- Blood in urine
- Causes of blood in urine
- What causes blood in semen?
- What causes blood in urine (haematuria)?
- What will the doctor do about penis blood?
- Penile cancer
- Treating penile cancer
- Blood in semen
- Urine – bloody
- Bladder Cancer Signs and Symptoms
- Blood in the urine
- Changes in bladder habits or symptoms of irritation
- Symptoms of advanced bladder cancer
- Is Blood in your Urine a Reason to be Concerned?
- What Causes Hematuria?
- Diagnosing the Cause
- Burning and Bleeding After Urination
Blood in urine
Causes of blood in urine
Blood in your urine could come from anywhere in the urinary tract – the bladder, kidneys or urethra (the tube that carries pee out of the body).
If you have other symptoms, this might give you an idea of the cause. Don’t self-diagnose – see a GP if you think it’s blood in your urine.
|Other symptoms||Possible cause|
|Burning pain when peeing, need to pee often, smelly or cloudy pee, high temperature (fever), pain in sides or lower back||urinary tract infections (UTIs)|
|Very bad pain in sides, lower back or groin that comes and goes, unable to lie still, feeling sick||kidney stones|
|Older men (common in over-50s) finding it difficult to pee, needing to pee suddenly and often, waking up to pee in middle of the night||enlarged prostate|
When it might be something else
It may not be blood in your urine if:
- you’ve recently eaten beetroot – this can turn your urine pink
- you’re taking a new medicine – some medicines can turn urine red or brown
- you’re bleeding from your bottom instead
- it’s happening during your period
If you experience blood coming out of your penis during intercourse or masturbation it may be alarming, but it usually isn’t anything more serious. However, blood in your sperm (haematospermia) or urine (haematuria), should be investigated immediately, as it can be an indicator of a medical condition.
Men’s health expert Dr Jeff Foster looks at the symptoms and possible causes for blood coming out of your penis:
What causes blood in semen?
The potential causes for blood in semen could be the following:
• Sexually transmitted infection
Blood or discharge from your penis could be a symptom of an sexually transmitted infection (STI) including gonorrhoea, genital herpes, and chlamydia.
If symptoms include painful or burning urination and unusual discharge from your penis, this can lead to serious health consequences, so make an appointment with your local sexual health clinic to get it checked out.
An injury to the penis can cause blood in semen. If you notice any bruising or unfamiliar marks on your penis caused by a sports injury, sex or an accident, make an emergency appointment with your GP.
• Surgery complications
If you have recently had a surgical procedure and experience blood coming out of your penis, make an appointment with your surgeon or GP to get it checked out.
• Systemic diseases
Severe uncontrolled high blood pressure, bleeding disorders such as haemophilia, lymphoma, leukaemia, and chronic infections—for example, tuberculosis, schistosomiasis can cause blood in semen and urine.
💡If you are under 40 and don’t have any underlying medical conditions, blood in semen often disappears on its own so try not to panic. For men over 40, make an emergency appointment with your GP.
• Prostatic disease
Blood in semen could be acute or chronic prostatitis, benign prostatic hyperplasia, prostatic calculi (stones), or abnormal prostatic blood vessels.
• Testicular orchitis or epididymitis
If your symptoms include swollen and painful testicles, it may be epididymitis, which is often caused by an infection and is easily treated with antibiotics. Visit your GP for advice.
• Prolonged abstinence
If you do not ejaculate for a prolonged amount of time, usually greater than three months, this could lead to blood in your semen.
• Urological cancers
Certain urological cancers can cause blood in semen including prostate, bladder, urethral, testicular/epididymal and seminal vesicle.
What causes blood in urine (haematuria)?
Potential causes for blood in urine could be the following, as outlined by Dr Foster:
• Urinary tract infection
If you experience blood in your semen and/or urine, if the symptoms include a burning sensation when you urinate and your pee smells strong or unfamiliar, it could be a urinary tract infection (UTI). This can occur anywhere in the urinary tract, including the urethra, ureters, bladder, and kidneys. Urine infections are less common in men than women and and it’s important that you always get it checked out by your GP.
