Saw blood in your urine? Here’s what happens next
Perhaps the toilet water looked pink, or a routine urine test came back showing blood. Perhaps it cleared up and you’d rather forget it. Dr. Dev Mally of Advanced Urology’s advice is simple: a single episode is enough reason to find out why.
Questions in this guide
- Blood in the urine, or hematuria: is there a difference?
- Seen versus found on a test: does it matter?
- Could red urine be from food or a medicine?
- Could it be an infection?
- What about a kidney stone?
- Can the prostate cause it?
- When is cancer the cause?
- It went away. Can I skip the visit?
- Am I at higher risk?
- What does the evaluation involve?
- What do most people find out?
Blood in the urine, or hematuria: is there a difference?
No. Hematuria is simply the medical word for blood in the urine, whether you can see it yourself or it turns up on a lab test.
Seen versus found on a test: does it matter?
Both matter. When you can see it, urine may look pink, red or the color of cola, and that kind deserves a prompt visit. Microscopic blood can’t be seen at all; it turns up when a lab looks at a urine sample. Either one is worth following up.
Could red urine be from food or a medicine?
It can. Beets and blackberries can tint urine, and so can some medicines, including phenazopyridine, a bladder pain reliever that turns urine orange or red. Color alone can mislead, so a urine test settles the question.
Could it be an infection?
Infection is one of the more frequent explanations. Typical clues are burning, frequent, urgent urination, and urine that looks cloudy or smells strong. Fever, chills, back pain or nausea suggest the kidneys are involved. Treating the infection should clear the blood, and if it doesn’t, the search continues.
What about a kidney stone?
Stones are another frequent source. The textbook picture is sudden, intense pain in the side or back just under the ribs, traveling toward the groin in waves, often with nausea and a constant urge to go. Not every stone hurts, though, and some bleed quietly, which is one reason imaging is still part of the workup.
Can the prostate cause it?
In older men, yes. An enlarging prostate can grow delicate blood vessels on its surface, and these can bleed, sometimes alongside a weak stream or nights spent getting up to urinate. This kind of bleeding is usually not dangerous, but we rule out more serious causes before putting it down to the prostate.
When is cancer the cause?
Occasionally, blood is how a cancer first shows itself: usually a bladder cancer, sometimes in the kidney. The important clue is bleeding that comes without pain. Bladder cancer may cause blood and nothing else, or burning, frequency and urgency that don’t settle and can be mistaken for an infection. Kidney cancer tends to be quiet early; as it advances, flank or back pain, a mass, unplanned weight loss or fatigue may appear.
It went away. Can I skip the visit?
Please don’t. Bleeding often stops by itself and can come and go even when a cancer is present. Visible blood calls for a complete evaluation even after one episode, even after it has stopped, and even if you take a blood thinner. A blood thinner can make you bleed more easily, but it doesn’t explain why you bled.
Am I at higher risk?
For bladder cancer, no risk factor outweighs smoking, whether current or past. Risk also climbs with age, with certain chemical exposures at work, and after some cancer treatments or radiation to the pelvis.
What does the evaluation involve?
For most people there are two main steps. The first is a CT urogram, a CT scan tailored to picture each kidney, its drainage tube, and the bladder, so that stones, growths and other problems can be spotted. It uses contrast dye, so your kidney function is checked beforehand, and if contrast isn’t an option, a different scan is used. The second is cystoscopy, where a thin camera looks inside the bladder. Advanced Urology performs it with you asleep under anesthesia, in one of the practice’s own surgery centers. It’s over in minutes and you leave the same day. If anything looks abnormal, a small sample can be taken then and there. Like any procedure, it carries risks and benefits, which we’ll talk through. Your urine is tested too, and for a small group of very low-risk patients with microscopic blood, repeating that test may come first.
What do most people find out?
Usually a cause that can be treated: an infection, a stone, or prostate enlargement. In other cases nothing serious turns up, and knowing that is worth a lot. If cancer is the answer, catching it early counts, and our urologists care for the whole range of what an evaluation can uncover. Waiting to see if it happens again isn’t the answer; call instead.
Watch a short video
This Advanced Urology episode covers the hidden clues blood in the urine can give.
This guide is educational, not medical advice. Every treatment and procedure has risks and benefits; your care team will review yours. More on this topic: Advanced Urology condition page.