Should I be worried if there is blood in my urine?

It can be scary to see blood in your urine. But try to stay calm. Blood in the urine is not always serious. Still, you should see a doctor or nurse. The medical term for blood in the urine is “hematuria.”

Blood in the urine can come from the kidneys (where urine is made) or from anywhere in the urinary tract (figure 1).

What causes blood in the urine?

Blood in the urine can be caused by lots of problems, including:

• Bladder infection, which also often causes burning or pain when you urinate
• Kidney infection, which also often causes back pain and fever
• Kidney stones, which also often cause back pain
• Certain kidney diseases
• Intense exercise
• Injury (for example, if you fall off of a bike and bruise a kidney)
• Enlargement of the prostate (called “benign prostatic hyperplasia”), which is common in older males
• Cancer of the bladder, prostate, or kidney (cancer is an uncommon cause of blood in the urine, and it usually affects people older than 50)

Sometimes, urine can look as though it is bloody even though it isn’t. This can happen if you eat a lot of beets or food dyes, or if you take certain medicines.

Should I see a doctor or nurse?

Yes. See your doctor or nurse if you see blood in your urine, or if your urine is pink, red, brownish-red, or the color of tea.

Sometimes, doctors find blood in the urine when they do a routine urine test. That can happen even if the urine looks normal. It means that there are microscopic (trace) amounts of blood in the urine.

Will I need tests?

Maybe. This depends on your age and symptoms. Not everyone needs tests.

If your doctor or nurse thinks that you need tests, they might include:

• Urine tests – These can show what kind of cells are in your urine. This can help the doctor find out what’s happening. The test might also measure the amount of protein in your urine. Too much protein can be a sign of a kidney problem.
• Blood tests – These can show whether your kidneys are working normally, or if you might have certain diseases.
• CT scan – This is a special kind of X-ray. It creates a picture of the kidneys and urinary tract. Doctors can use it to check for kidney stones and other problems in the urinary tract.
• Kidney ultrasound – This is another way to create a picture of the kidneys. Doctors sometimes use ultrasound instead of a CT scan.
• Cystoscopy – This is a procedure that lets the doctor look inside your bladder and urethra. During cystoscopy, a doctor puts a thin tube with a tiny camera on the end into the urethra and moves it up into the bladder. The tube is called a “cystoscope.” If the doctor sees anything unusual, they might take a sample of tissue (called a biopsy) to look at under a microscope.
• Kidney biopsy – For this test, the doctor takes a small sample of tissue from the kidney to look at under the microscope. The most common way to get the sample is by inserting a needle straight through the skin in the back and into the kidney.
• Blood pressure – Your blood pressure will probably be measured. That’s because high blood pressure can be a sign of certain kidney problems.

Will I need treatment?

It depends on what caused the blood in your urine. If you had blood in your urine because you exercised too intensely or because your kidney was bruised, you might not need any treatment. But if you have blood in the urine because of a bladder or kidney infection, you will probably need antibiotics.

What problems should I watch for?

Call your doctor or nurse for advice if:

• You have signs of an infection – These include a fever of 100.4°F (38°C) or higher and chills, or pain when urinating.
• You have very bad pain in your back or side.
• You can’t urinate at all, or only a small amount of urine comes out.
• You have blood clots in your urine.
• Your symptoms are not getting better after a few days or are getting worse.