Blood in Urine (Hematuria): Symptoms, Causes, and Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is hematuria?
Hematuria is blood in the urine, either visible (gross hematuria) or found only under a microscope (microscopic hematuria). Urine may look pink, red or cola-colored. Causes include urinary tract infections, kidney or bladder stones, an enlarged prostate, kidney disease, cancer, certain medicines and hard exercise. Treatment depends on the cause, and follow-up testing confirms the blood is gone.
What the research says
Visible blood is the strongest warning sign for urinary cancers. A systematic review of 11 primary care studies (more than 3.4 million patients) found that the positive predictive value of visible hematuria for bladder or kidney cancer was 5.1% in adults, higher with age and in men, while other single symptoms had very low values. The reviewers concluded that visible hematuria clearly warrants investigation, though not every patient with these cancers has blood in the urine (Schmidt-Hansen et al., Br J Gen Pract, 2015) [3].
Microscopic blood is common, and cancer is uncommon. A systematic review and meta-analysis of 78 studies found that the likelihood of urological cancer in people with non-visible hematuria rose with age (under 1% below age 40), male sex, and smoking, and that fewer than 1% were found to have cancer after a negative evaluation. Cancer detection rates ranged from 0% to 16% for bladder cancer across studies, with substantial heterogeneity (Jubber et al., Eur Urol, 2020) [4].
A dipstick test cannot rule hematuria out. A systematic review of 118 studies found that dipstick tests are moderately useful for establishing the presence of hematuria but cannot be used to rule it out, and that the evidence for a single best diagnostic pathway was limited. The authors' modelling suggested that confirming a positive dipstick with microscopy reduces false positives (Rodgers et al., Health Technol Assess, 2006) [5].
What Blood in Urine Actually Means
The medical word for blood in urine is hematuria. It is a symptom rather than a disease, and it means that somewhere along the urinary tract, red blood cells are leaking into the urine.
The urinary system has four main parts: the kidneys, the ureters, the bladder, and the urethra. The kidneys sit toward the back of the upper belly and filter waste and fluid from the blood to make urine. Urine travels down narrow tubes called the ureters into the bladder, which stores it until you urinate. Urine leaves the body through a small tube called the urethra. Blood can enter the urine at any point along this path.
It can be scary to see blood in your urine. In many cases the cause turns out to be harmless. But blood in urine can also be a sign of a serious illness. That is why the rule is simple: find out the reason for the bleeding every time.
Two Kinds of Blood in Urine
When you can see the blood, it is called gross hematuria. Urine may look pink, red, or cola-colored. It takes only a small amount of blood to change the color.
When the blood cannot be seen with the naked eye, it is called microscopic hematuria. The amount is so small that it can only be detected under a microscope when a laboratory tests the urine.
Feature | Gross hematuria | Microscopic hematuria |
Can you see it? | Yes | No |
What urine looks like | Pink, red, or cola-colored | Looks normal |
How it is found | You notice it | A lab test finds it under a microscope |
Is it always painful? | Often no; clots can hurt | Usually no |
Blood in Urine Symptoms: What to Watch For
Seeing blood in urine is itself the main symptom, and the color change is often the only clue. Red blood cells cause the urine to change color, and it takes only a small amount of blood to turn urine red.
The bleeding often is not painful. But if blood clots get passed in the urine, that can hurt.
When to see a doctor: see a healthcare professional whenever urine looks like it might have blood in it.
Red urine is not always caused by red blood cells. Some medicines can turn urine red, such as phenazopyridine, which eases urinary tract symptoms. Certain foods also can turn urine red, including beets and rhubarb.
It can be hard to tell whether a change of urine color is caused by blood. That is why it is always best to get a checkup.
Symptom or clue | What it typically points to |
Pink, red, or cola-colored urine | Red blood cells in the urine, but check foods and medicines first |
Burning or pain while urinating, strong urge, strong smell | Often a urinary tract infection |
Fever and pain in the back, side, or groin | May signal a kidney infection |
Severe pain when a stone blocks or passes | Often a kidney or bladder stone |
Trouble starting urine, urgent or lasting need to pee | Common with an enlarged prostate in men |
No pain at all | Still needs a checkup; painless blood can have serious causes |
What Causes Blood in the Urine
Blood in urine happens when the kidneys or other parts of the urinary tract let red blood cells leak into the urine. Many different problems can cause that leaking, and the causes range from everyday infections to inherited conditions.
Urinary tract infections (UTIs) happen when bacteria enter the urethra, the tube through which urine leaves the body, and multiply in the bladder. UTIs can cause bleeding that makes urine look red, pink, or brown. You may also feel a strong urge to pee that lasts a long time, pain and burning while urinating, and a very strong urine smell.
A kidney infection, also called pyelonephritis, is a type of UTI. It can happen when bacteria reach the kidneys from the bloodstream or travel up from the bladder through the ureters. It can cause the same urine symptoms as other UTIs, but it is more likely to cause a fever and pain in the back, side, or groin.
Kidney and bladder stones form when the minerals in urine create crystals on the walls of the kidneys or bladder. Over time the crystals become small, hard stones. The stones are often painless, but they can hurt a lot if they cause a blockage or leave the body through the urine. They can cause blood that is visible as well as blood found only in the lab.
An enlarged prostate (see our guide to benign prostatic hyperplasia) sits just below the bladder and surrounds the top of the urethra. It often gets bigger toward middle age and puts pressure on the urethra, partly blocking the flow of urine. Signs include trouble peeing, an urgent or lasting need to pee, and blood in the urine. An infection of the prostate, called prostatitis, can cause the same symptoms.
Kidney disease is another cause. Blood in urine that is seen only in the lab is a common symptom of glomerulonephritis, a disease in which the tiny filters in the kidneys become inflamed. It may be part of a condition that affects the whole body, such as diabetes, or it can happen on its own.
Cancer is the cause everyone wants to rule out. Visible blood in urine may be a sign of advanced kidney, bladder, or prostate cancer. These cancers might not cause symptoms earlier, when treatments could work better.
Cause | Who it affects | How it causes bleeding |
Urinary tract infection | All ages, very common in children | Bacteria irritate the bladder lining |
Kidney infection (pyelonephritis) | Any age | Bacteria inflame kidney tissue; often adds fever and back or side pain |
Kidney or bladder stones | Any age | Stones irritate or block the urinary tract |
Enlarged prostate | Mainly middle-aged and older men | Growth presses on the urethra; prostatitis does the same |
Glomerulonephritis | Any age, often with diabetes | Inflamed kidney filters let blood cells leak |
Kidney, bladder, or prostate cancer | Risk rises after 50 | Tumors can bleed silently |
Sickle cell anemia, Alport syndrome | Inherited conditions | Damage to red blood cells or kidney blood vessels |
Kidney injury | All ages | A blow from an accident or contact sports |
Medicines | Anyone taking them | Includes certain anti-cancer drugs, antibiotics, and blood-thinning medicines |
Hard exercise | Runners, contact-sport athletes | May be bladder damage from impact or other causes; often clears within a week |
Sometimes the cause of hematuria is unknown.
Risk Factors
Almost anyone can have red blood cells in the urine, including children and teens. Some things raise the risk.
Middle-aged and older men are more likely to have hematuria because of an enlarged prostate, and the risk of some cancers that cause blood in urine rises after age 50. Urinary tract infection is one of the top causes of visible blood in children's urine. A family history of kidney disease raises the odds. Certain medicines, including some pain relievers, blood thinners, and antibiotics, can raise the risk. Hard exercise raises it too: marathon runner's hematuria is one nickname for the condition, and contact sports raise the risk as well.
A Note on Blood Thinners and Pain Relievers
Several medicines are linked to blood in the urine. The anti-cancer drug cyclophosphamide and the antibiotic penicillin are both linked to it. Medicines that prevent blood clots also are tied to blood in urine. This includes aspirin, which keeps platelets from sticking together, and blood thinners such as heparin.
If you take one of these medicines and notice blood in your urine, do not stop taking it on your own. Talk with a healthcare professional about what the bleeding means for you.