• Strenuous exercise
High impact exercise can cause blood in urine from an exercise-induced hematuria or dehydration. It is usually temporary but if symptoms persist, visit your GP.
• Sexual activity
Extreme sexual activity can cause blood in urine. It usually goes away after a short while, but if symptoms persist get it checked out by a sexual health clinic.
• Penile injury
An injury to the penis can cause blood in the urine. If you notice any bruising or unfamiliar marks on your penis caused by a sports injury, sex or an accident, make an emergency appointment with your GP.
• Kidney disease
Kidney cysts, tumours, cancer, nephritis and stones can all cause blood in urine. If symptoms include severe pain in your side and back, or your pain radiates to the lower abdomen and groin, make an emergency appointment with your GP.
• Prostate disease
Blood in urine can be a symptom of benign prostate enlargement, infection of the prostate (prostatitis) and prostate cancer. Classic prostate symptoms include a weak or slow urinary stream, frequently getting up in the night and difficulty starting to urinate.
• Bladder cancer
This often presents with painless obvious bright red blood in the urine. However some patients also present like prostate disease, so speak to your GP.
• Fake blood
Have you been snacking on raw beetroot or blood oranges? Red urine due to coloured foodstuffs is not that uncommon!
• Anticoagulation drugs
For patients on anticoagulation drugs such as warfarin, passing blood can mean the drug levels are higher than they should be and the dose may need to be altered. Other medicines that can impact urine include overuse of anti-inflammatories such as ibuprofen and immunosuppressants.
What will the doctor do about penis blood?
Your doctor will carry out the following examinations:
✔️ Blood in your semen
If you experience blood in your semen your doctor will do a detailed history and examination which might be followed by an ultrasound and a blood test depending on the likely cause.
✔️ Blood in your urine
Blood in urine is more complicated than semen due to the large number of causes. If you experience blood in your urine your doctor will carry out a urine dipstick test initially and if confirmed then look for a underlying cause. For example, if it’s a simple infection they will prescribe antibiotics. If you are in an older age group you will likely be referred for scanning and a cystoscopy to rule out cancer.
Late updated: 13-11-19
Dr Jeff Foster (BSc MBCHb MRCGP DRCOG) Men’s health specialist Dr Jeff Foster is a Men’s Health specialist, and one of the founders of TFJ Private GP Services in Warwickshire. Dr Foster completed an honours degree in Physiology at King’s College London.
Treating penile cancer
Treatment for penile cancer depends on the size of the affected area and the rate at which the cancer has spread.
For example, in most cases of carcinoma in situ (CIS), where only the skin cells of the penis are affected, treatment usually involves either using a chemotherapy cream or having laser surgery to remove the affected area of skin.
You’ll usually have a skin graft after surgery.
The main treatments for later-stage penile cancer are:
Surgery involves removing the cancerous cells and possibly some of the surrounding tissue.
In most cases, any physical changes to your penis after an operation can be corrected with reconstructive surgery.
Skin and muscle can be taken from elsewhere in the body to recreate a functioning penis.
But with early diagnosis and modern surgical techniques, your surgeon will usually be able to preserve as much penile tissue as possible.
As part of most treatments for penile cancer, the lymph glands (small organs that are part of the immune system) in the groin will be assessed to determine if the cancer has spread.
In some cases, the lymph glands may need to be surgically removed.
As with most types of cancer, the outlook for individual cases depends largely on how far the cancer has advanced at the time of diagnosis.
Want to know more?
The Cancer Research UK website has more information about:
- staging penile cancer
- types of treatment for cancer of the penis
You can also read about penile cancer on the male cancer website Orchid or call the helpline on 0203 465 5766 (Monday to Friday, 9am to 5.30pm).
Marsha recently noticed blood coming from her dog’s penis.
Sometimes the blood shows up after urination; other times, there is only blood. The 7-year-old old boxer apparently is oblivious to any problems, as Marsha says he is in good spirits, with normal rambunctious activity and appetite.
