Blood in Urine (Hematuria): Symptoms, Causes, and Diagnosis

Seeing blood in your urine is one of the most alarming experiences a person can have. Whether the colour is a faint pink, a deeper red, or a brownish tinge, the immediate reaction is almost always the same: Is something wrong with me? That instinct is worth trusting. Blood in urine, medically known as hematuria, is never normal, and while many of its causes are benign and treatable, some indicate conditions that require prompt medical attention.

What makes hematuria particularly important to address is that it does not always come with pain. Many people assume that if there is no discomfort, the blood is probably not serious. This is a dangerous misconception. Painless blood in urine is one of the earliest and most significant warning signs of bladder and kidney cancer - conditions where early detection makes a critical difference to outcomes.

This blog covers everything you need to know about hematuria: what it is, what causes it, how it presents differently in men, women, pregnant women, and children, how it is diagnosed, and when to seek specialist care without delay.

What is Hematuria?

Hematuria is the medical term for the presence of blood in the urine. It occurs when red blood cells enter the urinary tract through the kidneys, ureters, bladder, urethra, or nearby structures such as the prostate. In a healthy urinary system, urine should not contain blood cells.

Blood in the urine can result from infections, kidney stones, prostate conditions, kidney disease, or more serious conditions such as bladder or kidney cancer. While some causes are temporary and harmless, hematuria should never be ignored.

It is also important to distinguish hematuria from haemoglobinuria, a condition where urine appears red or dark due to free haemoglobin rather than actual blood cells. Certain foods and medications such as beetroot, berries, rifampicin, and some laxatives can also temporarily change urine colour, a harmless condition known as pseudohaematuria. Urine testing helps confirm whether true blood is present.

Types of Hematuria

Doctors classify hematuria based on whether the blood is visible and whether symptoms such as pain are present. Types of hematuria include:

Why Painless Hematuria Should Never Be Ignored

Many people assume blood in the urine is harmless if there is no pain. However, painless hematuria is one of the most important warning signs of bladder and kidney cancers. Early diagnosis significantly improves treatment outcomes, which is why any episode of blood in the urine, even if it happens only once, should be evaluated by a urologist.

Symptoms of Hematuria

The most obvious symptom of gross hematuria is pink, red, or brown discolouration of the urine. However, the symptoms accompanying blood in the urine often provide important clues about the underlying cause.

Blood in the urine may occur along with:

• Burning or pain during urination, commonly linked to urinary tract infections (UTIs)
• Severe pain in the lower back, side, or flank, which may suggest kidney stones
• Frequent or urgent urination associated with bladder irritation or infection
• Difficulty urinating or a weak urine stream, often seen with prostate enlargement in men
• Blood clots in the urine, which may indicate significant bleeding within the urinary tract
• Fever or chills, which can point to a kidney infection requiring urgent treatment
• Unexplained weight loss or fatigue, which may raise concern for an underlying cancer
• Swelling in the face, hands, or feet, which may indicate kidney disease

Microscopic hematuria does not cause visible changes in urine colour and is usually detected only through routine urine testing. This is why regular health check-ups and urine analysis remain important, especially for people with persistent urinary symptoms or risk factors for kidney and bladder disease.

Common Causes of Blood in Urine

Hematuria can occur due to infections, kidney conditions, urinary tract disorders, medications, or more serious diseases such as cancer. Identifying the underlying cause is essential for proper treatment. Here is an overview of the most common causes of blood in urine:

Causes of Blood in Urine in Men

Some causes of hematuria are more common in men due to conditions affecting the prostate and male urinary tract. Common male-specific causes include:

• Benign prostatic hyperplasia (BPH): Enlargement of the prostate gland can compress the urethra and lead to bleeding. It is a common cause of hematuria in men over 50
• Prostate cancer: Blood in the urine, especially when associated with urinary difficulty or elevated PSA levels, may indicate prostate cancer
• Prostatitis: Infection or inflammation of the prostate can cause hematuria along with pelvic pain, burning urination, and urinary frequency
• Urethritis: Inflammation of the urethra, often linked to sexually transmitted infections, may cause blood at the start of urination
• Strenuous exercise: Long-distance running and high-impact sports can sometimes cause temporary blood in the urine due to repeated bladder irritation

Men over 50 who notice visible blood in the urine should seek prompt evaluation, particularly if there is no obvious cause such as a urinary tract infection. Early assessment helps rule out prostate and bladder cancer.

Causes of Blood in Urine in Women

Women are more prone to certain causes of hematuria due to anatomical and hormonal factors affecting the urinary and reproductive systems. The most common female-specific causes include:

• Urinary tract infections (UTIs): The most common cause of blood in the urine in women. The shorter female urethra allows bacteria to reach the bladder more easily
• Endometriosis: Endometrial tissue growing near the bladder or ureters can cause blood in the urine, often linked to the menstrual cycle
• Menstrual contamination: Menstrual blood can sometimes mix with a urine sample and produce a false-positive result for hematuria
• Kidney conditions: Certain kidney diseases such as IgA nephropathy or glomerulonephritis may be detected through routine urine testing
• Interstitial cystitis: A chronic bladder condition that can cause pelvic pain, urinary urgency, and microscopic hematuria

Women experiencing persistent blood in the urine, repeated UTIs, pelvic pain, or urinary symptoms should seek medical evaluation to identify the underlying cause and begin appropriate treatment.

Blood in Urine During Pregnancy

Blood in the urine during pregnancy is commonly linked to urinary tract infections (UTIs), which are more frequent during pregnancy due to hormonal and physical changes affecting the urinary tract. However, hematuria during pregnancy should never be ignored, as it may also indicate kidney stones, kidney infections, or conditions affecting kidney function.

