Common symptoms
- Side or back pain spreading to the groin, which points to a stone
- Burning, frequent urination or fever, which point to an infection
- A weak stream and night-time urination in older men, which point to the prostate
- Blood with no pain at all, which needs prompt tests to rule out a tumour
- Clots, or difficulty passing urine because of clots
- Swollen feet, frothy urine or high blood pressure, which point to the kidney filters
When not to wait: Go to an emergency department at once if clots stop you passing urine, if the bleeding is heavy and you feel dizzy or faint, if you have fever with chills, or if the blood follows an injury. Blood without pain is not an emergency, but book a visit within days, not months.
Visible and microscopic blood in urine: what is the difference?
Visible haematuria means you can see the colour change yourself. A few drops of blood can turn a whole bowl of urine red, so the colour does not show how much blood is lost. Clots mean the bleeding is heavier.
Microscopic haematuria means the urine looks normal, but red blood cells are found on a urine test, often at a routine health check. A dipstick strip can be falsely positive, so the result is confirmed under a microscope, and repeated if the test was done during a period, after heavy exercise or during an infection. Not all red urine is blood: beetroot, food colours and some medicines, such as rifampicin, can colour urine red or orange.
What causes blood in urine?
Many people describe it as peshab mein khoon. The table lists the common causes, the clues that point to each and what is usually done. More than one cause can be present at once.
| Cause | Other clues | What is done |
|---|---|---|
| Urinary tract infection | Burning, frequency, sometimes fever | Urine culture, then the right antibiotic |
| Kidney or ureter stone | Colicky side pain spreading to the groin, nausea | Ultrasound or CT scan; medicines, or a procedure if it does not pass |
| Enlarged prostate (BPH) | Men over 50 with a weak stream and night-time urination | Prostate examination, ultrasound, PSA; medicines or surgery |
| Kidney disease (in the kidney filters) | Brownish urine, protein in the urine, swollen feet, high blood pressure | Kidney tests; care with a nephrologist (kidney physician) |
| Bladder cancer | Blood without pain, often on and off; smokers; over 40 | CT urogram and cystoscopy; TURBT to remove and test the tumour |
| Kidney or ureter cancer | Blood without pain, sometimes side pain; often found on scans | CT scan; surgery to remove the tumour |
| Injury | A fall, road accident or blow to the side or pelvis | Emergency scan; many kidney injuries settle with rest |
| Urinary tuberculosis | Long-standing burning and frequency not settling with usual antibiotics | Urine tests for TB, imaging; anti-TB medicines |
| Heavy exercise | Blood after long running or an intense workout, clearing in a day or two | Repeat test after rest |
| Food colours, beetroot, some medicines | Red or orange urine but no red cells on testing | No treatment needed |
What about blood thinners?
Aspirin, clopidogrel and anticoagulants can make bleeding heavier, but they rarely cause blood in the urine on their own. Often they reveal a problem already there, such as a stone or a tumour, so the cause is looked for in the same way. Do not stop a blood thinner by yourself; ask the doctor who prescribed it.
When is blood in urine serious?
Any visible blood in the urine should be checked, even if it happened once and then cleared. Bleeding from a bladder or kidney tumour often comes and goes, so urine that looks normal again does not mean the cause has gone.
Blood without pain needs prompt tests, particularly if you:
- Are over 40
- Smoke cigarettes or bidis, or used to; smoking is one of the main risk factors for bladder cancer
- Have worked for years with dyes, rubber, leather or certain industrial chemicals
- Have had radiotherapy to the pelvis or certain cancer medicines in the past
- Have blood that keeps coming back
This does not mean cancer is likely; most people with blood in the urine have a non-cancer cause. But when a tumour is the cause, finding it early usually allows simpler treatment. Microscopic blood found once in a young person is usually lower risk, and the doctor will advise on repeat tests.
How the cause of blood in urine is found
The doctor asks about the colour, clots, pain, fever, smoking, your work, exercise, periods and your medicines. Timing helps: blood only at the start of the stream often comes from the urethra (the urine passage) or prostate, while blood all the way through may come from the bladder or kidneys.
The examination includes the abdomen, blood pressure and, in men, the prostate. A urine test and an ultrasound come first. For visible blood, especially over 40, a CT urogram checks the kidneys and ureters (the tubes from kidney to bladder). A scan can miss a small, flat tumour in the bladder lining, so cystoscopy is the key test for the bladder; see what happens during cystoscopy. If the urine shows protein, the kidney filters may be the cause and a nephrologist joins your care; see urologist vs nephrologist.
Treatment of blood in urine, by cause
Treatment is aimed at the cause, once the tests have found it.
- Infection: an antibiotic chosen from the culture; for infections that keep returning, see recurrent UTI treatment.
- Stones: fluids and medicines for small stones, laser or keyhole removal for larger ones; see kidney stone treatment and the kidney stones page.
- Enlarged prostate: some prostate medicines reduce bleeding; repeated bleeding may need surgery. See enlarged prostate treatment.
- Bladder tumour: TURBT removes it through the urine passage for testing; see bladder cancer treatment.
- Kidney tumour: removal of the kidney or the part with the tumour; see kidney cancer surgery.
- Tumour of the kidney lining or ureter: often nephroureterectomy, removal of the kidney with its ureter.
- Kidney filter disease: managed with a nephrologist.
Heavy bleeding with clots may need admission, a wider catheter and washing of the bladder with saline until the urine clears.
Blood in urine in women, children and pregnancy
In women, a positive test during or just after a period is often contamination, so it is repeated after the period. Visible blood without infection is still checked, because women also get stones and bladder tumours.
In children, causes include infection, kidney filter inflammation after a throat or skin infection, stones and injury. A child with blood in the urine or a puffy face should be seen soon; see pediatric urology care. In pregnancy, infections and stones are the usual causes, and ultrasound is used instead of CT where possible.
Tests that may be needed
- Urine microscopy and culture, which confirm red cells and look for infection
- Urine cytology in selected cases, which looks for abnormal cells from the bladder lining
- Blood tests for kidney function, blood count and, in men, PSA where suitable
- Ultrasound of the kidneys, bladder and prostate
- CT urogram, a contrast CT scan that shows the kidneys, ureters and bladder
- Cystoscopy, a thin camera that looks directly at the bladder lining
Cost, insurance and government schemes
Cost depends on the procedure and your hospital stay. See how estimates, insurance and schemes work.
Frequently asked questions
The blood in my urine stopped by itself. Do I still need tests?
Yes. Bleeding from a stone, the prostate or a tumour often stops and starts again. Visible blood should be checked even if it happened once, especially if you are over 40 or smoke.
Does blood in urine mean cancer?
Usually not. Infections, stones and an enlarged prostate are more common causes. But because cancer is one possible cause, and finding it early matters, the tests are still advised.
Is cystoscopy painful?
It is done with numbing jelly in the urine passage or under anaesthesia, depending on the case. With jelly, most people feel pressure and stinging rather than sharp pain. Mild burning on passing urine for a day or two afterwards is common.
Can drinking more water stop the bleeding?
Water helps flush out small clots and helps with stones and infections, but it does not treat the cause, so the tests are still needed.
Which doctor should I see for blood in the urine?
A urologist, who treats the kidneys, ureters, bladder and prostate and does cystoscopy. If tests point to the kidney filters, a nephrologist joins your care. Dr. Nitin Negi sees patients at the Uro-Andrology Centre, VS MediHUB, Nirman Nagar, Jaipur, Monday to Saturday; see the contact details.
This page is general information, not a diagnosis. Please read our medical disclaimer.