Blood in the urine

Blood in the urine: What does it mean for your health?

Updated: March 19, 2019Published: October, 2010

Urinary bleeding can be dramatic and frightening, prompting an appropriate call to your doctor. But sometimes the call travels in the other direction; many people are surprised and alarmed to get a call from their doctors reporting that the urine that looked clear in the specimen jar actually contains red blood cells (RBCs). Either way, blood in the urine, known technically as hematuria, requires medical evaluation. Although the results are often reassuring, hematuria is a warning symptom that you should never ignore.

Blood can enter the urine from any place in the urinary tract. So the first step in understanding hematuria is to understand your anatomy.

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Hematuria (Blood in the Urine)

What is blood in the urine?

Blood in the urine means there are red blood cells (RBCs) in the urine. Often, the urine looks normal to the naked eye. But when checked under a microscope, it contains a high number of red blood cells. In some cases, the urine is pink, red, or the color of tea, which you can see without a microscope.

What causes blood in the urine?

Most of the causes of blood in the urine are not serious. For example, heavy exercise may cause blood in the urine, which often goes away in a day.

Other, more serious causes include:

  • Cancer
  • Kidney infection or disease
  • Urinary tract infection (UTI)
  • Enlarged prostate (men only)
  • Kidney or bladder stones
  • Certain diseases (like sickle cell anemia and cystic kidney disease)
  • Injury to the kidneys

Some medications cause blood in the urine. And many people have it without having any other related problems.

What are the symptoms of blood in the urine?

There not be enough blood in the urine to change the color, but in severe cases, the urine may look pink, red, or tea colored.

How is blood in the urine diagnosed?

Your doctor will review your medical history and do a physical exam. Other tests may include:

  • Urinalysis. Urine is tested for various cells and chemicals, such as red and white blood cells, germs, or too much protein.
  • Blood tests. Blood is checked for high levels of waste products.

If these tests aren’t clear you may need other tests, such as:

  • Intravenous pyelogram (IVP). A series of X-rays of the kidney, ureters (the tubes connecting the kidneys and bladder), and bladder is done after a contrast dye is injected into a vein. This is done to look for tumors, kidney stones, or any blockages, and to check blood flow in the kidneys.
  • Ultrasound. An imaging test that uses high-frequency sound waves to make images of the organs of the urinary tract on a computer screen.
  • Cystoscopy. A thin, flexible tube and viewing device, is put in through the urethra to examine the parts of the urinary tract for structure changes or blockages, such as tumors or stones.

How is blood in the urine treated?

If you have blood in your urine that lasts more than a day, see a health care provider, especially if you have unexplained weight loss, discomfort with urination, frequent urination, or urgent urination.

Treatment will depend on the cause of the blood in the urine.

Key points about blood in urine

  • Blood in the urine means there are red blood cells (RBCs) in the urine. Often, the urine looks normal. But when checked under a microscope, it contains a high number of red blood cells. In some cases, the urine is pink, red, or the color of tea, which can be seen without the use of a microscope.
  • Most of the causes of blood in the urine are not serious. For example, in some cases, strenuous exercise will cause blood in the urine.
  • Some more serious causes of blood in the urine are cancer, infection, enlarged prostate (men only), kidney or bladder stones, and certain diseases (like sickle cell anemia and cystic kidney disease).
  • Blood in the urine can often be diagnosed with urine tests. If these are not clear, imaging tests may be needed to look at the urinary tract.
  • Treatment depends on the cause of the blood in the urine.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Hematuria or Blood in Urine

How is hematuria diagnosed and evaluated?

Having blood in your urine does not necessarily mean you have a medical problem. It may be caused by routine activities such as vigorous exercise. However, because it can sometimes involve a serious condition, you should contact your doctor right away.

Your doctor will review your medical history. A physical exam will check for bruising and other signs of injury. If you are male, your doctor may use a digital rectal exam to see if your prostate is causing the hematuria. Tell your doctor about any medications you’re taking, including vitamins or supplements.

Your doctor may use one or more of the following exams to assess your condition:

  • X-ray: Your doctor may use abdominal x-ray to look for stones, especially if you have nausea and vomiting. An x-ray will not detect most causes of hematuria. Other exams will likely be needed.
  • MR/CT Urography: Your doctor may use CT or MR urography to examine your urinary tract, bladder, ureters, and kidneys.
  • Abdominal ultrasound: Your doctor may use ultrasound to examine your kidneys and bladder for potential causes of blood in your urine.
  • Intravenous pyelogram (IVP): An IVP x-ray exam helps your doctor visualize your kidneys, bladder and ureters. It can help detect urinary system abnormalities and show how efficiently your system works. This exam requires an injection of contrast material.
  • MRI of the prostate: If you are male, your prostate may be causing your condition. If so, your doctor may assess your prostate and seminal vesicles using MRI.

Is Blue Urine Normal? Urine Colors Explained

Depending on what you eat, any medications you’re taking, and how much water your drink, urine colors can vary. Many of these colors fall on the spectrum of what “normal” urine can look like, but there are cases where unusual urine colors may be a cause for concern.

Clear

Clear urine indicates that you’re drinking more than the daily recommended amount of water. While being hydrated is a good thing, drinking too much water can rob your body of electrolytes. Urine that occasionally looks clear is no reason to panic, but urine that’s always clear could indicate that you need to cut back on how much water you’re drinking.

Yellowish to amber

The color of “typical” urine falls on the spectrum of light yellow to a deeper amber color. The urochrome pigment that’s naturally in your urine becomes more diluted as you drink water.

Urochrome is produced by your body breaking down hemoglobin, the protein that carries oxygen in your red blood cells. In most situations, the color of your urine will depend on how diluted this pigment is.

Having a lot of B-vitamins in your bloodstream can cause urine to appear neon yellow.

Red or pink

Urine may look red or pink if you eat fruits with naturally deep pink or magenta pigments, such as:

  • beets
  • rhubarb
  • blueberries

While urine that’s red or pink might be from something you ate recently, there are sometimes other causes. Some health conditions can cause blood to appear in your urine, a symptom known as hematuria, including:

  • enlarged prostate
  • kidney stones
  • tumors in the bladder and kidney

Speak to a doctor if you’re ever concerned about blood in your urine.

Orange

If your urine appears orange, it could be a symptom of dehydration. If you have urine that’s orange in addition to light colored stools, bile may be getting into your bloodstream because of issues with your bile ducts or liver. Adult-onset jaundice can also cause orange urine.

Blue or green

Blue or green urine can be caused by food coloring. It can also be the result of dyes used in medical tests performed on your kidneys or bladder.

The pseudomonas aeruginosa bacterial infection can also cause your urine to turn blue, green, or even indigo purple. In general, blue urine is rare and most likely connected to something in your diet.

Dark brown

In most cases, urine that’s dark brown indicates dehydration. Dark brown urine can also be a side effect of certain medications, including metronidazole (Flagyl) and chloroquine (Aralen).

Eating large amounts of rhubarb, aloe, or fava beans can cause dark brown urine. A condition called porphyria can cause a buildup of the natural chemicals in your bloodstream and cause rusty or brown urine. Dark brown urine can also be an indicator of liver disease, as it can be caused by bile getting into your urine.

Cloudy

Cloudy urine can be a sign of a urinary tract infection. It can also be a symptom of some chronic diseases and kidney conditions. In some cases, cloudy urine is another sign of being dehydrated.

Cloudy urine with foam or bubbles is called pneumaturia. This can be a symptom of serious health conditions, including Crohn’s disease or diverticulitis. There are some cases where urine is foamy, and doctors can’t determine the cause.

Blood in the Urine (Hematuria)

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What Is Hematuria?

Peeing is one way our bodies get rid of waste products. The process starts in the kidneys, which remove excess fluids and waste from the blood and turn them into urine. The urine then flows through tubes called ureters into the bladder, where it’s stored until we pee it out. If blood cells leak into the urine at any part of the process, it causes hematuria.

There are two kinds of hematuria:

  1. Microscopic hematuria is when blood in the urine can be seen only with a microscope. Often, this goes away without causing any problems. In fact, people might never know they have it unless they get a urine test.
  2. Gross hematuria is when you can see the blood in the urine even without a microscope. This is because there is enough blood in the urine to turn it red or tea-colored.

