Intimate Wellness Institute

What is blood in urine (hematuria)?

Hematuria is the medical name for the presence of blood cells in urine (pee). Healthcare providers label blood in urine as gross (visible) or microscopic or dipstick.

Gross hematuria occurs when there’s enough blood present in your urine that it’s visible to the naked eye. It can turn toilet water a pale pink or bright red color.

Microscopic hematuria happens when your urine has blood in it, but the amount is too small for humans to see. In fact, you need a microscope to see it.

Dipstick hematuria results when oxidation of a urine test strip causes a color change. It doesn’t always mean that blood cells are present in your urine. Dipstick tests have relatively high false-positive rates.

How common is blood in urine?

Blood in urine is a common finding. It affects an estimated 2% to 30% of the U.S. adult population.


What are the causes of hematuria?

There can be a number of different causes of blood in your urine, some more serious than others. These conditions can involve infections or stones, including:

Urinary tract infection (UTI): This means that you have an infection in any part of your urinary system.

Pyelonephritis: This describes an infection that has reached as far as your kidney.

Cystitis: This condition refers to an inflamed bladder, which can have infectious and non-infectious causes.

Urinary stone disease: This term describes stones found in your urinary system, including kidney stones, bladder stones and ureteral stones.

Other conditions leading to blood in urine may include:

Injury to your urinary tract: You have blunt or penetrating trauma from accidents or assault.

Menstruation: You may see blood in your urine when you have your period.

Endometriosis: In this condition, fragments of the inner lining of the uterus grow in places other than inside the uterus.

Vaginal atrophy: thinning of the vaginal tissue after menopause leading to fragile tissue.

Kidney (renal) disease: With this chronic condition, damage to your kidneys means they don’t work as well.

Sickle cell disease: This inherited condition affects your red blood cells.

In addition to these other conditions, cells growing uncontrollably in certain body parts — what we know as cancer — can cause blood in your urine. These conditions include:

  • Bladder cancer.
  • Kidney cancer.
  • Ureteral cancer.
  • Urethral cancer.

What are the signs and symptoms of hematuria?

Many times, there are no symptoms except blood in your urine. When this happens, it is called “asymptomatic.” If you’re having symptoms, this may include frequent or painful urination or urination that is urgent or needs to happen “right away.” There can also be associated nausea, vomiting, fevers, chills or pain in your back or lower abdomen.

Although blood in your urine doesn’t always mean you have a disease, it can be an important warning sign to a possible health problem.

Don’t ever ignore bloody urine. Contact IWI as soon as you find blood in your urine, as earlier detection for any problem is helpful.


How is hematuria diagnosed?

During your appointment, the IWI team will take a medical history and perform a physical examination that might include a pelvic exam or a digital rectal exam. These things will us understand your symptoms better. We may order other tests. These tests may include:

  • Urinalysis: A test on a urine sample.
  • Urine culture: A urine test that checks for an infection.
  • Urine cytology: A urine test that checks for any abnormal-appearing cells.
  • Cystoscopy: A test that uses a device called a cystoscope to look at the inside of your bladder and urethra.
  • Ultrasound: A test that uses ultrasound waves to examine your kidney, ureters and bladder.
  • Computed tomography (CT) scan: A test that uses X-rays and computers to make cross-sectional images -of your abdomen and pelvis.
  • Magnetic resonance imaging (MRI) scan: A test that uses a large magnet, radio waves and a computer to produce images of your organs and structures.


How is blood in urine treated?

Treating blood in your urine depends strongly on the actual cause of the hematuria. We will use the information collected from your medical history, physical exam and test results to work with you to find the best treatment.

Medications to treat causes of blood in urine:

For hematuria caused by infections, the IWI team will prescribe appropriate antibiotics. These antibiotics work by killing the bacteria causing the infection, which should stop the bleeding.

For sickle cell disease, we may prescribe disease-modifying agents like hydroxyurea, pain medications, antibiotics and drugs that prevent blood cells from dying or forming into sickles.

For kidney disease the IWI team will connect you with a preferred kidney specialist.

For endometriosis, your provider may suggest hormone-related medications(link).

Untreated hematuria could lead to bigger problems, especially if the cause is more serious than vigorous exercise. The IWI team should treat any condition that causes blood in your urine. If the cause is something like cancer or kidney disease, early detection leads to early treatment. These things lead to better outcomes.


Who is at risk for blood in their urine?

People who are most likely to have blood in their urine are those with existing diseases known to cause hematuria, such as infections of the urinary system, urological anatomical abnormalities, family histories of urologic diseases and certain genetic conditions. For instance, you may be more at risk if you have a kidney disease or kidney stones or a family history of kidney disease.

You may also be more at risk if you take certain types of medications, such as blood thinners and some types of pain relievers. This shouldn’t delay the same workup if you do see blood in your urine.

However, certain actions may increase your chances of having blood in your urine. These include:

  • Smoking.
  • Overusing pain medications.
  • History of radiation exposure and certain chemicals.
  • Occupational risks (metals, fumes, dyes, rubbers).
  • Exposure to certain chemicals and/or radiation.
  • Running or jogging for long distances.
  • Vigorous sexual activity.

You may decrease your chances of having blood in your urine by avoiding some of these behaviors. It’s true that staying properly hydrated by drinking enough fluids — preferably, water — is good for your urinary tract and your body. If you’re dehydrated, your pee is darker in color. If you’re extremely dehydrated, you could possibly have bloody urine.


When should I contact IWI?

You shouldn’t ever ignore blood in your urine. It’s important to contact us if you see blood in your urine or if you have other symptoms related to hematuria.