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Blood in Urine (Hematuria): Symptoms, Causes, and Treatment

Dr Alvin Ng Profile
Dr Alvin Ng
Senior Consultant Nephrologist
  • Bachelor of Medicine and Surgery (Auckland, New Zealand)
  • Fellow of the Royal Australasian College of Physicians
  • Fellow of the Academy of Medicine, Singapore (Renal Medicine)

Seeing blood in your urine, also known as hematuria, can be alarming and often raises immediate concerns about your health. Sometimes it appears only once, other times it happens repeatedly, and the cause is not always obvious. Hematuria can arise from minor irritation or infection, but it can also reflect conditions that become more difficult to manage when overlooked. If the cause is unclear, it is worth looking into the possibilities to better understand what may be affecting your urinary health. Here, we explore the common reasons blood may appear in urine and the steps involved in assessing and managing this symptom.

What Is Hematuria?

Hematuria describes the condition in which blood is present in the urine. Hematuria can be either gross or microscopic. Gross hematuria refers to the urine appearing pink, red, or brown, and that the blood can be seen with the naked eye. Microscopic hematuria, on the other hand, means that the urine appears normal but is found to contain blood when tested in a laboratory.

Blood in the urine can be a sign of a more serious underlying condition, so it is important to see a healthcare provider for proper evaluation and diagnosis. Some possible causes of hematuria can be severe, such as cancer or kidney disease. In contrast, others may be less serious, such as kidney stones or a urinary tract infection. 

Some causes of hematuria can lead to serious complications without proper treatment, so it is essential to get a prompt and accurate diagnosis. However, it is also important to keep in mind that hematuria can sometimes have no apparent cause and may resolve on its own without treatment.

Symptoms
Photo of Blood in Urine Test Sample

What Are the Symptoms of Hematuria?

Hematuria, or blood in the urine, is often a symptomless condition. In some cases, the blood may be visible in the urine, causing it to appear a different colour. However, in many cases, the blood is present in such small amounts that it can only be detected through laboratory testing.

If you do experience symptoms in addition to having blood in your urine, they may vary depending on the underlying cause of the condition. Some possible symptoms that may occur with hematuria include:

  • Pain or burning sensation during urination

  • Frequent urination

  • Urgency to urinate

  • Lower abdominal pain or pressure

  • Blood in the semen

  • Fatigue or weakness

It is essential to see a specialist for hematuria if you experience any of these symptoms, as they may be a sign of a more serious underlying condition.

Symptoms

What Are the Causes of Blood in the Urine?

There are various possible causes of hematuria, including:

  • Urinary tract infections

    Infections in the urinary tract (including the bladder, kidneys, and urethra) can cause blood to appear in the urine, particularly in women.

  • Kidney stones

    Kidney stones can cause blood in the urine as they pass through the urinary tract.

  • Kidney inflammation or infection

    These affect the urethra, bladder or prostate and are more prevalent in men, resulting in blood in urine.

  • Bladder or prostate infections

    Infections of the bladder or prostate can cause blood to appear in the urine.

  • Enlarged prostate

    An enlarged prostate (a common condition in men) can cause blood to appear in the urine.

  • Certain medications

    Some medications, such as blood thinners, can result in blood appearing in the urine.

  • Cancer

    Blood in the urine can be a sign of bladder, kidney, or prostate cancer. This is common in older adults.

  • Other conditions

    Other conditions that can cause hematuria include sickle cell anaemia, glomerulonephritis, vascular abnormalities, and trauma to the urinary tract. Some of these can arise from hereditary factors.

In some cases, the cause of hematuria may not be found. This is referred to as idiopathic hematuria. Therefore, seeing a healthcare provider for proper evaluation and diagnosis is essential.

Who Is at Risk of Hematuria?

Hematuria, or blood in the urine, can affect anyone, but certain groups are more at risk due to factors such as age, lifestyle and medical history.

  • Older Adults: The risk increases with age as conditions like an enlarged prostate, kidney disease and bladder cancer become more common.
  • Smokers: Smoking introduces harmful chemicals that can irritate or damage the urinary tract, increasing the likelihood of bleeding.
  • Individuals with Recurrent UTIs: Frequent urinary tract infections can cause inflammation of the bladder or urethra, which may lead to microscopic or visible blood in the urine.
  • Athletes in Endurance Sports: Long-distance running or high-intensity exercise can sometimes cause hematuria due to repeated bladder trauma or dehydration.
  • Family History of Kidney Disease: A genetic predisposition to renal conditions, such as polycystic kidney disease, can increase the risk of developing hematuria.

How Is Hematuria (Blood In Urine) Diagnosed?

When blood is detected in the urine, your specialist will perform several tests to identify the cause and assess the condition of the urinary tract.

  • Medical History and Physical Examination: Your doctor will review your symptoms, medications and any recent infections or injuries. A physical exam may help detect tenderness or swelling around the kidneys or bladder.
  • Urine Tests
    • Urinalysis: Checks for red blood cells, protein and signs of infection to confirm the presence of blood and other abnormalities.
    • Urine Culture: Identifies bacterial infections in the urinary tract and guides antibiotic treatment if needed.
    • Urine Cytology: Examines urine under a microscope for abnormal or cancerous cells, helping rule out bladder or urinary tract cancers.
  • Blood Tests: These evaluate kidney function and detect possible causes such as glomerulonephritis or systemic disease. Tests may include creatinine and urea levels to assess how well the kidneys are filtering waste.
  • Imaging Studies
    • Ultrasound: Uses sound waves to visualise the kidneys and bladder.
    • CT Urogram: Provides a detailed view of the urinary tract to detect tumours, stones or structural issues.
    • MRI: Uses magnetic fields to create detailed images of the urinary system.
  • Cystoscopy: In this procedure, a thin tube with a camera is inserted through the urethra into the bladder, allowing the doctor to inspect the bladder lining for inflammation, stones or tumours.

If you’ve noticed blood in your urine, it’s important not to ignore it. Schedule a consultation today so we can identify the cause and start the right treatment early.

What Are the Treatment Options for Hematuria?

A thorough investigation of the cause is required. This includes laboratory tests for blood and urine tests, an ultrasound scan, CT or MRI scan of the kidneys, ureters and bladder. Results may indicate the need for a kidney biopsy, in which the diagnosis obtained from the tests will determine the subsequent course of treatment.The treatment for hematuria (blood in the urine) will depend on the underlying cause of the condition. However, some possible treatment options may include the following:

  • Antibiotics

    : If a urinary tract infection is causing hematuria, antibiotics may be prescribed to clear the infection.

  • Medications

    : If an enlarged prostate or certain medications are causing the hematuria, medicines may be prescribed to shrink the prostate or to stop the bleeding.

  • Surgery

    : If kidney stones or specific abnormalities in the urinary tract are causing the hematuria, surgery may be necessary to remove the stones or to correct the abnormalities.

  • Other treatments

    : If cancer is causing hematuria, treatment may involve chemotherapy, radiation, or surgery.
Working with a healthcare provider to determine the most appropriate treatment plan for your needs is crucial.

Lifestyle Tips to Help Manage Hematuria

Lifestyle adjustments can help reduce the frequency or severity of hematuria and support overall kidney health. These measures are especially useful for individuals with recurrent urinary issues or chronic kidney conditions.

  • Stay Hydrated: Drinking enough water helps dilute the urine, flush out bacteria and prevent the formation of kidney stones.
  • Maintain Good Urinary Hygiene: Good hygiene practices, such as wiping from front to back and urinating after sexual activity, can help reduce the risk of urinary tract infections.
  • Avoid Smoking: Quitting smoking supports both kidney and overall health, reducing the chance of recurrent hematuria.
  • Healthy Diet: Maintaining a healthy weight also lowers the risk of conditions such as diabetes and hypertension, which can contribute to hematuria.
  • Manage Chronic Conditions: Chronic illnesses like diabetes, high blood pressure and kidney disease should be properly managed with medication and regular monitoring.
  • Limit Excessive Physical Strain: Gradually increasing workout intensity and staying hydrated during physical activity can help prevent exercise-related urinary bleeding.

When to See a Specialist for Hematuria

It is wise to consult a specialist as soon as you notice red or brown discoloration in your urine, even if it happens only once. While some causes are harmless, hematuria can also signal conditions that require timely attention.

You should seek medical advice urgently if you experience any of the following:

  • Persistent or Recurrent Hematuria: If the discoloration does not go away or keeps returning, a proper assessment is important to identify the cause.
  • Accompanying Symptoms: Painful urination, frequent urination, severe abdominal or flank pain, fever, or unexplained weight loss should prompt immediate review.
  • History of Kidney or Urinary Issues: If you have had kidney stones, recurrent UTIs, or previous urological procedures, new symptoms should be checked by your specialist.
  • Age-Related Factors: Older adults, especially men over 50, should be assessed for prostate or age related urinary conditions if blood appears in the urine.

Get Personalised Assessment for Hematuria

If you have noticed blood in your urine or are unsure of the cause, book an appointment at our clinic for careful assessment and tailored guidance to help you understand your next steps.

Frequently Asked Questions About Blood in the Urine

Blood in the urine can have many causes. Common reasons include urinary tract infections, kidney stones, and inflammation or infection in the kidneys, bladder, or prostate. It may also result from an enlarged prostate, certain medications, or more serious conditions such as cancers of the urinary tract. Other causes include inherited disorders, vascular issues, and physical injury.

Healthy habits can lower the risk of hematuria and support kidney function. Staying well hydrated, practising good urinary hygiene, avoiding smoking, and maintaining a balanced diet all help protect the urinary system. Managing chronic conditions such as diabetes or high blood pressure and avoiding excessive physical strain can also reduce the likelihood of recurrent bleeding.

Treatment begins with identifying the cause through blood and urine tests, imaging such as ultrasound or CT scans, and sometimes a kidney biopsy. Management depends on the findings. Infections are treated with antibiotics, prostate related bleeding with medication, and stones or structural issues may require procedures. More serious causes, including cancer, may involve specialised therapies.

Leaving haematuria untreated can be dangerous, as it may indicate an underlying condition such as a urinary tract infection, kidney stones or cancer. Ignoring the symptom can delay diagnosis, allowing the disease to progress and potentially cause kidney damage or other serious complications. If you notice blood in your urine, it is important to see a doctor promptly for proper evaluation and treatment.

Do you have a question about your kidney or medical condition?

Reach out to us for a consultation with Dr Alvin Ng. 

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Our Specialist for Hematuria

Dr Alvin Ng (黄国雄医生)

  • Bachelor of Medicine and Surgery (Auckland, New Zealand)
  • Fellow of the Royal Australasian College of Physicians
  • Fellow of the Academy of Medicine, Singapore (Renal Medicine)

Dr Alvin Ng is a renal specialist with more than 20 years of medical experience. He manages a wide range of kidney conditions, including those that lead to blood in the urine. His work includes directing peritoneal dialysis services and leading community health outreach to improve kidney disease prevention. He has also held key roles in clinical quality and served on national nephrology committees. Dr Ng strongly believes in taking the time to explain each condition clearly and ensures that patients and their families understand their options. His approach focuses on personalised care that supports the best possible outcome and a positive experience.

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