He is not urinating more often and otherwise is showing no signs of health problems. Both Marsha and her husband, Rod, have looked closely at Toby’s penis and have not seen any bleeding.
Let’s assume that Marsha and Rod have ruled out a lesion that might be causing the bleeding. The source of the blood then is from farther inside.
First consider that the penis contains the urethra, a tube in male dogs connected to the urinary tract. The urinary tract consists of the kidneys, the tubes leading from the kidneys called ureters, the bladder and finally the urethra. Blood from any part of this tract can show up from the penis.
The other tract associated with the urethra is the reproductive tract. The reproductive tract of a male dog consists of the testicles, the vas deferens, which carries sperm from the testicles to the urethra and then out the penis during ejaculation, and the prostate gland. The prostate gland, among other things, makes a fluid called prostatic fluid, which makes up part of the ejaculate. Bleeding from any of these structures can show up as blood from the penis.
A urinalysis will help rule out blood from most of the urinary tract. If a urinalysis does not show blood, we can consider it less likely the blood is coming from Toby’s bladder, ureters or kidneys. I say less likely because it is possible the bleeding is intermittent and thus might be missed on a single urinalysis. The only structure not likely ruled out is the urethra, because it is shared with the reproductive tract.
Let’s say the blood is not from the urinary tract. Then I am putting my money on the reproductive tract as the source of the blood. This is even more likely if Toby still has his testicles. This is because un-neutered male dogs can have prostate issues. These can range from prostatic hypertrophy from chronic testosterone stimulation to inflammation and or infection of the prostate and even cancer of the prostate. All of these conditions can cause bleeding.
Palpation of Toby’s prostate can reveal whether it is enlarged as it would be with prostatic hypertrophy or if it is irregular in shape, as it might be with cancer. Inflammation and/or infection of the prostate is/are usually quite painful and these dogs will express pain when their prostate is palpated.
Further diagnostic steps will need to be performed in order to definitively diagnose a particular prostate ailment, but the good news is that if Toby does have an issue with his prostate that is not yet cancer, neutering him along with appropriate medication when needed, will likely result in resolution of his problem.
— — —
Blood in semen
If blood in your semen is the only symptom that you have, and no other symptoms are found after tests and a physical examination, then usually you won’t need any sort of treatment. It should go away on its own.
Blood in semen can go away and come back, but it generally clears up without treatment and doesn’t increase the risk of other diseases. On its own, blood in your semen doesn’t put your sexual partner at the risk of other diseases either.
If other symptoms are found, the blood in your semen might have an underlying cause that means you need treatment.
Minor injuries are treated with rest and keeping track of symptoms.
Major injuries may need surgery
Infections can often be treated with antibiotics
Blockages (e.g. due to prostate enlargement) are usually treated with specific medicines
In the rare case of prostate cancer, surgery, radiation or hormonal therapy may be needed.
If you are over the age of 40 and continue to have blood in your semen, especially if you also have other symptoms, it’s a good idea to talk to your doctor.
Urine – bloody
There are many possible causes of blood in the urine.
Bloody urine may be due to a problem in your kidneys or other parts of the urinary tract, such as:
- Cancer of the bladder or kidney
- Infection of the bladder, kidney, prostate, or urethra
- Inflammation of the bladder, urethra, prostate, or kidney (glomerulonephritis)
- Injury to the bladder or kidney
- Kidney or bladder stones
- Kidney disease after strep throat (post-streptococcal glomerulonephritis), a common cause of blood in the urine in children
- Kidney failure
- Polycystic kidney disease
- Recent urinary tract procedure such as catheterization, circumcision, surgery, or kidney biopsy
If there is no structural or anatomical problem with your kidneys, urinary tract, prostate, or genitals, your doctor may check to see if you have a bleeding disorder. Causes may include:
- Bleeding disorders (such as hemophilia)
- Blood clot in the kidneys
- Blood thinning medicines (such as aspirin or warfarin)
- Sickle cell disease
- Thrombocytopenia (low numbers of platelets)
Blood that looks like it is in the urine may actually be coming from other sources, such as:
- The vagina (in women)
- Ejaculation, often due to a prostate problem (in men)
- A bowel movement
The urine can also turn a red color from certain drugs, beets, or other foods.
