cause early can help prevent complications and ensure the best possible outcome.
