Blood in Urine: What It Can Mean, Tests and When to Get Help

Noticing pink, red or brown pee can be alarming. Knowing what can cause it, how it is checked and when to get help makes the next step clearer.

Is Blood in Your Urine Serious?

Blood in urine (haematuria) is not usually anything serious, but it is important to get medical help [1]. If you think there is blood in your pee, it needs to be checked, even if there is only a small amount or you are not sure it is blood [1]. Though the colour change may be alarming, it only takes a small amount of blood in the urine to cause it [2].

Researchers estimate that at least 1 out of 5 people evaluated by a urologist is diagnosed with blood in their urine [2].

What It Can Look Like

Blood in your pee may be bright pink, red or dark brown [1][2]. Doctors describe two types:

• visible blood, when you can see the blood in your urine [2]
• microscopic blood, when you cannot see it but it can be seen under a microscope or is found with a urine test called a urinalysis [2]

Microscopic blood does not change the colour of urine and typically has no symptoms [2]. Visible blood is less common than microscopic blood [2].

In most cases, visible blood does not cause pain or other symptoms [2]. However, you may have bladder or back pain if there are blood clots in your urine [2]. Clots can be painful to pass when you pee, and they can also cause pain if they block the flow of urine [2].

Where the Blood Comes From

Urine is made in the kidneys and flows through tubes called the ureters to the bladder, then out of the body through the urethra [2]. Blood in your pee could come from anywhere in this urinary tract: the bladder, kidneys or urethra (the tube that carries pee out of the body) [1].

Common Causes

Other symptoms you have alongside the blood might give an idea of the cause, but do not self-diagnose [1]. Common possible causes include:

• a urinary tract infection (UTI), which may also bring burning pain when peeing, needing to pee often, smelly or cloudy pee, a high temperature and pain in your sides or lower back [1]
• kidney stones, which may also bring bad pain in the sides, lower back or groin that comes and goes, being unable to lie still and feeling sick (nausea) [1]
• an enlarged prostate, in men aged over 50 who find it difficult to pee, need to pee suddenly and often and wake up to pee in the middle of the night [1]

Can It Be Cancer?

In the UK, the NHS states: "Blood in your pee must be checked out because it can be a sign of cancer. Cancer may be easier to treat if it's found early." [1]

Blood in your pee is the main symptom of bladder cancer [3][4].

More serious reasons for blood in the urine include cancer of the bladder, kidney or prostate, blood-clotting disorders such as haemophilia, sickle cell disease and kidney disease involving the glomeruli, the tiny filters in the kidneys [2].

Other Possible Causes

Blood in the urine can also be linked to:

• infection in or inflammation of the bladder, kidney, urethra or prostate [2]
• trauma [2][5]
• a recent urinary tract procedure [2][5]
• strenuous exercise, such as long-distance running [2][5]
• a recent bacterial or viral infection, such as streptococcus or hepatitis [2]
• a form of kidney disease called glomerulonephritis [2]

Sickle Cell Trait

People with sickle cell trait sometimes have blood in their urine, and because this can be a sign of a serious medical condition, it needs a thorough medical evaluation [6].

When It Might Be Something Else

Red or dark pee is not always caused by blood from the urinary tract. It may not be blood in your pee if:

• you have recently eaten beetroot, which can turn pee pink [1]
• you are bleeding from your bottom instead [1]
• it is happening during your period [1]
• you are bleeding from your vagina between periods [1]

Even so, get it checked by a GP if you think it is blood in your pee [1].

What Happens at Your Appointment

A GP will ask about your symptoms and may need to check inside your bottom (rectal examination) or your vagina [1]. Health care professionals use your medical history, a physical exam and a urine test to diagnose blood in the urine and help find the cause [2].

The GP might also ask you for a pee sample, arrange a blood test and refer you to a specialist for tests [1]. In some cases the urine test is repeated to confirm the result [2]. Blood from a period can get into a urine sample and make the test show blood when there is none, so women who test positive during a period may be asked to repeat the test after it stops [2].

Tests You May Have

If a urine test shows too many red blood cells, one or more of these tests may follow [2]:

• a blood test, to look for problems with your kidneys and signs of other diseases [2]
• an ultrasound scan, which uses sound waves, without using x-rays, to make an image of organs such as the kidney [2]
• a computed tomography (CT) scan, which uses x-rays and computer technology to create images of the urinary tract [2]
• a magnetic resonance imaging (MRI) scan, which makes pictures of organs such as the bladder and kidney using magnets and radio waves [2]
• a cystoscopy, where a thin camera is passed through the urethra to look inside the bladder [2][7]
• a kidney biopsy, where one or more tiny pieces of tissue are taken from the kidney and checked under a microscope for signs of kidney damage or disease [2]

Treatment and What Comes Next

Treatment is aimed at the underlying cause of the bleeding [2]. You may not need treatment if there is no serious condition causing it [2].

Researchers have not found that eating, diet and nutrition play a role in causing or preventing blood in the urine [2].

When to Get Help

In the UK, the NHS gives this urgent advice:

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if:

• you have blood in your pee or think you may have blood in your pee

Blood in your pee may be bright pink, red or dark brown.

You can call 111 or get help from 111 online. [1]

Conclusion

Pink, red or brown pee is a reason to get checked rather than to guess at the cause. A GP can start with simple questions and tests, then arrange more if they are needed.

Medical Disclaimer

This article is for general information and does not replace advice from a qualified health professional. If you think you need urgent medical care, get emergency help straight away.