Hematuria

What is blood in urine (hematuria)?

Hematuria (hee-muh-TOOR-ee-uh) is the medical name for the presence of blood cells in your urine (pee).

It’s pretty common for blood to be in your pee. But you may not even know it because it doesn’t always turn your pee pink or red. Sometimes, there’s only a small amount of blood in your pee that you can’t see — healthcare providers discover it during a urine test.

But if you notice your pee looks pink or red or you have other hematuria symptoms, it might be a sign that something is wrong. You should reach out to a healthcare provider.

What are the types of hematuria?

Healthcare providers label blood in pee as:

• Gross hematuria. This is when there’s enough blood in your pee that it’s visible to the naked eye. It can turn toilet water a pale pink or bright red color.
• Microscopic hematuria. If you have microscopic hematuria (microhematuria), you have blood in your pee, but the amount is too small for you to see with your naked eye. You need a microscope to see it.
• Dipstick hematuria. Dipstick hematuria occurs when oxidation (exposure to oxygen) of a dipstick causes a color change. Dipsticks are thin strips of plastic or paper with patches of chemicals. The chemicals change colors if you have certain substances in your pee.

Dipstick tests have relatively high false-positive rates. A false-positive rate is when the dipstick test says you have blood in your pee, but you don’t. Providers need to confirm dipstick hematuria with a microscopic urinalysis.

How common is blood in urine?

Hematuria is common. Medical experts estimate that more than 20% of people who receive an evaluation from a urologist have blood in their pee. Microscopic hematuria affects an estimated 2% to 31% of people. Microscopic hematuria is more common than gross hematuria.

What are the signs and symptoms of hematuria?

Many times, there are no symptoms except blood in your pee. When this happens, a healthcare provider may say you’re “asymptomatic.”

If you have other symptoms, they may include:

• Peeing more than usual (frequent urination)
• Pain or burning when you pee (dysuria)
• A strong need to pee right away (urinary urgency)

You may have other associated symptoms, too, including:

• Nausea and vomiting
• Fever
• Chills
• Lower back pain
• Abdominal pain
• Pain on either side of your lower back, just above your hips (flank pain)

Having blood in your pee doesn’t always mean you have a condition. But it can be an important warning sign that something is wrong with your body. Don’t ignore it. Contact a healthcare provider as soon as you find blood in your pee.

What is the main cause of hematuria?

There are many different causes of hematuria. Some conditions are more serious than others. Serious conditions may include:

• Urinary stone disease. This term describes masses of minerals or other substances that form in your urinary system. This includes kidney stones, bladder stones and ureteral stones.
• Urinary tract infection (UTI). This is a bacterial infection in any part of your urinary system.
• Kidney infection (pyelonephritis). This is an infection that spreads to your kidney(s).
• Bladder inflammation (cystitis). This is when inflammation affects your urinary bladder. It may have infectious or noninfectious causes.

Certain cancers can also cause blood to appear in your pee.

Other conditions that may lead to blood in your pee include:

• Enlarged prostate (benign prostatic hypertrophy or BPH). BPH causes your prostate to grow. Your prostate is a gland that produces semen.
• Injury to your urinary system. Examples include blunt trauma (like a fall, automobile collision or sports injury) or a penetrating injury (like a knife wound or gunshot wound).
• Menstruation. You may see blood in your pee when you have your period.
• Endometriosis. This causes tissue that’s similar to your uterine lining (where blood and tissue come from during menstruation) to grow outside of your uterus.
• Chronic kidney disease (CKD). CKD affects how well your kidneys work. It’s a long-term (chronic) condition.
• Sickle cell disease. This is a condition you inherit from your biological parents that affects your red blood cells.

What cancers cause hematuria?

Different types of cancer can cause blood to appear in your pee. These include:

• Bladder cancer
• Kidney cancer
• Ureteral cancer
• Urethral cancer
• Prostate cancer

Is hematuria contagious?

No, hematuria isn’t contagious. But a common cause of hematuria is UTIs. Healthcare providers don’t consider UTIs contagious. But sometimes, you can spread the bacteria that cause UTIs to a partner during sexual intercourse.

Who does hematuria affect?

Anyone of any age can have blood in their pee. But you may be more likely to have hematuria if you:

• Have a UTI
• Have a congenital urinary abnormality
• Are 50 or older
• Have a biological family history of conditions that affect your urinary system, such as CKD or kidney stones
• Take certain medications, including anticoagulants (blood thinners), nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics
• Smoke
• Don’t drink enough fluids (dehydration)
• Encounter certain chemicals and/or radiation at work
• Work around metals, fumes, dyes or rubbers
• Play contact sports, including hockey, soccer, boxing and football
• Run long distances or exercise a lot (exercise-induced hematuria)
• Have vigorous sexual intercourse

What complications are related to blood in urine?