Bladder Cancer Signs and Symptoms
Bladder cancer can often be found early because it causes blood in the urine or other urinary symptoms that cause a person to see a health care provider.
Blood in the urine
In most cases, blood in the urine (called hematuria) is the first sign of bladder cancer. There may be enough blood to change the color of the urine to orange, pink, or, less often, dark red. Sometimes, the color of the urine is normal but small amounts of blood are found when a urine test (urinalysis) is done because of other symptoms or as part of a general medical check-up.
Blood may be present one day and absent the next, with the urine remaining clear for weeks or even months. But if a person has bladder cancer, at some point the blood reappears.
Usually, the early stages of bladder cancer (when it’s small and only in the bladder) cause bleeding but little or no pain or other symptoms.
Blood in the urine doesn’t always mean you have bladder cancer. More often it’s caused by other things like an infection, benign (not cancer) tumors, stones in the kidney or bladder, or other benign kidney diseases. Still, it’s important to have it checked by a doctor so the cause can be found.
Changes in bladder habits or symptoms of irritation
Bladder cancer can sometimes cause changes in urination, such as:
- Having to urinate more often than usual
- Pain or burning during urination
- Feeling as if you need to go right away, even when your bladder isn’t full
- Having trouble urinating or having a weak urine stream
- Having to get up to urinate many times during the night
These symptoms are more likely to be caused by a urinary tract infection (UTI), bladder stones, an overactive bladder, or an enlarged prostate (in men). Still, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed.
Symptoms of advanced bladder cancer
Bladder cancers that have grown large or have spread to other parts of the body can sometimes cause other symptoms, such as:
- Being unable to urinate
- Lower back pain on one side
- Loss of appetite and weight loss
- Feeling tired or weak
- Swelling in the feet
- Bone pain
Again, many of these symptoms are more likely to be caused by something other than bladder cancer, but it’s important to have them checked.
If there’s a reason to suspect you might have bladder cancer, the doctor will use one or more exams or tests to find out if it’s cancer or something else.
Is Blood in your Urine a Reason to be Concerned?
If you notice blood in your urine, don’t ignore it. There are many possible causes of this condition, known as hematuria. While some are simply treated and not dangerous, others may need immediate medical attention.
Not all hematuria can be seen with the human eye. In fact, the most common type of hematuria-called microscopic hematuria-can only been seen by a health care expert under a microscope. In many cases, microscopic hematuria is spotted when a person has a urine test during a health exam.
When a person can see the blood in his or her urine, the condition is called gross hematuria. People with gross hematuria have urine that is pink, red or brown.
“There’s a common misconception that if you see blood in your urine once and then it goes away that you’re in the clear,” says Angela B. Smith, MD, Assistant Professor of Urology at the University of North Carolina School of Medicine in Chapel Hill. “But it’s important to seek care the very first time you see blood in the urine, so your doctor can confirm that it’s there and refer you to a urologist for an evaluation.”
In most cases, people with either type of hematuria do not have pain or any other signs or symptoms.
What Causes Hematuria?
Common Causes of Hematuria:
- Urinary tract infection
- Enlarged prostate
- Kidney stones
- Vigorous exercise such as long-distance running
- Certain drugs, such as blood thinners, aspirin and other pain relievers, and antibiotics
More serious causes are swelling of the kidney, urethra, bladder or prostate, or cancer of the kidney or bladder. Only a small percentage of people with microscopic hematuria have cancer. A history of smoking raises the risk of bladder or kidney cancer.
