Blood in Urine: 12 Potential Causes and What to Do Next
Learn about blood in urine (hematuria), its causes, diagnosis, and treatment options. Understand when to seek medical help for visible or microscopic blood in urine.
Written by Dr. Siri Nallapu
Reviewed by Dr. Rohinipriyanka Pondugula MBBS
Last updated on 9th Sep, 2025
Introduction
Noticing blood in your urine can be a shocking and anxiety-inducing experience. Medically known as hematuria, this symptom is a clear signal from your body that something requires attention. While it might be something minor and easily treatable, like a urinary tract infection, it can also be an early warning sign of more serious conditions affecting your kidneys, bladder, or prostate. This article will demystify the potential causes of hematuria, from the most common to the less frequent, explain the difference between visible and invisible blood, and guide you through the typical diagnostic process. Most importantly, we’ll emphasise why consulting a healthcare professional is a non-negotiable first step. Understanding what leads to what blood in urine is the first move toward getting the right diagnosis and peace of mind.
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What Exactly is Blood in Urine (Hematuria)?
Hematuria is simply the presence of red blood cells in urine. It's crucial to understand that this isn't a disease itself but a symptom of an underlying condition. The intensity of the colour does not always correlate with the seriousness of the cause. Doctors categorise hematuria into two main types.
Gross Hematuria: When You Can See It
- This is when there is enough blood in the urine to change its colour visibly. You might see pink, red, brownish, or tea-coloured urine. It takes only a small amount of blood to produce a red colour, so the volume of blood isn't necessarily massive. However, the sudden appearance of gross hematuria can be frightening and should always prompt an immediate call to your doctor.
Microscopic Hematuria: The Hidden Sign
- This is when the urine appears normal to the naked eye, but a laboratory test (urinalysis) detects red blood cells under a microscope. This is often discovered during a routine check-up or while being tested for another condition. Like its visible counterpart, microscopic hematuria requires investigation to rule out serious underlying issues, even in the absence of other symptoms of a UTI or kidney problems.
Common Causes of Blood in Urine
The causes of hematuria are diverse, ranging from infections to structural issues. Here are the most frequent offenders.
Infections: A Leading Culprit
- Infections are among the top reasons for blood to appear in urine. They cause inflammation and irritation of the urinary tract organs, leading to bleeding.
Urinary Tract Infections (UTIs)
UTIs occur when bacteria, usually from the digestive tract, enter the urethra and multiply in the bladder. This causes inflammation (cystitis), which can lead to bleeding. Symptoms of a UTI in women (who are more prone to them) and men often include a strong, persistent urge to urinate, a burning sensation when urinating, and strong-smelling, cloudy, or red-tinted urine.
Kidney Infections (Pyelonephritis)
- This happens when a UTI spreads upward from the bladder to one or both kidneys. It can be more serious than a bladder infection and often causes additional symptoms like high fever, chills, flank pain (pain in the back or side), and nausea.
Stones: The Crystalline Agitators
- Crystals formed from minerals in concentrated urine can harden into stones inside your kidneys or bladder.
Kidney Stones
These hard deposits can cause excruciating pain, especially when they move or block part of the urinary tract. They often scrape the lining of the urinary tract, causing gross hematuria. The pain associated with kidney stones is typically severe and colicky, located in the back, side, or lower abdomen.
Bladder Stones
These can form when your bladder doesn't empty completely, and the concentrated urine crystallises. They can also cause irritation and bleeding, often accompanied by lower abdominal pain and difficulty urinating.
Enlarged Prostate (BPH): An Issue for Men
- In older men, the prostate gland—which surrounds the neck of the bladder—often enlarges. This condition, known as benign prostatic hyperplasia (BPH), compresses the urethra, partially blocking urine flow. This can cause the bladder to work harder to empty, leading to irritation and bleeding. Enlarged prostate symptoms often include dribbling at the end of urination, a weak stream, and frequent urination, especially at night.
Kidney Disease
- A diseased kidney glomerulus—the tiny filter within the kidney—can leak red blood cells into the urine. This type of hematuria is often microscopic but can sometimes be visible. Glomerulonephritis can be a primary kidney disease or occur as a result of other conditions like diabetes, viral infections, or vascular diseases.
Cancer: A Less Common But Serious Cause
- Visible blood in urine can be a first sign of advanced cancer in the urinary system, including kidney, bladder, or prostate cancer. It's important to note that these cancers are often treatable when caught early, which is why hematuria should never be ignored, even if it happens only once. Risk factors include smoking, chemical exposure, and a family history.
Other Potential Reasons for Hematuria
Strenuous Exercise
- Rarely, vigorous exercise—particularly long-distance running—can cause gross hematuria. The exact cause is unclear but may be linked to bladder trauma, dehydration, or the breakdown of red blood cells. This usually resolves with rest and hydration within a day or two.
