Hematuria (Blood in the Urine)

By Dr. Jason Lomboy, Advanced Urology
Updated 9:26 AM ET, Mon Jan 20, 2020


Have you ever seen blood in your urine? If your urine has ever been pink, orange, red, or even brown, there is a high likelihood you have blood present in your urine. Your primary doctor may also tell you there is blood in your urine, even if you’re not able to see it.

It is not normal to have blood in the urine, also known as hematuria. There are many things that can cause hematuria, and the majority of them are benign. However, there is a small risk that the blood in your urine could be coming from something dangerous. It is imperative you make an appointment see a urologist at Advanced Urology as soon as possible. Keep in mind that even if the blood in your urine goes away, you should still seek care.

We know that it may be inconvenient or embarrassing to see a doctor about urinary problems. Our urologists and staff are trained to make your visit as comfortable as possible for you. All of our centers have ample free parking and house the most advanced diagnostic and therapeutic technology on the market for your problems. At Advanced Urology, your urologist will take the time to listen to your concerns and priorities to create a structured, individual plan of action.

Worry no further! Call today to set up your appointment with a specialist at Advanced Urology.

What is hematuria (blood in the urine)? What are the risk factors for hematuria?

Hematuria is the presence of red blood cells in the urine and affects up to 30% of the adult population in their lifetime. These red blood cells can originate from any part of the urinary tract, including the kidneys, bladder, prostate (if male), and urethra.

Hematuria can be detected both by your own eyes and with a microscope. When visible to the naked eye, it is called gross hematuria. When seen only under the microscope, it is called microscopic hematuria.

There are several risk factors that increase the likelihood of an adult developing hematuria from a concerning cause. Patients over the age of 50 years and patients who smoke or have a history of smoking carry the highest risk of developing hematuria.

What other symptoms can you have with hematuria (blood in the urine)?

When you have hematuria, it is common to not have any other symptoms. If you do have other symptoms, these symptoms can be various annoying urinary symptoms, including burning with urination, urge to urinate, frequent urination, getting up at night to urinate, straining to urinate, starting and stopping during urination, and feeling unable to empty your bladder.

If you are passing blood clots with your urine, it is even more important that you see a urologist soon, as the blood clots could block the outflow of your urine, which can be dangerous if untreated.

You may also experience nausea or vomiting, low back pain, or pain in your side or flank. If you or your family members have a history of kidney stones, having pain while seeing blood in the urine could be attributed to a kidney stone. Your urologist will order special testing to find a diagnosis.

If you have a fever, it is also very important to see a urologist as soon as possible, as hematuria could be from an active infection.

It is important to note that even if you are taking a blood thinning medication (such as Aspirin, Coumadin, Plavix, Xarelto, Eliquis, among others), it is still important for you to see a urologist to rule out any secondary causes.

What are the possible causes for hematuria (blood in the urine)? 

There are a variety of diagnoses that could cause hematuria.

