Haematuria (Blood in Urine)

Overview of Haematuria (Blood in Urine)

Haematuria is the medical term meaning, ‘presence of blood in the urine (pee)’. It occurs both in males and females due to many medical reasons.

Haematuria is the medical term meaning, ‘presence of blood in the urine (pee)’. It occurs both in males and females due to many medical reasons. Blood contains red blood cells (RBCs) that can come from the urinary tract or anywhere depending upon its cause. You cannot self-diagnose haematuria just by seeing your urine. At times, normal color urine may contain red blood cells when observed under the microscope.
Seeing bloody urine is frightening but it’s not always life-threatening!

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Signs and Symptoms of Haematuria (Blood in Urine)

The main symptom of visible haematuria is pink, red, or brown color urine. If the flow of urine becomes slow during urination due to the presence of blood clots then the patient may experience bladder or back pain. There is no other sign or symptoms of visible or macroscopic haematuria in most cases.


Types of Haematuria (Blood in Urine)

It is classified into two main types:

  • Macroscopic haematuria: It is commonly known as visible haematuria or gross haematuria. Blood can be seen in the urine with the naked eye, coloring red or dark brown.
  • Microscopic haematuria: It is commonly known as non-visible haematuria. Blood in the urine cannot be seen with the naked eye, can only be visible by microscopy. It is further divided into two types:
  • Symptomatic non-visible (s-NVH)
  • Asymptomatic or non-visible (a-NVH)

Is asymptomatic microscopic haematuria a medical emergency?


Asymptomatic microscopic haematuria is more prevalent in adults i.e. 1-13%. Non-visible asymptomatic haematuria may show a signal for bladder cancer, which is the second most cancer of the genitourinary tract.
The dipstick test is widely used for urine analysis. The patient with dipstick-positive haematuria should be re-examined by urine microscopy before referring to a urologist for further diagnosis. According to a retrospective study conducted in the Urological Department of John Hopkins Hospital, only 1.4% of patients with microscopic haematuria possessed malignant pathology. Thus, microscopic haematuria doesn’t need an urgent referral.

Causes of Haematuria (Blood in Urine)

Haematuria has a vast etiology. It can be categorized into urological (related to the urinary tract) and non-urological causes.

Urological causes include;

  • Urinary tract infection (UTI)
  • Renal calculi (kidney stones)
  • Bladder stones
  • Pyelonephritis (inflamed kidney)
  • Prostatitis (enlarged prostate)
  • Polycystic kidneys
  • Urothelial carcinoma (malignancy)
  • Prostate adenocarcinoma (malignancy)
  • Renal injuries

Non-urological haematuria may be due to other diseases or pseudo-hematuria;

  • Sickle cell anemia
  • Vigorous exercise
  • Viral illness e.g. hepatitis (liver infection)
  • Menstruation
  • Sexual activity
  • Endometriosis (occurs in women when a tissue lining the uterus grows somewhere else)

‘Pseudohaematuria’ is red urine without blood. Reasons may include;

  • By eating an excessive amount of beet (beeturia)
  • Food dyes
  • Use of some medicines such as rifampin, Pyridium, senna, and nitrofurantoin
  • Presence of myoglobin or hemoglobin in urine due to the breakdown of red blood cells

Risk Factors of Haematuria (Blood in Urine)

Factors that make you more susceptible to haematuria include;

  • 50 years old people
  • Men are more at risk than women
  • Smokers
  • History of irritating lower urinary tract
  • Chemical or dyes exposure
  • Enlarged prostate
  • Use of blood-thinning medicines, certain antibiotics, and pain relievers

Now it’s time to get alert!


Immediately look for a urologist when you see red or cola-colored urine followed by fever, malaise, or lower abdomen pain.



Like treatment, prevention is recommended according to the cause. Pseudohaematuria including strenuous exercise and intake of certain drugs can be easily prevented by switching to light activities and by managing the physician's drug prescription, respectively. To prevent urological haematuria, a healthy lifestyle should opt. For a healthy urinary tract, one must observe the following:

  • stay hydrated (8-10 glasses of water per day)
  • avoid smoking
  • healthy diet

How much time does haematuria last?


Haematuria due to heavy exercise (trauma) usually lasts a day or two. Haematuria due to kidney or bladder stones end after the stones are removed through urination (peeing). Haematuria due to any infection (kidney or urinary tract) ends when the condition is treated.




Haematuria is diagnosed in four steps: medical history, physical examination, urinalysis, and additional tests.