Medications and Supplements
- Certain drugs can cause urinary bleeding. These include the anti-cancer drug cyclophosphamide, the antibiotic penicillin, and blood thinners like aspirin and heparin. Even over-the-counter supplements like high doses of vitamin C (ascorbic acid) can sometimes be a factor.
Inherited Disorders
- Sickle cell anaemia—a genetic defect of haemoglobin that causes red blood cells to become misshapen—can cause hematuria. Another inherited condition, Alport syndrome, affects the filtering membranes in the glomeruli of the kidneys and can also lead to blood in the urine.
Diagnosing the Root Cause: What to Expect
If you report blood in your urine, your doctor will follow a systematic approach to find the cause.
The Initial Consultation and Urinalysis
- The first step is a detailed discussion of your symptoms and medical history, followed by a urinalysis. This test not only confirms the presence of red and white blood cells but can also detect bacteria, proteins, and other clues.
Advanced Imaging: CT Scans and Ultrasounds
- A CT scan of the abdomen and pelvis is often the gold standard for detecting kidney stones, tumours, and other structural abnormalities. An ultrasound is also a common, non-invasive tool used to get images of the kidneys and bladder.
Cystoscopy: A Look Inside the Bladder
- In this procedure, a urologist inserts a thin, flexible tube with a camera (cystoscope) through the urethra to see the inside of the bladder and urethra. This is a crucial test for identifying bladder tumours, stones, or signs of inflammation that other tests might miss. If your condition does not improve after initial tests, a urologist might recommend a cystoscopy for further evaluation.
Conclusion
Discovering blood in your urine is undoubtedly alarming, but knowledge is the first step toward resolution. As we've explored, the causes range from simple, easily resolved infections to more complex conditions requiring specialised care. The critical takeaway is that hematuria is a symptom your body uses to get your attention. Ignoring it, hoping it will go away, or attempting to self-diagnose can allow a manageable condition to become a serious one. Your journey to answers begins with a professional medical consultation. A doctor can connect the dots between your symptoms, medical history, and test results to pinpoint the underlying cause and recommend an effective treatment plan. If symptoms persist beyond a day or are accompanied by pain or fever, book a physical visit to a urologist with Apollo24|7 for a comprehensive examination. Taking swift action is the surest path to restoring your health and your peace of mind.
Consult a Specialist for Personalised Advice
Consult a Specialist for Personalised Advice
Dr. M L Ezhilarasan
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Dr. Ritesh Motghare
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Dr. Pankaj Tripathi
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20 Years • MBBS, MD Pathology
Lucknow
Best Diabetologist Clinic, Lucknow
Consult a Specialist for Personalised Advice
Dr. M L Ezhilarasan
General Practitioner
6 Years • MBBS
Visakhapatnam
Apollo 24|7 Clinic - Andhra Pradesh, Visakhapatnam
Dr Syed Mateen Pasha
General Physician
2 Years • MBBS
Bengaluru
PRESTIGE SHANTHINIKETAN - SOCIETY CLINIC, Bengaluru
Dr. Avinash Pasuparthy
General Practitioner
5 Years • MBBS
Visakhapatnam
Apollo Clinic Vizag, Visakhapatnam
Dr. Ritesh Motghare
General Practitioner
18 Years • MBBS PGCDM
Nagpur
HEALTH CENTRE VNIT NAGPUR, Nagpur
Dr. Pankaj Tripathi
General Practitioner
20 Years • MBBS, MD Pathology
Lucknow
Best Diabetologist Clinic, Lucknow
Frequently Asked Questions
Can dehydration cause blood in urine?
Yes, severe dehydration can concentrate the urine and, in some cases, cause irritation or contribute to kidney stone formation, both of which can lead to hematuria. However, dehydration alone is rarely the sole cause, and other factors should be ruled out by a doctor.
Should I go to the ER for blood in my urine?
You should seek emergency care if the blood in your urine is accompanied by severe pain (especially flank or abdominal pain), nausea/vomiting, high fever, chills, or an inability to urinate. These could be signs of a kidney stone or a severe infection.
What does it mean if I have blood in my urine but no pain?
Painless hematuria can be a sign of several conditions, including bladder or kidney cancer, an enlarged prostate, or kidney disease. It is especially important to investigate painless hematuria, as the absence of pain can sometimes lead to a delay in diagnosis.
Can certain foods like beetroot cause red urine?
Yes, eating large amounts of beets, blackberries, or rhubarb can turn your urine red or pink. This is called beeturia and is harmless. However, if you are unsure whether your diet is the cause, it is always safest to get it checked to rule out actual blood.
How is microscopic hematuria treated?
Treatment is not for the hematuria itself but for its underlying cause. If a urinalysis reveals microscopic hematuria, your doctor will investigate further to find the root cause (e.g., infection, kidney disease, stone) and treat that condition accordingly.