Blood in Urine (Hematuria): Causes, Diagnosis and Next Steps

Hematuria means blood in the urine. It may appear visibly red, pink, or brown (gross hematuria) or only found under a microscope (microscopic hematuria).  Common causes include infections, kidney stones, exercise, or medications. In some cases, it can signal more serious issues like bladder, kidney, or prostate cancer. If you see blood in your urine, you should always see a doctor. 

What is hematuria?

Hematuria means there is blood in your urine. The two types of hematuria are: 

• Gross hematuria: you can see the blood in your urine. It may look pink, red or brown. 

• You may have  blood clots in your urine. Blood clots can be painful to pass during urination or can cause pain if the clots block the flow of urine. 

• Microscopic hematuria: you cannot see the blood in your urine, but it can be seen under a microscope or found using a urine test called a urinalysis. 

Type of Hematuria	Visibility	Symptoms
Gross hematuria	Visible	May include pain or clots
Microscopic hematuria	Not visible	No symptoms

Urine is produced in the kidneys, then it flows from the kidneys through the ureters to the bladder. When the bladder empties, urine flows out of the body through the urethra.

How common is hematuria?

Hematuria is a common condition.  

• About 1 out of 5 patients who see a urologist are diagnosed with hematuria. 
• Microscopic hematuria happens more often than visible (gross) hematuria. 

Who is at higher risk for hematuria?

You are more likely to have hematuria if you:

• Have an enlarged prostate (benign prostatic hyperplasia –BPH).
• Have bladder, kidney, or prostate cancer.  
• Have kidney stones (calculi). 
• Take certain medicines(blood thinners, antibiotics, and aspirin or other pain relievers). 
• Do strenuous exercises (like long-distance running). 
• Recently had an  infections (such as streptococcus or hepatitis). 
• Have kidney diseases like glomerulonephritis. 

What causes blood in urine?

Common causes:

• Urinary tract infections (UTIs)  
• Kidney or bladder inflammation  
• Kidney stones  
• Vigorous exercise  
• Medications  
• Trauma or recent procedures  
• Endometriosis  
• Sexual activity 

Serious causes:

• Bladder cancer  
• Kidney cancer  
• Prostate cancer  
• Blood disorders (e.g., hemophilia, sickle cell disease)  
• Chronic kidney disease 

How do health care professionals diagnose hematuria?

Healthcare professionals use a combination of: 

1. Medical history and physical exam 

• Includes pelvic exam (women) or digital rectal exam (men)  

2. Urine test (urinalysis) 

• Detects blood in urine  

• May be repeated for confirmation  

3. Imaging tests 

• CT scan, ultrasound, or cystoscopy to find out the cause  

Note: Menstrual blood can affect a urine sample, so repeat testing may be needed. 

FAQ 

What does hematuria mean? 

Hematuria means there is blood in your urine. It may be visible or only detected through laboratory testing. 

Is blood in urine always serious? 

Not always. Some infections or exercise can cause blood in the urine. However, it may also be a sign of cancer. You should always see a doctor. 

What are the first signs of hematuria? 

The most common sign is red, pink, or brown urine. Many people have no symptoms at all. 

When should I see a doctor for blood in urine? 

You should see a doctor immediately if you notice blood in your urine, even if you don’t have any pain. 

Can exercise cause hematuria? 

Yes. Working out really hard or for a long time (especially running) can cause blood in urine. 

Other Resources 

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Hematuria overview 

Mayo Clinic Hematuria overview  

Signs and Symptoms of Bladder Cancer

Bladder Cancer Diagnosis and Monitoring

What Is Bladder Cancer?

Bladder Cancer in Women

Cystoscopy video

Bladder Cancer Support Resources