  • Medical history

Before doing any examination, the doctor will take your medical history to determine the cause of haematuria. You are supposed to tell about your medical history, recent medication, and symptoms.

  • Physical Examination

After taking your medical history, the doctor will examine you by tapping your abdomen and back to check for pain in the bladder or kidney. In men, a digital examination is performed to check for prostate problems. In women, a pelvic examination is performed to find the source of blood in the urine.

  • Urinalysis

A urine sample is taken for urine examination. A dipstick test is commonly performed to check for blood in the urine. Dipstick positive means you have blood in your urine while dipstick negative means there is no visible blood in the urine. Sometimes dipstick tests can be positive despite having normal urine. This is known as, a false-positive (not positive in reality) dipstick test. In this case, microscopy is performed to look for red blood cells.
Menstruation is the possible reason for false-positive dipstick tests.
The blood from a women’s menstrual period may mix into the urine sample, making the test false positive. In this case, the dipstick test should be re-performed after a woman stops menstruation.

Important tips while taking urine samples:

  • Early morning
  • Mid-stream urine (after peeing a little urine)
  • After menstruation
  • After healing of wound at peeing place (if any)
  • Further tests

If too many red blood cells are detected in the patient’s sample then the physician would recommend further tests.


  • Urine culture: To determine if any pus cells and bacterial or fungal infections are present.
  • Blood test: To determine the creatinine level (a waste product of the kidney).
  • CT Scan (computed tomography): X-rays of the urinary tract or kidney. For X-rays, you have to lie down on a plane table that slides into an image-taking device. No anesthesia is given to the patient. A Radiologist will interpret the results including cysts, obstructions, traumatic injuries, tumors or cancers, and stones in the urinary tract or kidney.
  • Cystoscopy: After a CT scan, the urologist will do a cystoscopy if recommended by the radiologist. Cystoscopy is a procedure in which a tube-like instrument is inserted into the patient’s urethra and bladder. It may be a painful procedure and the doctor will recommend a pain reliever. It is a very useful technique for detecting bladder cancer.
  • Kidney Biopsy: Cutting of small pieces of tissues from the kidney. The procedure is performed by the surgeon in a hospital and mostly slight local anesthesia is given to the patient. However, in some cases, general anesthesia may require. The part of kidney tissues is then examined by the pathologist, who will examine it in a laboratory. He will tell you whether the haematuria is due to kidney disease or due to some other medical issues.
  • MRI (magnetic resonance imaging): The image of internal organs without using X-rays. No need for anesthesia while slight sedation may give to patients showing fear. A technician will take the image and a patient will hear a knocking or loud noise from the MRI machine. MRI report will help the urologist see the internal kidney or bladder problems.

You should consider a proper investigation approach (as shown here).


Treatment of Haematuria (Blood in Urine) | When to Consult a Doctor

As haematuria is a symptom of other diseases, there is no treatment specific to haematuria. Treatment depends on its cause. Haematuria is treated by treating the underlying pathology.

A study reported that 5% of patients with microscopic haematuria and 20% of patients with macroscopic haematuria are found to have malignancies (cancer or tumor). 

Here are some possible treatments for haematuria:

  • Antibiotics: If the haematuria is caused by a urinary tract infection, antibiotics may be prescribed to clear the infection.
  • Pain relief: If you are experiencing pain or discomfort, pain relievers such as paracetamol or ibuprofen may be recommended.
  • Treatment for kidney stones: If the haematuria is caused by kidney stones, your doctor may recommend medication to help pass the stones, or in more severe cases, surgery may be necessary.
  • Treatment for bladder or kidney cancer: If the haematuria is caused by cancer, treatment options may include surgery, chemotherapy, or radiation therapy.
  • Management of underlying medical conditions: If the haematuria is caused by an underlying medical condition such as high blood pressure, diabetes, or kidney disease, the treatment will focus on managing the underlying condition.

Where to consult a doctor?

In Pakistan, the Nephrology department of Aga Khan University Hospital, Mayo Hospital, Jinnah Hospital, General Hospital, and Services Hospital provide more efficient treatment of kidney diseases.  For urine cultures or blood tests, Chughtai Lab and Shaukat Khanum Pathology Laboratory prepare trustworthy reports.

You can consult with a nearby Urologist. You can also find reputable doctors specializing in haematuria or kidney disease diagnosis in our list of top doctors. You can easily connect with them anywhere in Pakistan via Healthwire.pk.