Urine - bloody
Hematuria; Blood in the urine
Blood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the blood is visible. It often turns the toilet water red or pink. Or, you may see spots of blood in the water after urinating.
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 health care provider 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 medicines, beets, or other foods.
If you ever have severe pain in your belly or one side of your back that comes and goes suddenly, you may be passing a kidney stone. Let's talk about the painful condition of kidney stones. A kidney stone is a mass of tiny crystals in your kidney or urinary tract. Stones are quite common, and tend to run in families. They can form in weeks or months when your urine contains too much of certain substances. There are several kinds of kidney stones. Calcium stones are by far the most common kind. They often form in men between the ages of 20 to 30. Calcium can combine with other substances found in your food, like oxalate, phosphate, or carbonate, to form stones. Cystine stones can form in people who have cystinuria, a condition passed down through families in which stones are made from an amino acid called cystine. Struvite stones are found mostly in women who have urinary tract infections. These stones can grow very large and can block the kidney, ureter, or bladder. Uric acid stones are more common in men than in women. They can occur in people who have a history of gout or are going through chemotherapy. So, how do you know if you have kidney stones? Well, you may not have symptoms until the stone move down the ureter tubes through which urine empties into your bladder. When this happens, the stones can block the flow of urine out of your kidneys. The main symptom is severe sharp pain that starts suddenly, usually in your belly or one side of your back, and it may go away just as quickly. Other symptoms can include abnormal urine color, blood in your urine, fever, chills, nausea, and vomiting. So, what do you do about kidney stones? Well, your health care provider will perform a physical exam. You may need blood tests, kidney function tests, and tests that look for crystals in your urine. Several imaging tests, like a CT scan, can see stones or a blockage in your urinary tract. Treatment will depend on the type of stone you have, and how bad your symptoms are. Small kidney stones that are less than 5 mm in diameter will usually pass on their own. You should drink at least 6 to 8 glasses of water per day to produce a large enough amount of urine to help bring the stone out. Pain can be pretty bad when you pass a kidney stone, so your doctor may prescribe pain medicines to help as well as medications that will help the stone pass. Other medicines can decrease stone formation or help break down and remove the material that is causing you to make stones. You may need surgery if the stone is too large to pass, the stone is growing, or the stone is blocking your urine flow. Kidney stones are painful, but you can usually pass them without causing permanent harm. However, kidney stones often come back, so you and your doctor will need to work on finding the cause of your stone. Lastly, delaying treatment can lead to serious complications, so if you think that you have kidney stones see your doctor right away.
When to Contact a Medical Professional
You may not see blood in your urine because it is a small amount and is microscopic. Your provider may find it while checking your urine during a routine exam.
Never ignore blood you see in the urine. Get checked by your provider, especially if you also have:
- Discomfort with urination
- Frequent urination
- Unexplained weight loss
- Urgent urination
Contact your provider right away if:
- You have fever, nausea, vomiting, shaking chills, or pain in your abdomen, side, or back
- You are unable to urinate
- You are passing blood clots in your urine
Also contact your provider if:
- You have pain with sexual intercourse or heavy menstrual bleeding. This may be due to a problem related to your reproductive system.
- You have urine dribbling, nighttime urination, or difficulty starting your urine flow. This may be from a prostate problem.
What to Expect at Your Office Visit
Your provider will perform a physical exam and ask questions such as:
- When did you first notice blood in your urine? Has the amount of your urine increased or decreased?
- What is the color of your urine? Does your urine have an odor?
- Do you have any pain with urination or other symptoms of infection?
- Are you urinating more often, or is the need to urinate more urgent?
- What medicines are you taking?
- Have you had urinary or kidney problems in the past, or recently had surgery or an injury?
- Have you recently eaten foods that may cause a change in color, like beets, berries, or rhubarb?
Tests that may be done include:
- Abdominal ultrasound
- Antinuclear antibody test for lupus
- Blood creatinine level
- Complete blood count (CBC) with platelet count
- CT scan of the abdomen
- Kidney biopsy
- Strep test
- Tests for sickle cell, bleeding problems, and other blood disorders
- Urinary cytology
- Urine culture
- 24-hour urine collection for creatinine, protein, calcium
- Blood tests such as PT, PTT or INR tests
The treatment will depend on the cause of blood in the urine.
Boorjian SA, Raman JD, Barocas DA. Evaluation and management of hematuria. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 16.
Brown DD, Reidy KJ. Approach to the child with hematuria. Pediatr Clin North Am. 2019;66(1):15-30. PMID: 30454740
Elsamra SE. Evaluation of the urologic patient: history and physical examination. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 1.
Gharavi AG, Landry DW. Approach to the patient with renal disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 100.
Last reviewed on: 7/1/2023
Reviewed by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.