For many people, haematuria (blood in the urine) is a concerning symptom. 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 Mr Hama Attar, Consultant Urological Surgeon, to find out more about the causes of blood in the urine and what to do if you’re experiencing symptoms.
Blood in the urine
The presence of blood in the urine is called haematuria. It can be alarming to notice, but it is a relatively common symptom that may arise from a wide range of causes; some minor and temporary but others more serious and requiring prompt medical attention.
Haematuria is generally classified into two types:
1. Visible (macroscopic) haematuria – when the urine appears pink, red, or cola-coloured due to blood that can be seen with the naked eye.
2. Non-visible (microscopic) haematuria – when blood is present but only detected under a microscope or through laboratory testing e.g. a urine dipstick test.
While haematuria itself is not a disease, it is an important clinical sign that should never be ignored. Identifying the underlying cause is key to determining whether treatment is necessary.
What does haematuria look like?
The appearance of blood in urine can vary:
- light pink or rose-coloured urine
- bright red urine
- dark brown or tea-coloured urine
- clear urine (in cases of microscopic haematuria)
It is important to note that certain foods (such as beetroot) and medications can sometimes change urine colour, mimicking haematuria.
Symptoms
Haematuria itself may occur without any other symptoms, particularly in microscopic cases. However, depending on the underlying cause, individuals may experience:
- pain or burning during urination
- frequent urge to urinate
- lower abdominal or back pain
- fever or chills
- difficulty passing urine
In some cases, especially when associated with conditions affecting the kidneys or urinary tract, haematuria may be accompanied by swelling in the legs or around the eyes.
Causes of haematuria
Haematuria can arise from various parts of the urinary system, including the kidneys, ureters, bladder, prostate (in men), and urethra. Common causes include:
- Cancer. Haematuria needs prompt evaluation as it can be an early sign of cancers of the bladder, kidney, or prostate. There is a strong association between bladder cancer and smoking. Statistically, 1 out of 20 people with non-visible haematuria and 1 out 5 people with visible haematuria has cancer.
- Urinary Tract Infections (UTIs). Infections in the bladder (cystitis) or urethra can irritate the lining, leading to bleeding. These are often accompanied by pain, urgency, and cloudy urine.
- Kidney and bladder stones. Kidney stones can cause irritation and bleeding as they move through the urinary tract. Pain is often severe and sudden. Bladder stones may not be painful but can cause frequency of urination and haematuria.
- Enlarged prostate. In men, an enlarged prostate gland can press on the urethra and cause urinary symptoms, including haematuria.
- Kidney disease. Conditions affecting kidney function, such as inflammation (a condition called glomerulonephritis) or infection, may result in blood leaking into the urine.
- Vigorous exercise. Strenuous physical activity can occasionally lead to temporary haematuria, sometimes referred to as “exercise-induced haematuria.” This is usually a result of more blood filtering through the kidneys and appearing in urine. This is self-limited and does not imply any specific clinical condition.
- Trauma. This could be any type of blunt or sharp injury to any part of the urinary tract. Fortunately, it is not a common cause of haematuria.
- Medications. Certain medications, including blood thinners, can increase the likelihood of bleeding in the urinary tract.
Diagnosis
If haematuria is suspected or confirmed, a doctor may recommend several tests to identify the cause:
- urine tests to detect infection, blood, or abnormal cells
- blood tests to assess kidney function
- imaging scans such as ultrasound or CT scan
- cystoscopy, a procedure using a small camera to examine the bladder
The choice of investigations will depend on age, symptoms, and risk factors.
Treatment options
Treatment for haematuria depends entirely on the underlying cause. Some cases require minimal intervention, while others may need more specialised care.
- Cancer treatment
If haematuria is linked to cancer, treatment options may include surgery, chemotherapy, radiotherapy, or a combination of approaches.
- Treating infections
If a urinary tract infection is the cause, antibiotics are typically prescribed, often resolving symptoms quickly.
- Managing kidney stones
Small stones may pass naturally with hydration and pain relief. Larger stones might require procedures such as shockwave therapy or surgical removal.
- Addressing prostate conditions
Medications or procedures may be recommended to manage prostate enlargement or inflammation.
- Treating underlying kidney conditions
Management may include medication, lifestyle changes, or specialist care depending on the diagnosis.
Why choose Cromwell Hospital?
At Cromwell Hospital, patients will benefit from a comprehensive and patient-centred approach to diagnosing and managing haematuria.
Key advantages include:
- Rapid access to specialist care
We have a team of experienced urologists and multidisciplinary teams who will ensure timely assessment and diagnosis.
On-site imaging, laboratory services, and endoscopic procedures allow for efficient investigation — all arranged and evaluated in a short space of time.
- Personalised treatment plans
Care is tailored to each individual, taking into account their medical history, lifestyle, and preferences.
- Continuity of care
From initial consultation through to treatment and follow-up, patients receive consistent support from our consultant team and Urology Clinical Nurse Specialists (CNSs).
- Comfortable and modern environment
High-quality facilities are designed to enhance patient experience and wellbeing.
Cromwell’s integrated approach ensures that whether haematuria is caused by a minor issue or a more complex condition, patients receive appropriate, expert-led world-class care.
Conclusion
Seeing blood in the urine can be unsettling, but it is an important symptom that should not be ignored. In many cases, the cause is treatable, especially when identified early. Seeking prompt medical advice ensures accurate diagnosis and appropriate management.
At Cromwell Hospital, we have an expert team of urology consultants and nurses who can investigate and treat the condition in a timely fashion which will translate into an excellent outcome.
