Blood in Urine (Hematuria)

Hematuria occurs when red blood cells leak into the urine from anywhere along the urinary tract - kidneys, ureters, bladder, or urethra. The amount of blood can vary from a few cells only visible under a microscope to enough blood to turn urine visibly red. Even a small amount of blood can dramatically change urine color.

It's important to distinguish true hematuria from other causes of red or dark urine. Certain foods (beets, blackberries), medications (rifampin, phenytoin), and even strenuous exercise can cause urine discoloration without actual blood presence. However, any unexplained change in urine color should be evaluated.

The pattern and associated symptoms provide important clues. Painless hematuria may suggest bladder or kidney cancer, while painful hematuria often indicates stones or infection. Blood throughout urination suggests kidney or upper tract bleeding, while blood only at the beginning or end points to lower tract issues.

Urinary Tract Infections

• UTI: Most common cause, especially in women
• Cystitis: Bladder infection with burning, frequency
• Pyelonephritis: Kidney infection with fever, back pain
• Urethritis: Urethra inflammation
• Prostatitis: Prostate infection in men

Kidney and Bladder Stones

• Kidney stones: Severe pain, nausea, visible blood
• Bladder stones: Difficulty urinating, pain
• Ureteral stones: Excruciating flank pain
• Movement causes bleeding: Scratching of tissues

Kidney Diseases

• Glomerulonephritis: Kidney filter inflammation
• Polycystic kidney disease: Inherited disorder
• IgA nephropathy: Common kidney disease
• Thin basement membrane disease: Benign condition
• Kidney injury: From trauma or procedures

Cancers

• Bladder cancer: Often painless hematuria
• Kidney cancer: May have flank pain
• Prostate cancer: Advanced cases
• Ureteral cancer: Rare but serious
• More common over age 50

Prostate Conditions (Men)

• Benign prostatic hyperplasia (BPH): Enlarged prostate
• Prostatitis: Prostate inflammation
• After prostate procedures: Biopsy, surgery

Other Causes

• Medications: Blood thinners, aspirin, penicillin
• Strenuous exercise: "Runner's hematuria"
• Trauma: Injury to kidneys or bladder
• Blood disorders: Sickle cell, clotting disorders
• Endometriosis: In women, cyclical bleeding
• Recent procedures: Catheterization, cystoscopy
• Radiation therapy: To pelvic area

Blood in urine often occurs with other symptoms that help identify the cause:

• Pain: Location and severity indicate source
• Burning urination: Suggests infection
• Frequent urination: UTI, stones, or prostate issues
• Urgency: Feeling of needing to urinate immediately
• Difficulty urinating: Obstruction or prostate enlargement
• Fever: Indicates infection
• Back or flank pain: Kidney involvement
• Nausea and vomiting: Kidney stones or infection
• Weight loss: May suggest cancer
• Fatigue: Chronic kidney disease or cancer
• Swelling: Kidney disease
• Skin rash: Some kidney diseases
• Joint pain: Autoimmune conditions

Medical History

• When blood first noticed
• Pattern of bleeding
• Associated symptoms
• Medications taken
• Recent procedures
• Family history
• Smoking history
• Occupational exposures
• Recent travel

Physical Examination

• Blood pressure check
• Abdominal examination
• Kidney area assessment
• Prostate exam in men
• Pelvic exam in women
• Skin examination
• Edema check

Laboratory Tests

• Urinalysis: Confirms blood, checks for infection
• Urine culture: Identifies bacteria
• Urine cytology: Looks for cancer cells
• Blood tests: Kidney function, blood counts
• PSA test: Prostate screening in men
• Coagulation studies: If on blood thinners

Imaging Studies

• CT urogram: Best overall imaging
• Ultrasound: Safe, no radiation
• MRI: Detailed imaging
• Cystoscopy: Direct bladder visualization
• IVP: Older test, less common now

• Stay hydrated: Drink plenty of water daily
• Urinate regularly: Don't hold urine too long
• Proper hygiene: Especially for women to prevent UTIs
• Quit smoking: Major risk factor for bladder cancer
• Limit salt intake: Reduces stone risk
• Moderate protein: Excessive protein can stress kidneys
• Safe sex practices: Prevent STI-related urethritis
• Chemical safety: Proper protection if exposed
• Regular check-ups: Early detection important
• Manage chronic conditions: Diabetes, hypertension
• Medication review: Discuss risks with doctor
• Gradual exercise increase: Prevent exercise-induced hematuria

See a Doctor Immediately For:

• Any visible blood in urine
• Pink, red, or brown urine
• Blood clots in urine
• Microscopic blood on multiple tests
• Blood with any pain
• Blood with other urinary symptoms
• History of smoking
• Age over 50 with any hematuria
• Family history of kidney disease

Emergency Symptoms:

• Heavy bleeding
• Unable to urinate
• Severe pain
• High fever with blood
• Signs of severe blood loss
• Confusion or weakness
• After significant trauma

What's NOT Blood in Urine

• Beets or berries (red/pink urine)
• Food dyes
• Medications (rifampin, phenazopyridine)
• Menstrual blood contamination
• Myoglobin from muscle breakdown
• Porphyria (rare condition)

Follow-Up Care

• Complete all prescribed antibiotics
• Return for repeat testing
• Regular monitoring if risk factors
• Annual screening after age 50
• Report any recurrence
• Maintain follow-up appointments