For many people, blood in the urine is a worrying symptom which can be indicative of a wide variety of conditions. In rare cases, it may be a sign of a serious medical condition – but for most, it is a temporary issue that can be resolved relatively easily. We spoke to Professor Rakesh Heer, Consultant Urological Surgeon, to find out more about the causes of blood in the urine and what to do if you’re experiencing symptoms.
What is blood in the urine?
Blood in the urine (haematuria) can originate from different places, including the bladder, kidneys, prostate, or urethra. It usually occurs alongside other symptoms, which can help pinpoint the cause.
If you have blood in the urine, your urine may appear pink, red, or dark brown. In many cases, there are microscopic amounts of bleeding in the urine that are not visible to the eye; your doctors may use a dipstick test to look for this type of blood in the urine.
Urinary tract infection (UTI)
If your urinary tract becomes infected, you may experience blood in the urine alongside other symptoms. This may include:
- a burning pain when urinating (dysuria)
- an urgent need to urinate
- needing to urinate more at night (nocturia)
- smelly or cloudy urine
- a high temperature
- pain in your sides or lower back
UTIs can occasionally resolve on their own, but most can easily be treated with antibiotics. Men with a single infection, or women with recurrent UTIs, need to see a specialist for further investigation.
If bacteria from the bladder travels up to the kidneys, a kidney infection may develop. Some patients with kidney infections will require admission to hospital to receive intravenous antibiotics if they are considered vulnerable – for example, if they have underlying health conditions or are pregnant.
Kidney stones occur when small crystals collect inside the kidneys and form into a small, stone-like lump. They can develop in one or both kidneys and can fall into the ureter (tube that connects your kidneys to your bladder), where they can be extremely painful and cause serious infection if left untreated.
If you have kidney symptoms, you may experience the following symptoms:
- blood in the urine
- pain in the side of your stomach or groin (men may also experience pain in the testicles)
- a high temperature
- severe pain
- nausea or vomiting
Treatment depends on how large your stones are. Small stones may be managed with at-home treatment, such as taking painkillers and drinking plenty of fluids until the stones pass naturally. Large stones may require interventions such as shockwave to break the stone (lithotripsy), endoscopy to use a laser to fragment and remove the stone (ureteroscopy), or keyhole surgery directly in the kidney through the back to remove the stone (percutaneous nephrolithotomy).
Because people who have had kidney stones are more likely to develop them again, patients are often advised to have blood tests to investigate if there is a biochemical problem that needs treatment. They should also drink enough water to stay hydrated and prevent the stones from re-forming.
Prostate enlargement is a common condition found in men over the age of 40. An enlarged prostate is not usually a cause for concern; however, many men will wonder about prostate cancer and therefore an assessment of the prostate with a digital examination and a blood test (PSA) is advised.
The prostate is a small gland located in the pelvis, between the penis and the bladder. If the prostate becomes enlarged, it can press against the bladder and the urethra (the tube that urine passes through), causing symptoms and occasionally bleeding.
Blood in the urine can be a sign of enlarged prostate, especially if accompanied by the following symptoms:
- difficulty when beginning to urinate
- a frequent need to urinate
- difficulty fully emptying your bladder
If your symptoms are mild, you may be monitored and advised to make lifestyle changes. These include reducing your alcohol intake and exercising more regularly.
If your symptoms are moderate to severe, you may be prescribed medication that reduces the size of the prostate and relaxes your bladder. In rare cases where medication has not worked, you may require surgery.
Occasionally, an untreated enlarged prostate can lead to complications such as UTIs and retention of urine.
In rare cases, blood in the urine may be indicative of bladder cancer – a type of cancer that begins in the lining of the bladder.
Blood in the urine is the main symptom of bladder cancer. Other symptoms include:
- urinating more frequently
- sudden urges to urinate
- a burning sensation when urinating
There are two primary types of bladder cancer. Bladder cancer that is contained within the bladder lining is known as non-muscle-invasive bladder cancer – this is the more common type. Bladder cancer that has invaded the surrounding bladder muscle is known as muscle-invasive bladder cancer.
Treatment for bladder cancer depends on your overall health, what type of bladder cancer you have, and how advanced it is. Non-muscle-invasive bladder cancer is usually treated with endoscopic removal (transurethral resection of a bladder tumour, or TURBT). Muscle-invasive bladder cancer, if not showing evidence of spread elsewhere in the body, may require bladder removal (cystectomy), radiotherapy, and/or chemotherapy.
What should you do if you have blood in your urine?
If you have blood in your urine, it is important that you see your GP as soon as possible.
At your appointment, your GP will ask about your symptoms and may carry out a physical examination. They may also ask for a urine sample, arrange blood tests, or refer you to a urologist for further investigation. Urologists specialise in the diagnosis and treatment of urinary tract conditions, which includes the kidneys, ureter, bladder, and urethra, as well as male genital conditions.
At Cromwell Hospital, our team of consultant urologists and urological surgeons have trained at some of the UK’s top teaching hospitals and hold extensive experience in all aspects of urinary tract conditions. We have a dedicated haematuria clinic that provides diagnostic tests and investigations to help get to the root cause of a problem, including blood tests, ultrasounds, CT scans, and cystoscopy.
About the consultant
Professor Rakesh Heer has more than 25 years’ experience as an NHS doctor and over 10 years’ experience as a specialist consultant urologist. He has senior roles for national committees (NIHR and NICE) generating evidence for high quality clinical care and defining best practice for UK guidelines. His clinical interests include a focus on all aspects of prostate and bladder management, and he has a high-volume robotic surgery practice for prostatectomy, cystectomy, and urinary tract reconstruction.