Spotting a change in urine colour can trigger immediate concern – and frankly, it should. But here’s where most people go wrong: they either panic and rush to conclusions or dismiss it entirely as “probably nothing.” Neither response serves anyone well. Hematuria symptoms deserve attention, not alarm or apathy. The presence of blood in urine sits at a crossroads of possibilities, from something as treatable as a urinary tract infection to conditions requiring more extensive evaluation. Understanding what to watch for, how doctors diagnose the underlying cause, and when to seek help makes all the difference between catching something early and wishing you had.

Key Hematuria Symptoms to Watch For

Visible Blood in Urine

The most obvious hematuria symptom is exactly what it sounds like – you can see blood in your urine. This gross hematuria (visible to the naked eye) might appear as bright red streaks, darker clots, or simply a noticeable reddish tinge. Mayo Clinic categorises hematuria into two types: gross (visible) and microscopic (not visible without laboratory testing). Both warrant investigation.

The thing is, visible blood doesn’t always mean something catastrophic. It takes surprisingly little blood to change urine colour. A tiny amount of bleeding from an inflamed bladder lining can turn an entire toilet bowl pink. That said, any visible blood needs professional evaluation. Period.

Pink or Cola-Coloured Urine

Not all urine discolouration means blood. Eating beetroot can turn urine pink. Certain medications do the same. But genuine pink or cola-coloured urine often signals hematuria requiring attention.

The cola colour specifically raises flags. Think about that murky, brownish-red appearance – it typically indicates blood that’s been in the urinary tract longer, possibly originating from the kidneys rather than the bladder. Urology Austin notes that causes range from benign dietary factors to serious medical conditions. This is where a urologist earns their keep. Without proper evaluation, guessing becomes dangerous.

So how do you know if it’s beetroot or blood? Simple. Stop eating red foods for a few days. If the colour persists, that’s your answer.

Microscopic Blood Detection

Here’s what frustrates many patients: you feel perfectly fine, go in for a routine check-up, and suddenly the doctor mentions blood in your urine. You hadn’t noticed anything unusual. That’s microscopic hematuria – blood cells only detectable under laboratory examination.

AUA Guidelines define microscopic hematuria as three or more red blood cells per high-power field in urine microscopy. Three cells. That’s all it takes to trigger further investigation.

Microscopic hematuria gets discovered during routine screenings, pre-operative assessments, or investigations for completely unrelated conditions. It’s a bit like finding an unexpected crack in your home’s foundation during a termite inspection – you weren’t looking for it, but now you need to address it.

Associated Pain and Discomfort

Blood in urine accompanied by pain tells a different story than painless hematuria. The location and nature of discomfort provide crucial diagnostic clues.

• Lower abdominal pain with burning during urination often points toward urinary tract infection symptoms

• Sharp, severe flank pain radiating to the groin suggests kidney stones signs

• Dull, persistent back pain near the kidneys warrants evaluation for kidney infections or other renal conditions

• Suprapubic pressure (discomfort above the pubic bone) commonly accompanies bladder issues

Artemis Hospitals emphasises seeking urgent care if severe abdominal pain, difficulty urinating, or blood clots accompany hematuria – these may indicate serious complications requiring immediate attention.

Urinary Frequency Changes

The pattern of urination matters just as much as the appearance. Changes in frequency often accompany hematuria and provide additional diagnostic information.

Needing to urinate more often than usual, especially with small amounts each time, points toward bladder irritation or infection. Waking multiple times at night to urinate (nocturia) combined with blood in urine deserves investigation. The opposite – decreased urine output – can signal kidney problems or obstruction.

These changes don’t always announce themselves dramatically. Sometimes the shift is subtle. You might not consciously notice you’re visiting the bathroom more frequently until you actually count the trips.

Fever and Systemic Symptoms

When hematuria arrives with fever, chills, nausea, or general malaise, the picture shifts significantly. These systemic symptoms suggest the body is fighting an infection or dealing with inflammation affecting more than just the urinary tract.

National Kidney Foundation indicates that hematuria presenting with fever and flank pain points toward possible infection or obstruction requiring prompt medical evaluation. This isn’t a “wait and see” situation.

The combination of blood in urine plus fever plus flank pain essentially forms a clinical triad that doctors take seriously. It often indicates pyelonephritis (kidney infection) or another condition requiring antibiotics or intervention.

