DefinitionBlood in your urine, or hematuria, is blood that is found in your urine. It can be microscopic or gross.Microscopic hematuria is when there is very little blood in the urine and it can only be detected with urine tests or under a microscope.Gross hematuria is when there is enough blood in the urine that you can see it with the naked eye. Usually it turns toilet water pale pink or bright red. Or, you may see spots of blood in the water after urinating.
Alternative NamesHematuria; Blood in the urine
ConsiderationsBlood 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 movementIn any case, you should see a health care provider.The urine can also turn a red color from certain drugs, beets, or other foods.You may not see blood in your urine because it is too small. Your health care provider may find it while checking your urine during a routine exam. The health care provider will follow up to see if it persists and find the cause.When you can see blood in your urine, you will need an evaluation as soon as possible. Children may need to stay in the hospital for tests.
Common CausesThere are many possible causes of blood in the urine. Often, bloody urine is due to a problem in your kidneys or other parts of the urinary tract. If there is no problem with your kidneys, urinary tract, prostate, or genitals, your doctor may check to see if you have a bleeding disorder.Kidney and urinary tract causes include:Cancer of the bladder or kidneyInfection of the bladder, kidney, prostate, or urethraInflammation of the bladder, urethra, prostate, or kidney ( glomerulonephritis)Injury to the bladder or kidneyKidney or bladder stonesKidney disease after strep throat ( post-streptococcal glomerulonephritis) -- a common cause of blood in the urine in childrenKidney failurePolycystic kidney diseaseRecent urinary tract procedure such as catheterization, circumcision, surgery, or kidney biopsyCauses from blood disorders include:Bleeding disorders (such as hemophilia)Blood clot in the kidneysBlood thinning medications (such as aspirin or warfarin)Sickle cell diseaseThrombocytopenia (low numbers of platelets)
Call your health care provider ifNever ignore blood in the urine. Tell your doctor about this symptom and get it checked, especially if you also have:Discomfort with urinationFrequent urinationUnexplained weight lossUrgent urinationCall your doctor right away if:You have fever, nausea, vomiting, shaking chills, or pain in your abdomen, side, or backYou are unable to urinateYou are passing blood clots in your urineAlso call your doctor if:You have pain with sexual intercourse or heavy menstrual bleeding -- the problem may be related to your reproductive organsYou have urine dribbling, nighttime urination, or difficulty starting your urine flow -- the problem may be due to your prostate
What to expect at your health care provider's officeYour doctor will take a medical history and perform a physical examination. Medical history questions may include:When did you first notice blood in your urine?What is the color of your urine?Do you have any pain with urination?Has the amount of your urine increased or decreased?Does your urine have an odor?Are you urinating more often?Do you have an urgent need to urinate?What medications are you taking, including over-the-counter drugs?Have you recently eaten foods that may cause a change in color, like beets, berries, or rhubarb?Do you have any other symptoms?
Pain in your back, abdomen, or side?Fever, weight loss, nausea, vomiting, or diarrhea?Nighttime urination?Dribbling?Discharge from your penis or vagina?Pain with intercourse?Have you had past urinary or kidney problems?Do you have any allergies?Do you have a history of tobacco use?Have you had a recent injury?Have you had any recent procedures involving the urinary tract?Tests that may be done include:Abdominal ultrasoundAntinuclear antibody test for lupusBlood creatinine levelComplete blood count (CBC)CT scan of the abdomenCystoscopyIntravenous pyelogram (IVP)Kidney biopsyStrep testTests for sickle cell, bleeding problems, and other blood disordersUrinalysisUrinary cytologyUrine culture24-hour urine collection for creatinine, protein, calciumThe treatment will depend on the cause of blood in the urine. If a urinary tract infection is confirmed, you may take antibiotics. Your health care provider may also prescribe pain medications, if you need them.
ReferencesGerber GS, Brendler CB. Evaluation of the urologic patient: History, physical examination, and the urinalysis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 3.Landry Dw, Bazari H. Approach to the patient with renal disease. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 116.