Haematuria causes, symptoms and treatment

Haematuria refers to the presence of blood in the urine. It may be visible to the naked eye (known as macroscopic or visible haematuria) or detected only under a microscope or by urine testing (microscopic or non-visible haematuria). While it can sometimes be harmless, haematuria should always be investigated to rule out more serious causes.

Urine being tested for haematuria.

What are the symptoms of haematuria?

The main symptom of haematuria is blood in the urine, which may appear pink, red or brown. In some cases, there are no other symptoms and the condition is detected during a routine urine test. However, depending on the underlying cause, patients may also experience:

Pain or burning when passing urine
Increased urgency or frequency of urination
Lower abdominal or back pain
Fever (if an infection is present)

What causes haematuria?

There are many possible causes of haematuria, ranging from mild to serious. These include:

Urinary tract infections (UTIs) – common in women, these can cause inflammation and bleeding in the urinary system.
Kidney or bladder stones – stones can irritate the urinary tract and lead to visible bleeding.
Enlarged prostate – in men, benign enlargement of the prostate may lead to blood in the urine.
Kidney conditions – including glomerulonephritis (inflammation of the kidney's filtering system).
Bladder or kidney cancer – visible haematuria can sometimes be the first sign of a tumour.
Trauma – injury to the kidneys or bladder may cause bleeding.
Exercise-induced haematuria – vigorous physical activity can occasionally cause temporary blood in the urine.
Medications – such as blood thinners or certain antibiotics.
Inherited conditions – such as polycystic kidney disease or sickle cell disease.

How is haematuria diagnosed?

If blood in the urine is suspected, a GP or specialist will typically carry out:

Urine testing – to confirm the presence of red blood cells and check for infection.
Blood tests – to assess kidney function and rule out systemic conditions.
Imaging – ultrasound, CT or MRI scans may be used to identify stones, tumours or other abnormalities.
Cystoscopy – a procedure where a small camera is inserted into the bladder to inspect for signs of cancer, stones or inflammation.

Further investigation is particularly important if visible blood is present or if there are other concerning symptoms such as weight loss or persistent pain.

When should you seek medical help?

Any episode of visible blood in the urine should be assessed by a doctor, even if it only occurs once. You should also seek medical advice if:

You experience non-visible haematuria on more than one occasion
You are over 50 and notice urinary symptoms or changes
There is a family history of urinary tract cancers
There are other symptoms such as pain, weight loss or fatigue

While haematuria does not always indicate a serious condition, it can be an early warning sign of something that needs treatment. Prompt investigation ensures timely diagnosis and appropriate care, especially in higher-risk individuals.