Blood in the Urine (Haematuria)

Any episode of visible blood in the urine should be investigated, even if it settles. The workup is usually quick and the commonest cause is not cancer - but ruling out serious causes is important.

Two types of haematuria

  • Visible (macroscopic) haematuria - the urine appears pink, red or tea-coloured. This always warrants investigation.
  • Non-visible (microscopic) haematuria - blood cells are detected on a urine dipstick or microscopy but the urine looks normal. This is also important, especially if persistent.
When to seek urgent care: heavy bleeding with clots, inability to pass urine, severe flank pain, fever, or signs of dehydration - present to your nearest emergency department.

Common causes

Many causes of haematuria are benign, but some need prompt treatment:

  • Urinary tract infection or prostatitis.
  • Kidney or bladder stones.
  • Kidney or bladder tumours.
  • An enlarged prostate (BPH).
  • Kidney disease (glomerular bleeding).
  • Trauma or recent instrumentation (for example, a catheter or prior surgery).
  • Medications (especially blood-thinners, which can unmask an underlying cause).
  • Strenuous exercise - usually transient.

Key red flags

  • Visible blood without pain - always needs investigation.
  • Blood in the urine in a smoker or ex-smoker.
  • Blood in the urine in someone over 40.
  • Recurrent episodes, even if each settles.
  • Associated unexplained weight loss or new flank pain.

How it is investigated

A standard haematuria workup includes three parts - urine, imaging, and direct inspection of the bladder:

  1. Step 1

    Urine tests

    Urinalysis and urine culture to rule out infection; urine microscopy to characterise the blood; sometimes urine cytology to screen for cancer cells.

  2. Step 2

    Imaging

    Usually a CT urogram - a CT of the kidneys and urinary tract - to look for stones, tumours and structural abnormalities. Ultrasound may be used in younger or pregnant patients.

  3. Step 3

    Flexible cystoscopy

    A brief rooms procedure to inspect the bladder and urethra directly with a thin, flexible telescope. See the Flexible Cystoscopy page.

Depending on findings, further tests may be needed - for example, a biopsy of a bladder lesion, or renal imaging for a suspected kidney tumour.

What happens next?

Most patients are reassured by a normal workup. If something is found, Dr Kooner will explain the findings in plain language and discuss the treatment options. Many of the causes - stones, small bladder tumours, infections - are very treatable when identified early.

Frequently asked questions

My blood test was fine and the bleeding has stopped - do I still need investigation?

Yes. A single episode of visible haematuria that has settled still warrants a proper workup. Underlying tumours do not reliably announce themselves with ongoing symptoms.

I take a blood-thinner - isn't that the explanation?

Not necessarily. Blood-thinners often unmask an underlying cause of bleeding that would otherwise have stayed silent. The standard workup is still advised.

Is cystoscopy uncomfortable?

Flexible cystoscopy is usually quick and only mildly uncomfortable. Local anaesthetic gel is used for comfort. See Flexible Cystoscopy.

How soon can I be seen?

Visible blood in the urine is treated as a priority referral. Please contact the rooms with your GP referral and Dr Kooner's team will arrange an appointment promptly.

Related services

Speak with Dr Kooner's rooms

Arrange a consultation or request a second opinion on kidney cancer, stones, or reconstructive kidney surgery.