- Urine infections affecting the bladder (cystitis) are the commonest cause.
- Cancers of the bladder or kidney can cause blood in the urine, especially if the bleeding is painless and you see clots.
- Stones in the kidneys or bladder can cause bleeding, often with pain in the side, groin, or when passing urine.
- Kidney diseases (such as nephritis) can lead to blood and protein leaking into the urine.
- Injuries to the kidneys, bladder or urinary tract (for example, after a fall, accident or procedure) may cause blood in the urine.
- Blood disorders or medicines that thin the blood (such as warfarin, rivaroxaban, apixaban, aspirin or clopidogrel) can make bleeding more likely.
- Tropical infections (for example tuberculosis or schistosomiasis) may cause blood in the urine, usually in people with specific risk factors or travel history.
- No cause is ever found In many people, especially with only a small amount of blood seen on a test strip.
- Red urine can be caused by foods (such as beetroot) and some medicines (such as rifampicin).
When you should seek medical advice
- Visible blood in the urine (even once) should be reported to a healthcare professional urgently.
- Non-visible blood in the urine on a dipstick test, even if you cannot see it yourself, usually needs proper investigation.
- If you have burning when you pass urine and your GP suspects infection, you may be given antibiotics while tests are done.
Initial checks your GP may do
- Ask detailed questions about your symptoms, other illnesses, medicines you take, smoking history and exposure to chemicals linked to bladder cancer.
- Examine you, which may include a general check‑up, blood pressure measurement, and an internal rectal or vaginal examination.
- Take blood tests to check kidney function, blood counts, and sometimes prostate‑specific antigen (PSA) in men.
- Send a urine sample to look for infection, blood and protein, and sometimes to look for abnormal or cancerous cells.
- Occasionally arrange an ultrasound scan (or CT scan) of the kidneys and bladder as an early imaging test.
Reasons for urgent referral to a Urologist
- You are over 45 and have visible blood in the urine with no sign of infection.
- The blood in your urine does not clear up after treatment for a suspected urine infection.
- You have blood in the urine on testing plus significant urinary symptoms (such as frequency, urgency or pain).
- You are over 60 with non‑visible blood in the urine with white blood cells or discomfort when passing urine.
- If you have any other type of blood in the urine you may also like to see a urologist for investigation and reassurance.
Tests that may be done by a Urologist
- A repeat history and examination, focusing on urinary symptoms and risk factors.
- Blood tests and urine tests, if these have not already been done by your GP.
- Imaging such as a CT scan or ultrasound scan to look at kidneys, ureters and bladder.
- A flexible cystoscopy, where a thin camera is passed through the urethra into the bladder under local anaesthetic gel to look directly for any problems.