HealthInfo Canterbury
Blood in the urine (haematuria)
Important
If you think you have blood in your urine, you should go to see your GP.
Blood in urine is called haematuria. It's often a symptom of something and not a condition on its own.
When there's lots of blood in your urine, you can see this with the naked eye as it looks red or pink. You can't see very small amounts of blood in your urine. But it can be picked up when a urine sample is looked at under a microscope or by using a urine dipstick.
Not all red or dark looking urine means blood is present. Sometimes it can be due to eating certain foods such as beetroot, rhubarb, blackberries, or taking some drugs such as rifampicin. Extreme exercise can also cause muscle breakdown, which can cause kidney damage and change the colour of urine.
Common causes
Often the cause isn't found, but testing is needed to rule out important causes.
The most common causes are a urine infection (UTI) or a kidney infection (pyelonephritis).
Other causes include:
- cancer of the bladder, kidney or prostate
- kidney stones
- urethritis – inflammation of the urethra (the tube you pass urine through)
- prostate enlargement
- medications such as blood thinning medicines
- glomerulonephritis (inflammation of the blood vessels in the kidney).
Diagnosing the cause
Your GP will examine you and ask questions about your general health and about the blood in your urine.
The first test you will need is a urine test to check for the presence of blood or an infection. Some people may need to have this test more than once.
If you don't have a urine infection and continue to have blood in your urine, you'll need further tests. These depend on your age and if the blood is visible to the naked eye or only visible under a microscope.
These tests include:
- Tests to look for the possibility of bladder cancer. These tests include the Cxbladder triage test, which is done with other tests such as a urine test and either a CT scan or an ultrasound. If it's positive, it doesn’t mean you have bladder cancer, but it does mean you need further tests.
- Urine tests to look for protein and examine the shape of your blood cells.
- A blood test to check your how well your kidneys are working.
If you're under 40 or over 85, you'll need an ultrasound of your kidneys and bladder. This will check for stones or anything unusual in your urinary tract.
If you're between 40 and 85 and have had visible blood in your urine, your GP will arrange a CT scan of your urinary tract. This is an X-ray test using dye to look at how your urinary tract is working and to look for anything unusual. If you've had blood in your urine that's only visible under a microscope, your GP will arrange for an ultrasound test.
Next steps
If you have a urine infection, the first step is for your doctor to treat it with antibiotics before retesting your urine to see if the blood has gone.
Your GP will consider all your information and test results. Sometimes it isn't possible to work out the exact cause of blood in your urine. If your tests are all normal, your GP will reassure you and arrange any monitoring or further follow up if needed. If any of the tests are positive or suggest further assessment is needed, they'll refer you to a urologist for specialist assessment.
At the urology department, you may need to have a cystoscopy to identify and sample any problems in your bladder. In this test, a special type of thin telescope is inserted through your urethra (the tube you pass urine through) and into your bladder.
If no cause is found, the specialist may recommend that you and your GP keep monitoring your urine and blood pressure. Sometimes monitoring is all that's needed. Sometimes tests need to be repeated, or your GP might refer you back to the urology department.
Written by HealthInfo clinical advisers. Endorsed by clinical director, Urology, Canterbury DHB. Last reviewed November 2019.
SourcesReview key: HIURS-53047