Diagnostic Tests and Procedures for Hematuria

Initial Urine Analysis

The diagnostic journey begins with something deceptively simple: urinalysis. This isn’t just a quick dip-and-read test. Proper urinalysis involves three components:

1. Visual examination – checking colour, clarity, and any visible abnormalities

2. Dipstick testing – chemical strips that react to various substances including blood

3. Microscopic evaluation – laboratory examination identifying cells, crystals, bacteria, or casts

The microscopic component proves particularly valuable. It distinguishes between true hematuria and false positives from hemoglobin or myoglobin. It identifies dysmorphic red blood cells (misshapen cells that suggest glomerular origin) versus normal-shaped cells (typically from lower urinary tract sources).

One word of caution: factors like hydration status, recent exercise, and even menstrual contamination can affect results. Providing a proper midstream clean-catch sample matters more than most people realise.

Blood Tests and Kidney Function

Blood tests complement urinalysis by assessing kidney function and overall health status. Two key measurements stand out:

Test	What It Measures	Why It Matters
BUN (Blood Urea Nitrogen)	Waste products from protein breakdown	Elevated levels may indicate kidney dysfunction
eGFR (Estimated Glomerular Filtration Rate)	How well kidneys filter blood	Provides overall kidney function score
Serum Creatinine	Waste product from muscle metabolism	Rising levels suggest declining kidney function

These tests help determine whether hematuria relates to kidney disease or dysfunction. They also establish a baseline for monitoring if ongoing treatment becomes necessary.

Imaging Studies

When urinalysis confirms blood and initial evaluation raises questions, imaging becomes essential. The gold standard for hematuria evaluation is CT urography – a specialised computed tomography scan using contrast dye to visualise the entire urinary system.

CT urography excels at detecting:

• Kidney stones (even small ones that ultrasound might miss)

• Tumours in the kidneys, ureters, or bladder

• Structural abnormalities

• Obstructions blocking urine flow

Oman Medical Journal research indicates that most patients with visible hematuria require both flexible cystoscopy and radiological imaging for comprehensive evaluation. The two approaches complement each other – imaging shows the upper urinary tract while cystoscopy directly visualises the bladder.

Ultrasound serves as a radiation-free alternative, particularly useful for children, pregnant women, or initial screening. It’s excellent for detecting kidney stones and hydronephrosis (swelling of the kidney from urine backup) but less sensitive for small tumours.

Cystoscopy Examination

Cystoscopy sounds more intimidating than it typically is. A thin, flexible scope with a camera enters through the urethra to directly visualise the bladder lining. The entire procedure usually takes 5 to 10 minutes when no therapeutic intervention is needed.

Why bother looking directly when imaging exists? Because some bladder abnormalities – particularly flat, early-stage cancers called carcinoma in situ – can hide from CT scans. Direct visualisation catches what imaging sometimes misses.

Cystoscopy also allows simultaneous intervention. If a small tumour is spotted, biopsies can be taken immediately. Small stones in the bladder can be addressed during the same procedure. It’s diagnostic and potentially therapeutic in one session.

Most patients report mild discomfort rather than significant pain, especially with modern flexible cystoscopes and topical anaesthetic gel. The anticipation usually proves worse than the actual experience.

When Multiple Tests Are Needed

Single tests rarely tell the complete story. The diagnostic approach for hematuria typically involves layered investigations – each building on the previous to narrow possibilities.

Consider a typical pathway:

1. Urinalysis confirms microscopic blood – triggers further evaluation

2. Blood tests assess kidney function – reveals borderline GFR

3. CT urography shows a small stone in the left ureter – explains some symptoms

4. But the stone doesn’t fully account for the degree of bleeding – cystoscopy follows

5. Cystoscopy identifies an unrelated bladder polyp requiring biopsy

This layered approach ensures nothing gets missed. The frustration for patients lies in the time and multiple appointments required. But rushing to conclusions based on incomplete information risks missing diagnoses entirely.

Common Causes of Blood in Urine

1. Urinary Tract Infection Symptoms and Signs

UTIs rank among the most common causes of blood in urine, particularly in women. The infection irritates and inflames the bladder lining, causing bleeding that ranges from microscopic to visibly pink urine.