  • Urinary Tract Infections (UTI) – A UTI occurs when a virus or bacteria infiltrates and multiplies along the urinary tract. If you have a UTI, you commonly may experience pain or burning when urinating, cloudy or smelly urine, and other annoying urinary symptoms, such as frequent urination and a strong urge to urinate. Hematuria is also a common symptom of UTI. A urinary tract infection is not typically caused by poor hygiene, despite what you may have heard before. There are a variety of risk factors for frequent UTIs, including genetics, medications, sexual activity, hormone imbalances, and anatomical abnormalities.
  • Pyelonephritis (kidney infection) – When bacteria start in your urinary tract and make it into your kidney tissue, a kidney infection may develop. You will typically have similar symptoms as a UTI, but often you will have fever, nausea or vomiting, and pain in your side or flank. It is not uncommon to see blood in the urine with pyelonephritis. It is very important for you to see a doctor immediately in this scenario.
  • Stones – Stones can form both in the kidney and in the bladder and have many causes and risk factors. Many people associate kidney stones with pain, but you can also have kidney stones without bothersome symptoms. Often in this scenario, blood in the urine is the first symptom, and thus why it is very important to see a urologist for a possible work-up.
  • Benign Prostatic Hyperplasia (BPH, also known as Enlarged Prostate) – The prostate gland of men enlarges throughout their lifetime beginning in middle age. Often an enlarged prostate will cause bothersome urinary symptoms, but it can also contribute to hematuria and blood in the urine could be the first sign of an enlarged prostate. Enlarged prostate is a very common problem, and if left untreated can result in complete inability to urinate and bladder deterioration.
  • Prostatitis – Inflammation of the prostate can cause prostatitis. This may be either due to an active bacterial infection or can be due to chronic inflammation (chronic prostatitis). Often, pelvic pain is associated with prostatitis, but you may also have testicular or groin pain. Men with prostatitis also can have similar symptoms as enlarged prostate. Hematuria is also commonly seen in patients with prostatitis.
  • Kidney diseases – Blood in the urine could be secondary to a variety of kidney diseases, such as glomerulonephritis or nephropathy. When this is the case, your urologist will likely recommend you to see a nephrologist, who specializes in the treatment of common medical kidney diseases.
  • Trauma – If you have had a recent fall, been hit in your back, side or abdomen, or been in an accident, you can suffer damage to your urinary tract that may present as blood in the urine. It is important to see a urologist to ensure this damage doesn’t progress.
  • Cancer – Hematuria can be the first symptom of bladder cancer, kidney cancer, or prostate cancer. Because most cancers of the urinary system do not cause pain or other symptoms, it is very important to rule out early cancer in patients with hematuria.
  • Inherited diseases – Inherited medical conditions such as sickle cell anemia, which affects the hemoglobin in red blood cells, and Alport syndrome, which is a disease affecting the filtering membranes in the kidneys, can lead to gross or microscopic hematuria.
  • Certain medications – Penicillin or the anti-cancer drug cyclophosphamide may lead to hematuria. In some cases, when you take an anticoagulant (e.g., aspirin, coumadin, heparin) and you also have a disease that causes bleeding in the urinary tract, gross hematuria may sometimes occur. However, even if you are taking a blood thinning medication (such as Aspirin, Coumadin, Plavix, Xarelto, Eliquis, among others), it is still important for you to see a urologist to rule out a potentially dangerous secondary cause.

As soon as you or your doctor notice or find blood in your urine, make an appointment with a specialist at Advanced Urology immediately. If you have already begun seeking care by searching online for a “urologist near me”, look no further and call Advanced Urology today.

What you should expect when seeking an evaluation for blood in the urine (hematuria)

Hematuria (blood in the urine) does not always mean that you have an underlying severe medical condition. Most of the time it is caused by a completely benign condition. However, to make sure that your hematuria is not an indication of a serious and potentially dangerous condition, it is important to seek care with a specialist at Advanced Urology.

Whether your urine is clearly bloody, a shade of red, or completely clear but a doctor has told you there is microscopic blood in the urine, it is important that you are evaluated. If you have hematuria and are having fevers, sick to your stomach, or passing clots in your urine, it can be urgent that you make a same or next day appointment with one of our urologists.

When you make an appointment for an evaluation by one of our specialist at a convenient location to you, you can expect warm, welcoming staff who frequently see patients for this issue. Your urologist will take time to understand your medical history and symptoms. Your doctor will examine you and then will likely recommend several tests and diagnostics, which are all completed within each of our state-of-the-art facilities.

The following tests and diagnostic methods are often used:

  • Urinalysis: This test can confirm the presence of blood in the urine as well as evaluate for other abnormal findings in the urine that could suggest active infection, kidney disease, or other medical problems.
  • Urine culture: This test can rule in or out a urinary tract infection as a cause for your hematuria. This test may take a day or two to result as any bacteria in your urine have to be grown in a culture to be identified. If there are bacteria, an additional test will determine what antibiotics will kill that pathogen.
  • Urine cytology: This test looks at your urine under the microscope for cancerous appearing cells. It is especially helpful at detecting early cancers when all of your other testing is normal.
  • Imaging: As part of your evaluation, you will likely undergo an imaging study, which are also performed inside of our facilities. Your imaging study may be a CT (or CAT scan) or a kidney/bladder ultrasound. Sometimes, an MRI is needed if abnormal findings on your CT or ultrasound are found.
  • Cystoscopy: This study is when a narrow camera is placed into the urethra and bladder. Though imaging is helpful at finding many causes in the upper urinary tract (kidney and ureter), it is less reliable at the lower urinary tract (bladder and urethra). Therefore this is often a necessary test to complete the evaluation for hematuria. In men, this test also allows us to evaluate the size of the prostate and any likelihood that the prostate could be causing bothersome urinary symptoms.

There are many cases in which the cause of hematuria is not found. The reassuring aspect of this scenario is that we are able to rule out any dangerous conditions. However, in this case, you may be required to undergo routine follow-up testing of the urine, especially if you are determined to be at a higher risk category. Sometimes, even though your hematuria evaluation was negative, if you are found to have persistent hematuria in the future, it may be necessary to repeat the test.



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