Risk Factors for Hematuria:
- A family history of kidney disease
- Chronic urinary tract infection
- Exposure to chemicals in the workplace
- Treatment with radiation for pelvic cancer
“In many cases, kidney cancer and bladder cancer do not cause physical symptoms, so the tumor may continue to grow without a person being aware of it,” says Michael J. Kennelly, MD, Professor in the Department of Surgery, Division of Urology at the Carolinas Medical Center – Charlotte in North Carolina. “By the time the tumor does cause symptoms, it may not be curable. That’s why it is so important to seek medical attention if you see blood in your urine. It could be a warning sign for a potentially life-threatening illness. Fortunately, the majority of the time, blood in the urine is not a sign of a serious illness.”
Diagnosing the Cause
If your doctor thinks you may have hematuria, you will have a repeat urine test to make sure the first test was right. Your doctor will ask you about your health history, including infections, kidney stones, smoking, menstruation and recent injuries. He or she will also ask about medications you are taking.
Your doctor will perform a physical exam to check for pain or tenderness in the bladder or kidney area. Men may be given a digital rectal exam to look for prostate problems. Women may have a pelvic exam to look for the source of red blood cells in the urine.
Other Tests May Include:
Cystoscopy. This is a procedure a urologist performs to see inside the bladder and urethra (the tube that allows urine to pass out of the body). The doctor uses a thin tube with a camera and light on the end–called a cystoscope–to look for cancer cells or other problems.
Kidney imaging tests. The doctor may order an imaging test such as ultrasound, CT scan or MRI to look for a tumor, a kidney or bladder stone, an enlarged prostate or other problem.
Your doctor may order one more urine test to look for signs of infection, kidney disease and cancer. You may have a blood test to check for high levels of the protein creatinine, a sign of kidney disease.
In many cases, the doctor is not able to find out why there is blood in the urine, Dr. Smith notes. He or she may decide to retest your urine in a year. If blood is found, you may undergo more tests. Or you may be retested several years later.
Hematuria is managed by treating its underlying cause. For example, if the condition is caused by a urinary tract infection, it is treated with antibiotics. Treatment for kidney stones can include waiting for the stone to pass by itself, medication or surgery.
If you are found to have kidney or bladder cancer, your doctor may refer you to an oncologist or urologic surgeon. If the tumor is found early, the cancer often can be cured. There are a number of options for kidney and bladder cancer treatment, including surgery, chemotherapy and radiation.
If the doctor rules out any medical problem causing hematuria, you will not need treatment.
“If you find blood in your urine, or your doctor tells you that you have microscopic hematuria, don’t panic,” Dr. Kennelly says. “The good news is that with proper evaluation, your doctor can find out the cause and if needed, make sure you get the correct treatment right away.”
Burning and Bleeding After Urination
Q1. A few nights ago I was urinating and I suddenly felt as if something came into my penis and caused a really bad burning sensation. When I finished urinating, I noticed that I was bleeding. My doctor prescribed antibiotics, and the bleeding and burning sensation were reduced, but now the symptoms seem to be coming back. Do you have any thoughts about what this could be and how I should proceed with treatment?
— Arsalan, California
What you are describing is called terminal hematuria, or bleeding at the end of the urinary stream. Antibiotics are appropriate if the bleeding and burning are caused by a urinary tract infection. Some urinary infections, including bladder infections, prostate infections, and urethritis (inflammation of the urethra, the tube in the penis that leads from the bladder to the outside), can lead to blood in the urine or at the tip of the urethra. Recurrence of this symptom should make the treating physician suspicious that either the bleeding is not due to an infection, the infection was incompletely treated, or the same or another organism has caused a recurrent infection.
Appropriate use of cultures (placing some urine in a culture dish in the lab to see whether organisms grow — and if so, what kind) to guide antibiotic therapy is the best way to completely eradicate a urinary tract infection. If in fact you did not have a documented culture-positive infection, then other causes of hematuria need to be investigated. These can include a kidney stone that passed down into the bladder or urethra; a tumor of the bladder, urethra, or upper urinary tract; and a vascular (blood vessel) malformation. These potential sources of blood should be investigated. The most common cause of bleeding in the urinary tract in men is enlargement of the prostate, but this is a diagnosis of exclusion that can only be entertained when more serious causes have been ruled out.