Classic urinary tract infection symptoms include:

• Burning sensation during urination (dysuria)

• Frequent urge to urinate with small amounts passed

• Cloudy or strong-smelling urine

• Pelvic pressure or lower abdominal discomfort

• Blood in urine (hematuria)

The good news? Uncomplicated UTIs respond well to antibiotics. The key lies in getting proper diagnosis and completing the full course of treatment. Half-finished antibiotic courses breed resistant bacteria – and nobody wants to deal with that.

2. Kidney Stones Signs and Complications

If UTIs represent the nuisance category of hematuria causes, kidney stones occupy the “unforgettable pain” category. Anyone who’s passed a kidney stone remembers exactly where they were when it happened.

Kidney stones signs typically include:

• Severe, cramping pain in the back or side (renal colic)

• Pain radiating to the groin or lower abdomen

• Blood in urine – sometimes visible, sometimes only microscopic

• Nausea and vomiting accompanying pain episodes

• Difficulty finding a comfortable position

The pain comes in waves as the ureter contracts trying to push the stone downward. It’s been compared to childbirth – though making that comparison directly to someone in labour seems inadvisable.

Small stones often pass spontaneously with adequate hydration and pain management. Larger stones may require intervention – shock wave lithotripsy (breaking stones with sound waves), ureteroscopy (removing stones via scope), or occasionally surgical approaches.

3. Bladder and Kidney Infections

While UTIs primarily affect the bladder, infections can ascend to the kidneys (pyelonephritis) or develop directly in kidney tissue. These represent more serious conditions requiring aggressive treatment.

Kidney infection symptoms go beyond typical UTI presentation:

• High fever with chills

• Flank pain (sides of the back below the ribs)

• Nausea and vomiting

• Generally feeling unwell

• Blood in urine

Kidney infections typically require longer antibiotic courses and sometimes hospitalisation for intravenous antibiotics. Delaying treatment risks abscess formation or sepsis – genuinely life-threatening complications.

4. Glomerulonephritis

Here’s where causes of blood in urine get more complex. Glomerulonephritis involves inflammation of the glomeruli – the tiny filtering units within kidneys. When these structures become inflamed, they leak blood cells into urine.

Glomerulonephritis can develop independently or secondary to other conditions like diabetes, lupus, or certain infections. The hematuria it produces often appears “smoky” or tea-coloured rather than bright red, indicating blood has traveled from the kidneys through the entire urinary tract.

Diagnosis typically requires blood tests, urine tests checking for protein as well as blood, and sometimes kidney biopsy. Treatment depends entirely on the underlying cause and ranges from simple monitoring to immunosuppressive medications.

5. Inherited Conditions

Several genetic conditions predispose individuals to recurrent hematuria. Polycystic kidney disease (PKD), Alport syndrome, and certain clotting disorders can all cause blood in urine as part of their clinical picture.

Family history becomes crucial here. If multiple family members have experienced kidney problems, bladder issues, or recurrent hematuria, inherited conditions move higher on the diagnostic checklist. Genetic testing may be recommended to confirm specific conditions.

Managing inherited causes often involves long-term monitoring and treating complications as they arise rather than curing the underlying condition. Regular follow-up appointments become part of life.

6. Medication-Related Causes

The single most frustrating part of this whole topic? Sometimes medication causing hematuria gets overlooked because nobody thinks to ask what supplements or prescriptions someone takes.

Common culprits include:

• Blood thinners (warfarin, aspirin, clopidogrel) – increase bleeding risk throughout the body including the urinary tract

• Penicillin and some cephalosporin antibiotics – can cause drug-induced nephritis

• NSAIDs (ibuprofen, naproxen) – particularly with prolonged use

• Cyclophosphamide – a chemotherapy drug known for causing hemorrhagic cystitis

Don’t stop prescribed medications because you notice blood in urine. Do tell your doctor about everything you’re taking – including over-the-counter medications and supplements that seem harmless.

Treatment Approaches and When to Seek Help

Emergency Warning Signs

Not all hematuria requires emergency room visits. But some presentations demand immediate attention.

Seek emergency care if blood in urine accompanies:

• Inability to urinate despite urge

• Passing large blood clots

• Severe, uncontrolled pain

• High fever with confusion

• Signs of shock (rapid pulse, dizziness, pale skin)

Urinary retention combined with bleeding can indicate a clot blocking the urinary tract – a urological emergency. Fever with confusion suggests possible sepsis from urinary source infection.