You may experience side effects of hematuria treatments, including medications and procedures. They vary by treatment, and a healthcare provider will review any possible side effects with you.

But untreated hematuria can lead to bigger problems, especially if the cause is serious. A provider should treat any condition that causes blood in your pee. Early detection of a serious condition leads to early treatment. Your chances of successful treatment increase the sooner you get treatment.

How is hematuria diagnosed?

A healthcare provider will review your medical history, ask you questions about any other symptoms and perform a physical examination, which may include a pelvic exam or digital rectal exam. They may also recommend additional tests to help confirm a hematuria diagnosis.

What tests will be done to diagnose hematuria?

A healthcare provider may recommend the following tests to help diagnose hematuria:

• Urinalysis. You pee in a special cup and a provider looks at its appearance and checks it for signs of conditions that cause hematuria.
• Urine culture. You pee in a special cup and a provider checks it for signs of infection.
• Urine cytology. You pee in a special cup and a provider checks for any abnormal-appearing cells.
• Cystoscopy. A provider inserts a small camera (cystoscope) through your urethra into your bladder to examine your urethra and bladder.
• Imaging tests. Noninvasive imaging tests — including an ultrasound, CT scan and MRI — produce images of your urinary system and other organs and structures.

What is the best treatment for hematuria?

Hematuria treatment depends on its cause. A healthcare provider will use the information they collect from your medical history, physical exam and any test results to find the best treatment.

Medications to treat causes of blood in urine

Depending on the cause, a healthcare provider may recommend the following medications to treat hematuria:

Are there other ways to treat causes of blood in urine?

It depends on the cause of hematuria.

When an enlarged prostate causes blood in your pee and medications don’t treat it, a healthcare provider may suggest surgery. There are many different types of surgery to remove prostate tissue and stop prostate bleeding. A healthcare provider will review your options.

For cancers, you may need multidisciplinary care. Multidisciplinary care is when you have a group of healthcare providers who specialize in different diseases or conditions that affect different parts of your body. This may include:

• Urologists or urologic oncologists
• Medical oncologists
• Radiation oncologists
• Nephrologists

Can hematuria be prevented?

You can’t prevent all causes of hematuria. But you can help prevent some causes by:

• Drinking plenty of water every day
• Peeing before and after having sexual intercourse
• Always wiping your anus (butthole) from front to back after you poop, if you have a vagina
• Maintaining a weight that’s healthy for you
• Limiting foods that are high in sugar, sodium (salt) and animal proteins
• Quitting smoking
• Limiting your exposure to hazardous materials or chemicals

Can drinking water stop blood in urine?

You may decrease your chances of certain conditions that cause hematuria by drinking enough fluids — preferably, water. Water is good for your urinary system and your body.

If you don’t drink enough water, your pee may be darker in color. If you’re extremely dehydrated, you could possibly have bloody pee.

Is hematuria life-threatening?

Hematuria usually isn’t life-threatening. But sometimes, the cause of hematuria is serious. If you notice blood in your pee, schedule a visit with a healthcare provider so they can determine the cause.

What can I expect if I have hematuria?

Your outlook depends on what’s causing hematuria. But in general, your outlook is good. Hematuria may go away without treatment. Or it may go away pretty easily with treatment. A healthcare provider will tell you what to expect according to your specific cause.

When should I see a healthcare provider?

Contact a healthcare provider if the water in your toilet looks pink or red after you pee.

But some types of hematuria aren’t obvious. In those cases, it’s important to talk to a healthcare provider if you have symptoms that relate to hematuria, like:

• Changes to your peeing habits
• Signs of infection
• Pain in your abdomen, lower back or flanks

If any of your symptoms are severe, you should visit urgent care.

What questions should I ask a healthcare provider?

You may wish to ask a healthcare provider the following questions:

• What type of hematuria do I have?
• What tests do you recommend to diagnose hematuria?
• What’s causing blood in my pee?
• Do I need treatment?
• If I need treatment, what do you recommend?
• What should I do if I get blood in my pee again?

Can foods or drinks cause hematuria?

No, foods and drinks can’t cause hematuria. But certain foods can make you think you’re peeing blood because your pee looks pink, red or dark brown. These include:

• Beets
• Rhubarb
• Blackberries
• Fava beans