Hard Exercise and Blood in Urine
Blood in the urine can happen after playing contact sports such as football, where it may be linked to bladder damage caused by getting hit. It also can happen with long-distance sports such as marathon running, though the reason is less clear. It may be linked to bladder damage or to other reasons that do not involve an injury.
When hard exercise causes blood in urine, it may go away on its own within a week. But if you see blood in your urine after exercise, do not assume it is from exercising. See your healthcare professional.
How Blood in Urine Is Diagnosed
Finding the cause of blood in urine usually takes a small set of exams and tests. These play a key role in finding the source of the bleeding.
A physical exam includes a conversation with a healthcare professional about your health history. This often points toward the likely cause before any testing begins.
Urine tests can be used to diagnose blood in the urine. They can also be used weeks or months later to check whether the urine still has blood in it. Urine tests can check for a urinary tract infection or for the minerals that cause kidney stones.
Imaging tests are often needed to find the cause. You might need a CT or MRI scan, or an ultrasound exam. These let a provider look inside the kidneys and urinary tract without surgery.
Cystoscopy is a procedure in which a healthcare professional threads a narrow tube fitted with a tiny camera into the bladder to check for signs of disease, such as a bladder stone. Surgical tools can be passed through the cystoscope to treat certain urinary tract conditions at the same time.
Test | What happens | What it shows |
Physical exam | Conversation about health history and symptoms | Clues to the likely cause |
Urine tests | Urine sample checked in a lab | Blood, infection, and stone-forming minerals |
Imaging (CT, MRI, or ultrasound) | Pictures of the urinary tract | Stones, masses, and structural problems |
Cystoscopy | Camera tube into the bladder | Disease inside the bladder and urethra |
Sometimes the cause of blood in urine cannot be found. In that case, you might need regular follow-up tests, mainly if you have risk factors for bladder cancer. These risk factors include smoking, radiation therapy to the pelvis, or exposure to certain chemicals.
How Blood in Urine Is Treated
The treatment for blood in urine depends on the cause. The goal is to treat the condition that is producing the bleeding.
Antibiotic medicines clear a urinary tract infection. A prescription medicine can shrink an enlarged prostate. A treatment that uses sound waves can break up bladder or kidney stones.
In some cases, no treatment is needed at all.
If you get treatment, see your healthcare professional afterward to make sure there is no more blood in your urine. Follow-up matters because the bleeding is the signal, and confirming that it has cleared confirms the treatment worked.
Preparing for Your Appointment
You can start by making an appointment with your regular healthcare professional, or you might be referred to a urologist, a specialist in urinary tract disorders.
Before the appointment, make four lists: your symptoms, including any that seem unrelated, and when they began; your key medical information, including other conditions and whether bladder or kidney diseases run in your family; all medicines, vitamins, and supplements you take with their doses; and the questions you want to ask.
Questions worth asking include: What might be causing my symptoms? What tests do I need? How long might this condition last? What are my treatment choices? I have other health issues; how can I best manage them together? Are there brochures or other printed material I can have, and what websites do you suggest?
What your provider will ask: Do you have pain when you pee? Do you see blood only sometimes or all the time? When do you see it: at the start of the urine stream, toward the end, or the entire time? Are you passing blood clots, and what size and shape are they? Do you smoke? Are you exposed to chemicals at work, and what kinds? Have you had radiation therapy?
In the meantime, if your urine looks pink, red, or cola-colored, book a checkup promptly rather than waiting to see whether it clears. Do not assume the cause is a food, a medicine, or a workout, because the only reliable way to tell is a urine test.
Conclusion
Blood in urine is a symptom that deserves a prompt, patient workup. The color change itself is the warning, and because only a small amount of blood is needed to turn urine red, the bleeding can look dramatic even when the cause is mild. The range of causes is wide, from urinary tract infections and stones to an enlarged prostate, kidney disease, and cancer, which is why guessing is not a safe strategy.
