Blood in urine (haematuria)

Blood in urine, known medically as haematuria, means red blood cells are present in your pee. Sometimes you can see it, turning your urine pink, red or brown. Other times there's only a tiny amount that shows up on a urine test.

What causes blood in urine?

Blood in your pee can come from anywhere in your urinary tract, which includes your kidneys, bladder and urethra. Everyday causes include:

• a urinary tract infection (UTI), including infection or inflammation of your bladder (cystitis) or kidney
• kidney or bladder stones
• vigorous exercise, such as long-distance running
• a recent injury or urinary tract procedure
• an enlarged prostate, which is common in men over 50
• sexual activity
• endometriosis.

Less often, blood in urine is linked to something more serious, such as:

• cancer of the bladder, kidney or prostate
• a blood-clotting disorder, such as haemophilia
• sickle cell disease
• a kidney condition affecting the tiny filters inside your kidneys (glomerular disease).

You're more likely to develop haematuria if you're older, take blood thinners or anti-inflammatory painkillers, smoke, or have a family history of kidney problems.

Are there different types of blood in urine?

• gross (or visible) haematuria: you can see blood in your pee, which may look pink, red or brown, and may come and go
• microscopic haematuria: you can't see it, but it shows up on a urine test or under a microscope.

Microscopic haematuria is more common than visible blood, and many people never notice it.

How is blood in urine diagnosed?

A GP will ask about your symptoms and medical history, and examine you. For men, this may include an examination of your bottom (rectal examination), and for women, an internal examination.

You'll usually be asked for a urine sample, which may be tested more than once, since a period can sometimes affect the result. Depending on what's found, further tests may include:

• a urine culture, to check for infection
• blood tests, to check how well your kidneys are working
• an ultrasound, CT or MRI scan, to look at your kidneys and bladder
• cystoscopy, where a doctor passes a thin tube with a camera through your urethra to look inside your bladder
• a kidney biopsy, in which a small sample of kidney tissue is taken for examination, if kidney filter damage is suspected.

How is blood in urine treated?

Treatment focuses on the underlying cause. If tests find no serious cause, you may not need any treatment at all. Common treatments include:

• antibiotics, for a urinary tract infection
• medication, or occasionally surgery, for an enlarged prostate
• removal of kidney or bladder stones, if they're causing pain, blockage or infection
• medicines to reduce inflammation and protect your kidneys, for some kidney conditions
• cancer treatment tailored to the type and stage, which may include surgery, radiotherapy, chemotherapy or other drug treatments.

If no cause is found but blood keeps appearing in your urine, you'll usually be offered yearly check-ups to monitor your kidney health.

When should I see a doctor?

Ask for an urgent GP appointment or call 111 if you have blood in your pee, even if:

• you don't have any other symptoms
• it's the first time it's happened
• there's only a small amount
• you're not sure it's blood
• it seems to have settled since you noticed it.

Call 999 or go to A&E if you're passing large blood clots, bleeding heavily, or unable to pass urine at all.