Blood leaks into the urinary tract. This can happen anywhere in the urinary tract such as:

  • in the kidneys, which remove waste and water from the blood to make pee
  • in the ureters, which are tubes that carry pee from the kidneys to the bladder
  • in the bladder, which stores pee
  • in the urethra, where pee leaves the body

Teens can get hematuria for many reasons. The more common causes are:

  • bladder or kidney infections
  • kidney stones
  • high levels of calcium and other minerals in the urine
  • a problem with the urinary tract
  • injury to the kidneys or urinary tract
  • taking some types of medicines, like some over-the-counter pain medicines
  • strenuous exercise (many athletes, especially distance runners, get hematuria from time to time)

Sometimes what looks like hematuria might be something else. Things like food dye, some foods (like beets or blackberries), the blood from your period and some prescription medicines can make pee look red.

How Is Hematuria Diagnosed?

If you ever see blood in your urine, don’t panic. Chances are, it’s no big deal. But you’ll want to be sure, so tell your mom or dad and see a doctor. If you need treatment, it’s good to get started right away.

The doctor will do an exam and ask about symptoms, recent activities, and your

. You’ll give a urine sample (pee in a cup) for testing.

If the urine test comes back negative, the doctor will probably want another urine sample 1-2 weeks later to make sure the urine is free of red blood cells. If hematuria only happens once, treatment usually isn’t needed.

If urine samples point to something more serious or you’ve had a recent injury, you might need other tests, such as:

  • a urine culture (more peeing in a cup)
  • imaging tests like a kidney ultrasound, an MRI, or a CT scan

How Is Hematuria Treated?

Most teens who have hematuria won’t need any kind of treatment for it. Hematuria that is due to a UTI will be treated with antibiotics.

If you’ve been treated for hematuria, your doctor will probably want you to get follow-up tests to make sure your urine is free of red blood cells.

When hematuria is a sign of something more serious — like kidney stones or a specific kidney disease — doctors will treat that condition.

Reviewed by: Robert S. Mathias, MD Date reviewed: September 2019

Microscopic Hematuria

Your doctor will usually start by asking you for a urine sample. He or she will test your urine (urinalysis) for the presence of red blood cells. Your doctor will also check for other things that might explain what is wrong. For example, white blood cells in your urine usually mean that you have an infection. If you do have blood in your urine, your doctor will ask you some questions to find out what caused it.

If the cause isn’t clear, you may have to have more tests. You might have an ultrasound or an intravenous pyelogram (this is like an X-ray). A special tool, such as a cytoscope or an endoscope, may be used to look inside your bladder. These tests are usually done by a urologist.

How do I give a urine sample?

A nurse will give you an antiseptic wipe (to clean yourself) and a sterile urine collection cup. In the bathroom, wash your hands with soap and warm water first.

  • For women: Use the antiseptic wipe to clean your vagina. Do this by wiping yourself from front to back 3 times before you urinate. Fold the wipe each time you use it, so that you are wiping with a clean part each time.
  • For men: Use the antiseptic wipe to clean the head of your penis. If you’re not circumcised, pull the foreskin back behind the head of the penis before you use the wipe. Move the wipe around the head of your penis before you urinate.
  • Start urinating in the toilet. About halfway through the urination, start catching the urine in the cup.
  • Wash your hands with soap and warm water.
  • Give the sample to the nurse. Someone will look at your urine under a microscope to see if it has blood in it.

Blood in Urine (Hematuria)

Some of the underlying causes of hematuria are benign, temporary states that do no lasting harm and resolve with little or no specific treatment. Some causes, however, may be critical conditions or represent a chronic condition that requires medical intervention and monitoring.

The only way to understand the seriousness of hematuria in a specific individual and to decide on an appropriate treatment is to investigate. As part of the investigation, a health practitioner will evaluate an individual’s medical history, physical examination, and accompanying signs and symptoms to help determine what is causing hematuria.

This may include answering questions, such as:

Is it really blood?
One of the first questions to be asked is whether or not it is really blood that is present and/or seen in the urine.

