Blood In Urine: Reason For Worry?

Andrew Siegel MD  3/25/17

The medical term for blood in the urine is “hematuria.”  The most common type is seen only under a microscope and is referred to as “microscopic” hematuria. This is typically discovered at the time of a routine urine test during a health exam. When one can see blood in the urine it is referred to as “gross” hematuria, although I prefer “visible” hematuria. Visible hematuria may cause red urine if the bleeding is fresh or cola or tea-colored urine if the bleeding is old. Sometimes hematuria can be accompanied by blood clots, at times so severe that they clog up the outlet to the bladder causing the inability to urinate.  Sometimes hematuria is only evident by seeing bloodstains on one’s underwear or appearing on toilet tissue.

Image below is the urinary tract; note that blood in the urine can come from any part of this tract (Attribution of image: 2010, author Jordi March i Nogue)


ANATOMY QUIZ: Test your knowledge of urinary tract and adjacent anatomy by labeling structures 1-14 (answers at end of entry)


3 Misconceptions Concerning Hematuria

Misconception 1: If you have visible blood in the urine and it goes away, it can be ignored.

Truth: Even if it happens only once, it can be a sign of a serious underlying problem that needs to be determined.

Misconception 2: Microscopic hematuria can be ignored since you cannot see it.

Truth: Microscopic hematuria can be a sign of a serious underlying problem that needs to be evaluated, although it is less commonly associated with a serious problem than visible hematuria.

Misconception 3: Testing can always pinpoint the cause of the hematuria.

Truth: Sometimes the precise cause of the hematuria cannot be determined, despite appropriate testing. However, testing does result in excluding all of the serious underlying causes, meaning that whatever the cause, it is not of significance.

Like a nosebleed, hematuria can be a non-significant problem due to a ruptured blood vessel.  Alternatively, hematuria can be due to serious issues such as kidney or bladder cancers, the two most concerning causes of hematuria.  It is important to know that those who use or who have used tobacco (even if they ceased use many years ago) and have hematuria have a much higher risk of having bladder cancer than non-tobacco users.

Common causes of hematuria in men and women are benign prostate enlargement and urinary tract infections, respectively.  It can occur after vigorous exercise, particularly in those who have bladder stones or other structural abnormalities of the urinary tract. Although most hematuria is painless, when painful hematuria does occur it is often caused by a kidney stone, bladder stone or urinary tract infection. Many people use blood thinners for a variety of reasons. They do not cause hematuria, but if there is an underlying abnormality within the urinary tract, can provoke and perpetuate the bleeding. Hematuria can be a side effect occurring years after pelvic radiation for cancers of the bladder, prostate, uterus, etc.

How Hematuria Is Evaluated

Imaging Tests: A variety of tests can be used to image the urinary tract, including US (ultrasound), CT (computerized tomography) and MRI (magnetic resonance imaging). Retrograde studies involve the injection of contrast into the ureters (tubes that conduct urine from the kidneys to bladder) to image the upper urinary tracts.

Urine Cytology: A Pap smear of urinary tract cells to look for abnormal cells, obtained by providing a urine specimen.

Urine Culture: A lab test to see if a urinary infection is present.

Cystoscopy: A visual inspection of the bladder with a narrow, flexible instrument performed on a monitor with magnification.

Bottom Line: Do not ignore blood in urine, whether it is visible or microscopic. It may be “nothing” (not a sign of a serious illness) or may be “something” (a warning sign of a potentially life-threatening illness), so it is always worthwhile to be properly evaluated. If you experience hematuria, do not panic since the cause can usually be readily determined and treatment initiated; if the precise cause cannot be pinpointed, serious underlying causes can be excluded.

Wishing you the best of health,

2014-04-23 20:16:29

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Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

Answers to anatomy quiz:

  1. Urinary system
  2. Kidney
  3. Renal pelvis
  4. Ureter
  5. Urinary bladder
  6. Urethra (Left side with frontal section)
  7. Adrenal gland
  8. Renal artery and vein
  9. Inferior vena cava
  10. Abdominal aorta
  11. Common iliac artery and vein
  12. Liver
  13. Large intestine
  14. Pelvis


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3 Responses to “Blood In Urine: Reason For Worry?”

  1. 10 Urology Emergencies You Should Know Something About | Our Greatest Wealth Is Health Says:

    […] Urinary bleeding/clotting, a.k.a. “hematuria“/”clot […]

  2. Why and When You Might Want to See a Urologist | Our Greatest Wealth Is Health Says:

    […] comes to expertise in male pelvic health.  Common reasons for referral to a urologist include: blood in the urine (whether visible or found on a urine test); an elevated PSA (Prostate Specific Antigen); prostate […]

  3. 10 Reasons Why Finasteride is the Best Drug. Ever. | Our Greatest Wealth Is Health Says:

    […] It is useful to treat prostate-origin bleeding, the leading cause of blood in the urine (hematuria) in the aging […]

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