Modern diagnosis is thorough and efficient: a health history, urine tests, imaging, and when needed a camera exam inside the bladder. Once the cause is known, treatment is usually straightforward, and sometimes none is needed at all.
If you have pain in your urine, changes in your urine output, blood in your urine, or repeated urinary tract infections, do not wait it out. See a healthcare provider promptly, and treat fever with severe pain as a reason to seek care without delay.
Take the next step: See a healthcare provider promptly if you have changes in urine color, pain with urination, blood in your urine, or repeated urinary tract infections, and seek urgent care for pain with fever.
FAQ
Can blood in urine go away on its own?
Sometimes. Blood in urine caused by hard exercise may clear within about a week on its own, and some other causes resolve with treatment. But because visible blood can signal a serious condition, you should not assume it will go away. See a healthcare professional so a urine test can confirm what is happening.
Is blood in urine always a sign of cancer?
No. Many causes of blood in urine are far more common and not dangerous, such as urinary tract infections, kidney stones, and an enlarged prostate. However, visible blood can be a sign of advanced kidney, bladder, or prostate cancer, which is why it always deserves a proper medical workup.
Why does my urine look red after eating beets?
Certain foods and medicines can turn urine red without any blood present. Beets and rhubarb can cause red urine, and the medicine phenazopyridine can as well. Since it is hard to tell the difference between food-colored urine and blood in urine, a checkup with a urine test is the reliable way to tell.
Does blood in urine always hurt?
No. The bleeding often is not painful, and painless blood in urine is one reason it should never be ignored. What can hurt is passing blood clots, which may form when there is significant bleeding into the urinary tract.
What tests will my doctor order for blood in urine?
Diagnosis usually starts with a physical exam and a urine test to confirm blood and check for infection. Imaging such as a CT scan, MRI, or ultrasound looks inside the urinary tract, and cystoscopy uses a tiny camera to inspect the bladder directly. Follow-up urine tests check whether the blood has cleared after treatment.
Disclaimer: This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for questions about a medical condition.
Related Reading
Continuous Bladder Irrigation (CBI): Purpose and Procedure explains how bladder irrigation clears clots after surgery.
Learn more in our guide to Kidney Biopsy: Purpose, Types, Procedure, Risks and Recovery.
Learn more in our guide to Cystoscopy: Purpose, Procedure, Recovery and Risks.
Urinalysis: What It Tests, How to Prepare, Normal Values and What Results Mean explains how a urinalysis finds red blood cells in urine, even when you cannot see them.
Intravenous Pyelogram (IVP): What It Is, Why It's Done, Risks and Results explains the contrast X-ray of the kidneys, ureters and bladder that can show this condition.
CT Urogram: What It Is, Why It's Done, How to Prepare and What to Expect explains the contrast CT scan of the urinary system used to look for this condition.
Urine Cytology: Testing Urine for Bladder Cancer Cells explains the urine test that looks for bladder and urinary tract cancer cells.
References
Mayo Clinic Staff. Blood in urine (hematuria) - Symptoms and causes. Mayo Clinic. April 30, 2026. https://www.mayoclinic.org/diseases-conditions/blood-in-urine/symptoms-causes/syc-20353432
Mayo Clinic Staff. Blood in urine (hematuria) - Diagnosis and treatment. Mayo Clinic. April 30, 2026. https://www.mayoclinic.org/diseases-conditions/blood-in-urine/diagnosis-treatment/drc-20353436
Schmidt-Hansen M, et al. The association between symptoms and bladder or renal tract cancer in primary care: a systematic review. Br J Gen Pract. 2015;65(640):e769-75. PMID 26500325. https://doi.org/10.3399/bjgp15X687421
Jubber I, et al. Non-visible haematuria for the Detection of Bladder, Upper Tract, and Kidney Cancer: An Updated Systematic Review and Meta-analysis. Eur Urol. 2020;77(5):583-598. PMID 31791622. https://doi.org/10.1016/j.eururo.2019.10.010
Rodgers M, et al. Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation. Health Technol Assess. 2006;10(18):iii-iv, xi-259. PMID 16729917. https://doi.org/10.3310/hta10180
Comments