  • Reddish-brown coloring can also come from eating foods such as beets and rhubarb or taking drugs such as phenazopyridine (most commonly), and also cascara, diphenylhydantoin, methyldopa, phenolphthalein, phenothiazine, phenacetin, phenindione, etc.
  • Hemoglobin in the urine (hemoglobinuria). Some conditions cause red blood cells to break apart (hemolyze) and release hemoglobin, the iron-containing protein that gives red blood cells their color. The excess hemoglobin is eliminated through the urine, causing it to turn red or tea-colored. Hemolytic anemias, including sickle cell anemia for example, can lead to hemoglobinuria.
  • Other substances produced by the body and eliminated in the urine can change the color. For example, bilirubin is usually removed by the liver but can accumulate when the liver is damaged or diseased and can cause urine to be a dark amber color. This is a concern that needs to be further investigated, but it is not hematuria. Another example is myoglobin, a small, oxygen-binding protein found in heart and skeletal muscles that is filtered from the blood by the kidneys and eliminated in the urine. High levels of myoglobin can give urine a red color, making it appear as if there is blood in the urine.

Is the blood from the urinary tract?
Contaminating blood may find its way into the urine from:

  • Vaginal bleeding, such as from menstruation
  • Hemorrhoids

Is it due to an infection?
Infections can sometimes cause cloudy and smelly urine, painful urination, and occasionally blood in the urine.

  • Urinary tract infections (UTIs)—mostly affect the bladder and are usually caused by bacteria. UTIs can cause inflammation of the bladder (cystitis)
  • Kidney infection—UTIs can sometimes spread to the kidneys
  • Viral infection—infections like hepatitis, which causes liver disease and inflammation of the liver can cause blood to appear in the urine

Is the blood from a single isolated incident or from a known cause?
Sometimes blood may appear and then go away without the cause ever being identified. In other cases, it may be from an identifiable, resolvable or self-limited cause, such as:

  • Strenuous exercise
  • Fever
  • Exposure to toxins, such as contrast dyes used in radiologic procedures
  • Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or blood thinners that inhibit clotting and may increase the risk of a person having bleeding episodes with blood in the urine
  • A medical procedure that physically involves part of the urinary tract, such as surgery, a kidney biopsy, or inserting a urinary catheter, can cause temporary bloody urine.
  • Physical injury to the kidney or bladder, such as trauma
  • An isolated incident (cause never identified)

Is the hematuria due to an inflammation or irritation of the urinary tract (or prostate in men) or due to blockage by or the passage of a kidney stone?
The following can cause blood in the urine and sometimes radiating pain, painful urination, urinary urgency, and/or urinary hesitancy:

  • Urethritis—inflammation of the duct that carries urine from the bladder out of the body (urethra)
  • Prostatitis—inflammation of the prostate (which surrounds the urethra in men)
  • Benign prostatic hyperplasia (BPH)
  • Kidney stones or bladder stones

Is it caused by kidney disease or a condition that can cause kidney damage?

  • There are a variety of kidney diseases that can cause hematuria. An example is glomerulonephritis, a kidney disease associated with the filtering units in the kidneys (glomeruli). Another is kidney disease after strep throat (post-infectious glomerulonephritis), which can be the cause of blood in a child’s urine.
  • Diabetes and high blood pressure (hypertension) are common causes of kidney damage and can sometimes result in hematuria.
  • Polycystic kidney disease is an inherited disorder that can lead to the formation of cysts in the kidneys and can lead to kidney disease.

Is hematuria due to some other disease or condition within the urinary tract?

  • Structural abnormalities within the urinary tract can cause bleeding.
  • Blood clots can form within the urinary tract.
  • Endometriosis, a condition in which tissue that normally lines the uterus grows in other places, like the bladder, can also cause blood in the urine.

Is the hematuria due to some other underlying chronic and/or inherited disorder?
This may be a disorder that affects the body as a whole (systemic) or that results in excess blood within the urinary tract, leading to hematuria. Some examples include:

  • Bleeding disorders—these can lead to excessive bleeding episodes (bloody noses, bruising, prolonged bleeding, etc.) throughout the body. Examples include hemophilia and thrombocytopenia.
  • Alport syndrome—an inherited condition associated with hematuria and protein in the urine
  • Autoimmune disorders—with this group of diseases, the body’s immune system mistakenly attacks and damages its own tissue and organs, including the kidneys.

Is hematuria due to cancer?
Cancers associated with the urinary tract and prostate can cause hematuria. These include:

  • Bladder cancer
  • Kidney cancer
  • Prostate cancer

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