A urine test and urine culture are usually the first steps to identify the cause. Most conditions causing hematuria during pregnancy can be treated safely without harming the baby when diagnosed early.

Seek immediate medical attention if blood in the urine is accompanied by:

• Severe lower back or flank pain
• Fever or chills
• Swelling of the face, hands, or feet
• Reduced foetal movement
• Burning urination or difficulty passing urine

Early evaluation helps prevent complications and ensures timely treatment for both mother and baby.

Blood in Urine in Children

Blood in the urine is less common in children than in adults, but it should always be medically evaluated to identify the underlying cause. The most frequent causes of blood in urine in children include:

• Urinary tract infections (UTIs): One of the most common causes, especially in girls
• Hypercalciuria: Excess calcium in the urine, which may cause hematuria even without kidney stones
• Glomerulonephritis: Inflammation of the kidney’s filtering units, sometimes occurring after a throat infection
• Alport syndrome: An inherited kidney condition that causes recurrent hematuria and may run in families
• Trauma or injury: Falls, sports injuries, or abdominal trauma can lead to bleeding in the urinary tract
• Wilms tumour: A rare kidney tumour in children that may present with blood in the urine and abdominal swelling

Visible blood in a child’s urine should always be evaluated promptly by a doctor. Even microscopic hematuria detected during routine urine testing may require further paediatric assessment to rule out kidney or urinary tract conditions.

How is Hematuria Diagnosed?

Diagnosing hematuria involves identifying the source of bleeding and ruling out serious underlying conditions. At Yatharth Super Speciality Hospitals, the evaluation may include the following investigations.

Urine Tests

Urine testing is usually the first step in evaluation.

• Urine dipstick test: Rapid test to detect blood in the urine
• Urine microscopy: Confirms red blood cells and helps identify kidney-related causes
• Urine culture and sensitivity: Detects urinary tract infections and guides antibiotic treatment

Imaging Studies

Imaging helps identify structural abnormalities within the urinary tract.

• Ultrasound: Detects kidney stones, masses, enlarged prostate, and other abnormalities
• CT urography: Provides detailed imaging of the kidneys, ureters, and bladder and is considered the gold standard for hematuria evaluation
• MRI urography: Used when radiation exposure should be avoided, such as during pregnancy

Cystoscopy

Cystoscopy uses a thin flexible camera inserted through the urethra to directly examine the bladder and urethra. It helps detect bladder tumours, stones, inflammation, and other abnormalities that may not appear on imaging. This test is particularly important in patients with visible blood in the urine.

Blood Tests

Blood investigations help assess kidney function and overall health.

• Full blood count to check for infection or anaemia
• Kidney function tests such as creatinine and eGFR
• PSA testing in men when prostate disease is suspected
• Coagulation profile if a bleeding disorder is possible

Kidney Biopsy

A kidney biopsy may be recommended if tests suggest kidney disease such as glomerulonephritis. The procedure involves taking a small tissue sample from the kidney for detailed laboratory analysis.

Hematuria Treatment and Management

Treatment for hematuria depends entirely on the underlying cause. Managing the condition responsible for the bleeding is what resolves blood in the urine. Common treatment approaches include:

• Antibiotics for urinary tract infections (UTIs): Infection-related hematuria usually improves within days of targeted antibiotic treatment
• Treatment for kidney stones: Small stones may pass with hydration and medication, while larger stones may require procedures such as ureteroscopy, laser lithotripsy, or extracorporeal shock wave lithotripsy (ESWL)
• Cancer treatment: Bladder and kidney cancers may require surgery, cystoscopic tumour removal, targeted therapy, immunotherapy, or other oncology-led treatments
• Medication adjustment: If blood thinners or certain medications are causing hematuria, doctors may review and modify the treatment plan
• Treatment for prostate conditions: Enlarged prostate or prostatitis may be managed with medications or minimally invasive procedures depending on severity
• Management of kidney disease: Conditions such as glomerulonephritis may require immunosuppressive therapy and nephrology care

Exercise-induced hematuria often resolves on its own within 48 to 72 hours after rest and temporary reduction in physical activity. Persistent or recurrent episodes, however, still require medical evaluation.

When Should You See a Doctor for Blood in Urine?

Any visible blood in the urine should be medically evaluated, even if it happens only once or disappears on its own.

Seek emergency care immediately if blood in urine is accompanied by:

• Severe flank or abdominal pain that is worsening
• High fever with chills suggesting kidney infection
• Inability to urinate or severe urinary retention
• Large blood clots causing difficulty passing urine
• Blood in urine following a significant trauma or injury

Book an urgent specialist consultation at Yatharth Super Speciality Hospitals if you experience:

• Any episode of visible blood in urine, even if it occurred only once and resolved
• Microscopic hematuria identified on a urine test, particularly if it is recurrent
• Blood in urine alongside unexplained weight loss or fatigue
• Blood in urine in a child of any age
• Blood in urine during pregnancy
• Painless blood in urine with no obvious cause such as infection

At Yatharth Super Speciality Hospitals, our urology team provides comprehensive evaluation and management for all causes of hematuria, supported by advanced diagnostic facilities including CT urography, cystoscopy, and in-house pathology.

Book a Consultation

Blood in urine is a symptom that always deserves a specialist's attention. At Yatharth Super Speciality Hospitals, our experienced urologists and nephrologists provide accurate diagnosis and personalised treatment for all causes of hematuria across our facilities in New Delhi, Noida, Greater Noida, and Faridabad.