Q2. I am a 25-year-old healthy male. During a recent visit to the urologist, a trace amount of blood was found in my urine, but no signs of infection. I can’t see any blood myself when I go to the bathroom. The doctor sent me to get a CT scan, and everything came back normal. I’m really worried about something worse being the cause. Should I be? Or can blood just show up in the urine from time to time?
While microscopic amounts of blood in the urine, detected by urinalysis, can be a sign of a serious underlying condition, in low-risk individuals (younger than age 40, with no smoking history or other risk factors), the likelihood of finding a serious problem is very low. The urologist correctly sent you for imaging of your upper urinary tract. Rest assured that the likelihood of missing some underlying bladder disease is very low in a patient like you. Blood in the urine may also be a sign of medical kidney disease, which is generally evaluated by a nephrologist.
Once any significant underlying disease is ruled out, the recommendation generally is not to worry about things. As you suggested, blood does show up in the urine from time to time. It can be related to infection, trauma (including a form of trauma caused by exercise, in which the bladder collapses against itself and bleeding results), stones, and other unusual causes.
Some patients require more detailed evaluation of the bladder, which is done with cystoscopy. This may be indicated if the person is over 40, has risk factors for bladder cancer (smoking, chemical exposures, radiation), or the blood is actually visible in the urine. In this procedure a small telescope is inserted into the urethra and used to visualize the bladder.
Learn more in the Everyday Health Men’s Health Center.
Hey guys, if a simple visit to the bathroom has you seeing red, don’t ignore it. Blood in your urine (hematuria) can be a sign of a serious problem, so you should see your doctor right away.
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You may see a range of colors — from pink or slightly dark urine to bright red or cola-colored liquid. You may also see clots, which can come from the prostate, urethra, kidneys or ureters (tubes connecting the kidney to the bladder).
Blood in the urine may show up over a long time, come and go, or happen just once.
Many times, doctors don’t find a medical reason for the blood, says urologist Robert Abouassaly, MD. But your doctor will want to rule out serious illnesses and treat less serious ones if possible.
Common reasons for blood in the urine
Typical causes (for both men and women) may relate to:
- Urinary tract — most likely an infection (UTI) or urinary stone disease
- Kidneys — typically kidney stones or kidney disease
- Inherited conditions, including sickle cell disease
- Vigorous exercise
- Medications such as aspirin or blood thinners
Though blood in the urine most often comes from a benign condition, it also can signal bladder or kidney cancer. That’s why Dr. Abouassaly recommends getting to your doctor within a week or two after you first see the blood.
“This is because, should it be bladder cancer, a delay in treatment greatly compromises the cure rate,” he says.
Are there different causes for men?
In some cases, blood in the urine may mean something different for men than for women. Blood may show up from either an enlarged prostate gland or prostate cancer.
And, both bladder and kidney cancers are more common in men than in women.
For 2018, the American Cancer Society estimates 42,680 new diagnoses of kidney cancer in men and 22,660 in women.
For bladder cancer, the society estimates 62,380 new cases among men and 18,810 in women in 2018.
The most common cause of bladder cancer is smoking, Dr. Abouassaly says.
“The carcinogens get absorbed in the blood and filter into the kidneys and bladder and they just sit there,” he says. “I recommend if you are a smoker, do everything you can to stop smoking.”
What tests find causes for blood in the urine?
Your urologist will likely examine your upper urinary tract using a scan with dye that gives images from your kidneys to your bladder. This can check for stones, tumors or other abnormalities.
He or she will check the lower urinary tract with a scope that looks at the bladder, prostate and urethra. Your doctor also may perform other tests, such as a test for prostate cancer, as needed.
Sometimes doctors find that hematuria shows up in routine testing. A sample taken during an annual physical may find blood that isn’t visible. When this happens, your doctor will send the sample to a lab to check for red blood cells.
Dr. Abouassaly stresses the importance of getting in to see your physician if you see even a trace of blood in your urine.
“Cancers can bleed just one time and not again,” he says. “If you have doubts, a quick visit to your primary care provider can sort it out.”