Blood in the urine, medically known as haematuria, is a common symptom that can have many different causes. Sometimes blood is visible to the naked eye (visible haematuria), while in other cases it can only be detected on urine testing (microscopic haematuria).
Although haematuria is often caused by non-serious conditions such as urinary infections, kidney stones or prostate problems, it can occasionally be an early warning sign of more significant conditions affecting the urinary tract. For this reason, unexplained blood in the urine should always be assessed.
Mr Gidon Ellis is a Consultant Urological Surgeon specialising in the diagnosis and treatment of urinary tract conditions. He provides comprehensive assessment of haematuria, including appropriate imaging and endoscopic investigations where required.
What is haematuria?
Haematuria means the presence of blood in the urine. It can occur anywhere along the urinary tract, including:
- The kidneys
- The ureters (the tubes connecting the kidneys to the bladder)
- The bladder
- The urethra
- The prostate
There are two main types:
Visible haematuria
This is when blood can be seen in the urine. Urine may appear:
- Pink
- Red
- Brown or tea-coloured
Even if it occurs only once and then disappears, visible blood in the urine should be investigated.
Microscopic haematuria
This is when blood is present but cannot be seen. It is detected through urine testing. Microscopic haematuria can be temporary and harmless, but persistent or unexplained findings may require further assessment.
What causes blood in the urine?
There are many possible causes of haematuria. Common causes include:
Urinary tract infection (UTI)
Infections can irritate the lining of the urinary tract and cause blood in the urine, often alongside:
- Burning when passing urine
- Increased frequency
- Urgency
- Lower abdominal discomfort
Kidney and ureteric stones
Stones can cause bleeding by irritating the lining of the urinary tract. This may occur with:
- Severe flank pain (renal colic)
- Pain radiating towards the groin
- Nausea or vomiting
Enlarged prostate
An enlarged prostate (benign prostatic hyperplasia, BPH) can sometimes cause bleeding due to increased blood vessels within prostate tissue.
Urinary tract cancers
Less commonly, haematuria can be an early sign of cancers affecting the urinary tract, including:
- Bladder cancer
- Kidney cancer
- Upper urinary tract urothelial cancers
This is why visible haematuria, particularly in adults, should not simply be attributed to a benign cause without appropriate assessment.
When should I seek medical advice?
You should arrange medical assessment if you notice blood in your urine, particularly if:
- The blood is visible
- There is no obvious explanation
- It occurs without pain
- It happens repeatedly
- You have risk factors for urinary tract cancer
Seek more urgent advice if blood in the urine is associated with:
- Fever or feeling unwell
- Severe pain
- Difficulty passing urine
- Blood clots causing difficulty emptying the bladder
How is haematuria investigated?
The aim of investigation is to identify the cause and ensure that important conditions are not missed. Assessment usually includes:
Urine testing
This can identify:
- Blood in the urine
- Infection
- Other abnormalities
A urine culture may be arranged if infection is suspected.
Blood tests
These may assess:
- Kidney function
- General health markers
Imaging
- Ultrasound of the kidneys and bladder
- CT urogram (a specialised CT scan to assess the urinary tract)
Flexible cystoscopy
A flexible cystoscopy allows direct inspection of the bladder using a small camera passed through the urethra. This is an important investigation for many patients with unexplained haematuria, particularly visible haematuria, as it can identify abnormalities within the bladder that imaging alone may not detect. The procedure is usually performed under local anaesthetic as an outpatient and takes only a few minutes.
Not everyone with haematuria requires every test above – the combination of investigations is tailored to your age, symptoms, risk factors and initial findings.
Frequently asked questions
What Should I Expect During My Appointment?
During your consultation, a detailed history will be taken, and you may be asked about any related symptoms or risk factors. A physical examination and relevant tests will follow to ascertain the cause of the haematuria.
How Quickly Can I Be Seen?
Appointments are arranged as quickly as possible, with urgent symptoms prioritised.
Will I See a Consultant?
Yes, you will be seen directly by Mr Gidon Ellis, a Consultant Urological Surgeon, at every appointment, ensuring you receive personalised care.
Where Will I Be Seen?
Consultations can be scheduled at Welbeck London, The Wellington Hospital, or Royal Free London, whichever location is most convenient for you.
How Should I Prepare for My Appointment?
Please try to bring any details or a photo of the affected urine if possible, along with a list of current medications, especially blood thinners.
