Blood in Urine (Hematuria)

Going to the toilet and seeing blood in your urine can be pretty alarming.

While your first instinct may be to panic, it’s worth noting that in many cases the cause is harmless.

However, in some instances, blood in urine can indicate a severe disorder or underlying problem, which is why it is essential to consult a doctor.

This article will discuss what blood in the urine is and what could be causing it.

What is Hematuria?

The medical term for blood in the urine is hematuria. It is when urine contains blood that can appear pink, red, or maroon.

In some circumstances, blood clots can occur, which can indicate severe health complications, such as bleeding from the urethra or the prostate.

There are two main types of hematuria, these include:

  • Gross hematuria: blood in the urine that can be seen. This is also known as macroscopic hematuria.

  • Microscopic hematuria: blood that can only be seen under a microscope

When to see a Doctor

If you start to notice blood in your urine, it is important to make an appointment with a doctor.

In some instances, medications and certain foods, such as beetroot can cause your urine to appear red.

A change in urine color caused by factors such as drugs, food, or exercise might go away within a few days.

What causes Hematuria?

There are many possible causes for hematuria, and in some cases, the blood may be from a different source.

Reasons for blood in the urine vary, but some of the most common causes for men include:

  • Urinary tract infection: urinary tract infection is a common cause of hematuria, and although UTIs occur more frequently in women, men can also develop them.

    A UTI is an infection of any part of your urinary system — kidneys, ureters, bladder, and urethra. The bacteria, usually Escherichia coli, are mostly responsible for the UTIs and can gain entry via urethra or reach the urinary system via blood.

  • Enlarged prostate (BPH): Benign prostatic hyperplasia, also referred to as an enlarged prostate is a common problem as men reach their fifties.

    As men grow older, the prostate naturally enlarges, pressing down on the urethra. This causes obstruction, making urination difficult. As a result, the bladder may work harder to release urine, which could lead to damage and bleeding

  • Prostatitis: Prostatitis is when the prostate becomes inflamed, resulting in symptoms including painful/ frequent urination, painful ejaculation, pelvic pain, and hematuria.

  • Kidney or bladder stones: Kidney stones/ bladder stones occur when your urine contains more crystal-forming substances than the fluid in your urine can dilute. Side effects include painful urination, abdominal pain, hematuria, nausea, and vomiting.

  • Prostate cancer: Blood in the urine usually occurs in advanced stages of prostate cancer and should not be ignored.

  • Bladder cancer: Blood in the urine can be an early sign of bladder cancer. In some cases, blood may be present one day and absent the next, but if a person has bladder cancer, at some point, the blood reappears.

    Blood in the urine for people over the age of 35 should be taken even more seriously, with the most common cause being bladder cancer.

  • Sickle cell disease: Sickle cell disease is a form of anemia. This is a condition in which there aren’t enough healthy red blood cells to carry oxygen throughout the body. Gross hematuria is often a symptom of the disease.

  • Glomerular disease: Glomerular disease is when tiny filters in the kidneys, known as glomeruli, are damaged. As a result, the large-sized blood cells are passed into urine which is otherwise filtered.

    This is a type of kidney disease, and symptoms can include blood in the urine, protein in the urine, high blood pressure, and anemia.

  • Medication: Certain medications can also cause hematuria. These include blood thinners, such as warfarin (Coumadin) penicillins, and sulfa-containing drugs.

  • Strenuous exercise: In some cases, vigorous exercise can result in hematuria. This is usually harmless and is more common in men than in women.

How is Hematuria diagnosed?

As discusses above, hematuria is caused by many factors.

Therefore, to determine the underlying cause, your Doctor/ urologist will perform the following tests.

  • Physical examination: Including a discussion of your medical history. Your doctor may also perform a digital rectal exam (DRE) to determine if your prostate may be causing the hematuria.

  • Urinalysis: Urine tests can be used to detect a urinary tract infection UTI or the presence of minerals that cause kidney stones.

  • Urine cytology: This is used to look for abnormal cells in your urine.

  • Imaging test: Imaging tests are usually required to find the cause of hematuria. Your doctor may also recommend a CT scan (Computed tomography) or MRI scan.

  • Cystoscopy: During a cystoscopic examination, your doctor inserts a thin, flexible device called a cystoscope through the urethra into the bladder. This allows your doctor to view your lower urinary tract and check for any abnormalities.

How is Hematuria treated?

Treatment options will vary depending on the cause of hematuria.

For example, if the cause is a urinary tract infection, a course of antibiotics may be prescribed.

In terms of a diagnosis of bacterial prostatitis, a course of antibiotics will also be prescribed, which may wipe out the specific bacteria causing your prostatitis.

However, it’s also affecting the whole microbiome of probiotics living in your urinary tract. This could reduce the protective bacteria to seriously low numbers, leaving harmful fungi to grow – and potentially cause chronic prostatitis.

Lifestyle changes, including diet, exercise and probiotics, and natural supplements, may also help to alleviate symptoms.

If the underlying cause is an enlarged prostate, you may be recommended medication, such as 5-a reductase inhibitors such as finasteride. However, it is important to be aware that such prostate drugs can have adverse side effects.

Natural alternatives, such as saw palmetto, beta-sitosterol, pygeum, and stinging nettle, have also been found in clinical trials to relieve urinary symptoms effectively.


It is worth bearing in mind that hematuria itself isn’t a disease; it is a sign of an underlying health condition. Therefore, if you do spot blood in your urine, it is essential to get it checked out.

By undergoing a hematuria evaluation, your doctor can diagnose what is causing blood in your urine and thereby decide the best course of treatment.

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  1. Vasdev N, Kumar A, Veeratterapillay R, Thorpe AC. Hematuria secondary to benign prostatic hyperplasia: retrospective analysis of 166 men identified in a single one stop hematuria clinic. Curr Urol. 2013;6(3):146–149. doi:10.1159/000343529
  2. McVary KT. Clinical evaluation of benign prostatic hyperplasia. Rev Urol. 2003;5 Suppl 4(Suppl 4):S3–S11.
  5. Gofrit, O, Katz, R, Shapiro, A, Yutkin, V, et al. (2013). Gross Hematuria in Patients with Prostate Cancer: Etiology and Management. Hindawi- International Scholarly Research Notices. 1 (1), p1-4.

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