Paediatric Considerations

Children with hematuria require somewhat different evaluation than adults. The most common causes differ – post-streptococcal glomerulonephritis, for instance, primarily affects children following strep throat infections.

The evaluation pathway also considers radiation exposure more carefully. Ultrasound often serves as first-line imaging rather than CT scans. And the psychological aspect matters – procedures like cystoscopy require age-appropriate preparation and sometimes sedation.

Most paediatricians refer children with persistent or recurrent hematuria to paediatric nephrologists or urologists for specialised evaluation. This isn’t necessarily alarming – it simply ensures appropriate expertise guides the workup.

Treatment Based on Underlying Cause

Treating hematuria means treating whatever’s causing it. The blood itself isn’t the problem – it’s the symptom pointing toward the actual issue.

Cause	Typical Treatment Approach
Urinary tract infection	Antibiotics (typically 3-7 days)
Kidney stones	Pain management, hydration, possible intervention for larger stones
Enlarged prostate (BPH)	Medications, minimally invasive procedures, surgery
Glomerulonephritis	Depends on type – ranges from observation to immunosuppression
Bladder/kidney cancer	Surgery, chemotherapy, immunotherapy based on staging
Medication-related	Dose adjustment or alternative medication when possible

Sometimes no specific cause is identified despite thorough evaluation. This happens more often than doctors like to admit. In such cases, periodic monitoring ensures nothing develops over time.

Follow-up Care Requirements

Initial evaluation rarely represents the end of the road. Follow-up depends on what was found – or not found.

For resolved UTIs, simple confirmation of clear urine after treatment suffices. For kidney stones, dietary counselling and metabolic evaluation help prevent recurrence. For unexplained microscopic hematuria in low-risk patients, annual urinalysis monitoring typically continues for two to three years.

Patients diagnosed with bladder tumours face the most intensive surveillance – regular cystoscopy examinations, sometimes every three months initially, gradually spacing out if no recurrence appears. Bladder cancer has high recurrence rates, making vigilant monitoring essential.

Managing Hematuria Effectively

Living with hematuria – whether during investigation, treatment, or long-term monitoring – requires a practical mindset. Anxiety about “what if” scenarios helps nobody. Engagement with the diagnostic and treatment process does.

Keep records of when you notice blood, what colour it appears, whether pain accompanies it, and any potential triggers. This information proves invaluable at appointments. Drink adequate water to keep urine flowing and dilute any blood present. Follow up on scheduled appointments even when symptoms seem to resolve – conditions can smoulder quietly.

Most importantly, resist the urge to search endlessly online for explanations. Internet rabbit holes lead to worst-case scenarios that rarely apply. Professional evaluation provides actual answers tailored to individual circumstances. That’s what matters.

Frequently Asked Questions

Can hematuria resolve without treatment?

Sometimes. Transient hematuria from vigorous exercise, minor trauma, or even sexual activity can resolve spontaneously. But assuming it will disappear without evaluation risks missing treatable conditions. Even if blood clears, documenting its occurrence helps if it recurs.

Is blood in urine always serious?

No – but it always deserves investigation. Benign causes outnumber serious ones, particularly in younger patients. The concern lies in distinguishing benign from serious causes, which requires professional evaluation rather than assumptions.

How long does hematuria diagnosis take?

Initial urinalysis and blood tests provide results within days. Imaging appointments might take a week or two depending on availability. Cystoscopy can often be scheduled within weeks. Complete workup typically spans two to four weeks in most healthcare settings, though urgency can expedite this process.

What foods can cause red-coloured urine?

Beetroot stands as the most common culprit – a phenomenon called beeturia affecting roughly 10-14% of the population. Blackberries, rhubarb, and some artificial food dyes can also cause discolouration. The key difference: food-related colour change affects the entire urine uniformly and clears within 24-48 hours of stopping consumption.

Should children with hematuria see a specialist?

Persistent or recurrent hematuria in children warrants specialist referral – either paediatric nephrology or urology. One-time microscopic hematuria found incidentally may simply need repeat testing to confirm persistence before escalating to specialist evaluation.

Can dehydration cause blood in urine?

Severe dehydration concentrates urine and can make existing microscopic blood more apparent. It can also contribute to kidney stone formation, which then causes bleeding. However, dehydration alone rarely produces significant hematuria. If blood appears during dehydration, hydration should help – but if it persists, evaluation remains necessary.