Blood in urine is frightening. There's no need to be embarrassed about it: urine and blood are discussed as calmly as a runny nose. And there is one rule — any amount of blood in urine needs to be checked, even if there's only a little blood and even if you're not sure it's blood.
Visible and invisible hematuria
Hematuria is the passage of blood in urine. Macroscopic hematuria is visible to the eye: urine becomes bright pink, red, rusty, or dark brown. Microscopic hematuria is not visible to the eye — red blood cells are found only under a microscope. Normally, 1–2 red blood cells are seen per field of view (10× eyepiece, 40× objective), and up to 85,000 red blood cells are excreted in urine per hour. If there are more than three red blood cells per field of view in two routine urine tests, this is already microscopic hematuria. It's not about the shade but about counting cells under a microscope.
Blood can come from any part of the urinary tract: from the bladder, from the kidneys, or from the urethra — the tube through which urine leaves the body. The doctor identifies the source using the three-glass test — urine is collected in three portions: at the beginning, in the middle, and at the end of urination. Blood only in the first portion points to the urethra: trauma, papillomas, inflammation with pus. Only in the last portion — to the bladder or prostate. Total hematuria, when blood is present in all portions, occurs in acute hemorrhagic cystitis, bladder stones and tumors, as well as in kidney and urinary tract involvement — in particular in kidney stone disease and tumors. The three-glass test does not make a diagnosis but shows in which part of the urinary tract to look for the cause.
When to see a doctor
Immediately, without waiting. Booking an appointment with a family doctor is the first step. It's not up to you to decide whether this is serious or not — that's the doctor's decision.
When to call 103 or 112. Blood in urine by itself is not a reason to call an ambulance, but a check is needed right away. Call 103 or 112 if the person's condition deteriorates sharply and is life-threatening.
Possible causes
Hematuria is not a disease but a symptom of many diseases of the urinary system. Additional symptoms may suggest the cause, but they do not establish a diagnosis on their own.
- Urinary tract infection: burning during urination, frequent urges, foul-smelling or cloudy urine, fever, pain in the side or lower back.
- Kidney stones: severe pain in the side, lower back, or groin that comes in waves, inability to lie still, nausea.
- Enlarged prostate: in men over 50, difficulty urinating, sudden and frequent urges, having to get up at night.
This is not a complete list of causes — only those with characteristic additional symptoms. Usually, blood in urine does not mean anything serious.
Causes that must not be missed
Tumors of the bladder, kidneys, and urinary tract also cause blood in urine. Blood in urine can be a sign of cancer — that is exactly why it is checked, even when nothing else is bothering you; early detection makes treatment easier. Blood also occurs in hemorrhagic cystitis and stones, so the cause is not determined by eye.
What else colors urine
Not everything red in urine is blood. Urine turns pink after beetroot. Some medications color urine red or brown. Blood from the rectum, menstruation, and blood from the vagina between periods can also get into urine and give it a red color. The color of urine is not a diagnosis: if in doubt, the urine is tested.
What the doctor does
At the appointment, the doctor asks about symptoms. If needed, the doctor may examine the rectum or vagina. Next, the doctor may ask for a urine sample or order a blood test. The doctor may refer you to a specialist for further examinations. The decision about further tests is made based on the results of these steps, not on the appearance of the urine.
This is reference material, and it does not replace a doctor's consultation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer