What does blood in the urine mean for a woman?

Written by: Mr Simon Brewster
Edited by: Cameron Gibson-Watt

While both men and women can experience blood in the urine, also known as haematuria, there are some causes that are specific to, or more likely to affect, women. Oxford urologist, Mr Simon Brewster, explains more.

What is haematuria?

Haematuria means the presence of blood cells in the urine. This can be visible to the eye when the urine looks pink or red, or it may be detected by a sensitive urine dip test even when the urine looks its normal yellowish colour; this is termed "non-visible" or "microscopic" haematuria.


What are the main causes in women?

The most common causes are not serious, especially with non-visible haematuria. In many cases, a cause is never identified and this is regarded as harmless. Frequently though, haematuria is associated with urinary tract infection, such as cystitis and settles after treating the infection. However, more than 20% of visible haematuria and 5% of non-visible haematuria (if persisting after any infection is treated) do have a serious cause and so investigations of the kidneys and bladder with imaging and direct endoscopic inspection (cystoscopy) are usually recommended.


Serious causes can include kidney and bladder cancer, stones and rare non-infective inflammatory conditions, such as interstitial cystitis and amyloidosis. If blood is detected in the urine together with protein, this may indicate an intrinsic medical disease of the kidney filtering system, such as can occur with diabetes or high blood pressure.


Is blood in the urine an emergency?

Haematuria is rarely an emergency, although it does warrant an urgent investigation if an infection has been excluded. Emergency admission is necessary in the rare circumstances where blood clots have formed in the bladder and are blocking the bladder outlet into the urethra, or when the bleeding is so heavy over a period of weeks that anaemia has resulted in symptoms such as breathlessness or a raised heart rate.


Will it disappear on its own?

Sometimes it does disappear, especially if it’s associated with a urinary tract infection. If not, it should be investigated even if it does settle, to rule out a serious underlying condition.


What sort of treatments are given?

If the urine shows features of urinary tract infection, antibiotics are usually successful and are prescribed by GPs in primary care. If anticoagulants are being prescribed for other medical conditions, these may be safely discontinued in many cases to allow the body's blood clotting mechanism to stop the bleeding. If during the subsequent investigation a stone or cancer is identified, often surgical biopsy/removal is the main treatment under the care of a urologist.


Stones are increasingly treated with external shock-wave lithotripsy in hospital but as an outpatient. If intrinsic kidney disease is suspected, long-term monitoring of kidney function and blood pressure is necessary, often under the care of a kidney physician, sometimes called a renal physician or a nephrologist. If no cause is found after investigation, no treatment is necessary.


If you have noticed blood in your urine and would like to see a specialist, visit Mr Simon Brewster’s profile and check his availability.

By Mr Simon Brewster

Mr Simon Brewster is a consultant urological surgeon with more than 33 years' experience of clinical practice in urology. With a private practice in Oxford running alongside his senior NHS consultant position, Mr Brewster offers state-of-the-art care for the diagnosis and management of prostate cancer, benign prostate enlargement symptoms, prostatitis, urinary tract infections (UTI), scrotal conditions and blood in the urine (haematuria).

After qualifying as a doctor from London's Charing Cross Hospital in 1986 with a first class degree in anatomy and honours in pathology, Mr Brewster undertook his training in surgery and a doctorate research thesis based in Bristol. In 1998 he was appointed as a consultant in Oxford and pioneered the prostate cancer and HoLEP services there. He has led the University Hospitals department with teaching, clinical management, clinical governance and as an elected staff governor for the NHS Foundation Trust. He is a Fellow and Tutor at Hertford College, Oxford. Nationally and internationally, Mr Brewster has influenced specialist training and auditing of surgical outcomes by organising two major conferences and has sat on committees of the British Association of Urological Surgeons (BAUS) and the Uro-oncology Board of the European Association of Urologists (EAU).

Mr Brewster performs MRI-targeted prostate biopsy, diagnostic bladder examinations (cystoscopy) and a wide range of surgery with a high level of patient satisfaction. For prostate and bladder symptoms he offers all medical options and recent surgical innovations including holmium laser enucleation (HoLEP), BIPOLAR TURP and Rezum steam ablation which have the advantages of reduced bleeding, side-effects and a very short hospital stay compared to traditional prostate surgery. He also has considerable experience with ultrasound-guided prostate brachytherapy, gel spacer implants prior to prostate radiotherapy and day-case injections to treat incontinence after prostatectomy. Mr Brewster is hoping to offer patients the new  Water-jet prostate AquaAblation treatment in the near future. 

Mr Brewster maintains an active interest in research and education; he has produced over 90 publications in books and peer-reviewed journals. He is a co-author of the very popular Oxford Handbook of Urology, now in its 4th edition. He undergoes annual appraisal and revalidates with the GMC every five years. With extensive experience in patient care and urological surgery when necessary, Mr Brewster offers a comprehensive evidence-based and personalised service to private patients within and beyond Oxfordshire.

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