Seeing blood in your urine is frightening, and many people hope it will simply go away. Sometimes it does, but it should never be ignored. Blood in the urine (haematuria) is one of the most common reasons patients are referred to a urologist, and in a small but important number of people it is the first and only sign of a bladder or kidney cancer that is very treatable when found early. Here is what it can mean, what tests to expect, and when to book an appointment.
Two types of haematuria
Visible (gross) haematuria
The urine looks pink, red, brown or cola-coloured, or you pass clots. Even a single episode, with or without pain, needs a urology assessment.
Non-visible (microscopic) haematuria
The urine looks normal, but red blood cells are found on a urine test, often during a routine health check. Persistent microscopic haematuria, especially in adults over 40 or in smokers, should also be evaluated.
Note that beetroot, some food colourings and certain medicines (such as rifampicin) can turn urine red without any blood being present. A simple urine test tells the difference.
Common causes
- Urinary tract infection, usually with burning, frequency and urgency
- Kidney or ureteric stones, often with severe flank or groin pain
- Enlarged prostate (BPH) in older men, from fragile surface blood vessels
- Bladder cancer, classically as painless visible bleeding
- Kidney cancer and, less often, cancer of the ureter or kidney lining
- Kidney diseases such as glomerulonephritis, where protein in the urine or high blood pressure may also be present
- Recent strenuous exercise, injury or a urinary catheter
Painless bleeding deserves extra attention
Blood with pain is most often due to infection or a stone. Painless visible blood is different: it is the classic presentation of bladder cancer. The bleeding often stops on its own for weeks or months, which gives false reassurance. Smoking is the single biggest risk factor, along with long-term exposure to industrial chemicals and dyes. If you are a current or former smoker and see blood in your urine, please do not wait.
Blood thinners do not explain it away
Aspirin, clopidogrel, warfarin and newer anticoagulants can make bleeding more likely, but they rarely cause haematuria on their own. People on these medicines still need the same evaluation. Do not stop a blood thinner without speaking to the doctor who prescribed it.
What the evaluation involves
- Urine tests: routine examination, culture for infection and, where needed, urine cytology
- Blood tests: kidney function and, in men, PSA when appropriate
- Imaging: ultrasound for most patients, and a CT urogram for visible haematuria or higher-risk patients
- Cystoscopy: a thin, flexible camera passed into the bladder under local anaesthetic, usually taking only a few minutes. It is the only reliable way to rule out a bladder tumour.
If a tumour is found
Most bladder tumours detected early are non-muscle-invasive and can be removed through the urethra by TURBT (transurethral resection of bladder tumour), without any cut on the abdomen. Small kidney tumours can often be treated with laparoscopic partial nephrectomy, which removes the tumour while saving the rest of the kidney. Read more about our approach to uro-oncology. Stones causing bleeding are managed with minimally invasive RIRS or PCNL.
See a urologist promptly if you have
- Any visible blood in the urine, even once
- Blood clots, or difficulty passing urine
- Microscopic blood on repeated tests, particularly if you are over 40 or smoke
- Blood with fever, flank pain or vomiting (seek care the same day)
- Unexplained weight loss or loss of appetite along with bleeding
Book a consultation
Dr Bivek Kumar, Consultant Urologist and Andrologist, evaluates haematuria at Superhealth Hospital, Koramangala (Mon–Sat, 9 am–6 pm) and Nelivigi Multispeciality Hospital, Bellandur (Tue, Thu & Sat 7–8 pm; Sunday by appointment only). Consultations are available in English, Hindi, Kannada and Bengali. See all clinic locations, OPD timings and directions.
This article is for general information and does not replace a consultation with your doctor.