Passing blood in your urine usually results in your urine turning a red or brown colour. Although this can be alarming, it is often not due to a serious condition. However, it is important to see your doctor if you notice blood in your urine to determine the underlying cause for this. Blood in your urine can be due to a number of reasons, which will be discussed below. Alternatively, some people have very small traces of blood in their urine which cannot be seen but are found when a dipstick is put in a sample of their urine.
Understanding urine and the bladder
Your kidneys make urine continuously. A trickle of urine is constantly passing to your bladder down the tubes from the kidneys to the bladder (your ureters). You make different amounts of urine depending on how much you drink, eat and sweat.
Your bladder is made of muscle and stores the urine. It expands like a balloon as it fills with urine. The outlet for urine (your urethra) is normally kept closed. This is helped by the muscles below your bladder that surround and support your urethra (the pelvic floor muscles).
When a certain volume of urine is in your bladder, you become aware that your bladder is becoming full. When you go to the toilet to pass urine, your bladder muscle squeezes (contracts) and your urethra and pelvic floor muscles relax to allow the urine to flow out.
What is Haematuria?
Haematuria is the medical term for blood in your urine. This usually occurs when there is a problem with your bladder or kidneys. Some people have other symptoms when they have blood in their urine, whereas other people will feel completely well with no other symptoms.
What causes blood in the urine?
There are many different causes. The blood may be coming from your kidneys or from any area along your urinary tract – for example, from your bladder, ureters or urethra.
It can sometimes be difficult for women to know exactly where the blood is coming from. The blood from a menstrual cycle or from another cause from the vagina can lead to blood in the urine.
Urinary tract infection
A urine infection is the most common cause of blood in your urine, especially in women. A urine infection causes inflammation of your bladder (cystitis). The most common symptoms are pain passing urine and passing urine more often than normal. You may also have pain in your lower tummy and a high temperature (fever). Blood can occur in your urine as a result of this inflammation occurring in your bladder.
Urinary tract infections are usually very effectively treated with a short course of antibiotics. Further tests may be necessary if you have:
- Frequent episodes of infections
- Other underlying conditions – for example, kidney problems in the past
Kidney infections (also known as pyelonephritis) usually occur as a complication of a bladder infection. Symptoms of kidney infections are usually more severe than with a urinary tract infection. Often there is a very high temperature (fever) and pain in the side of your tummy (abdomen) or over the side of your back.
Kidney infections are treated with a longer course of antibiotics. If the infection is more severe then the antibiotics may need to be given straight into the vein in hospital.
This is inflammation of the tube draining urine out of your body (your urethra). Urethritis is often caused by a sexually transmitted infection which is easily treated with antibiotics.
Bleeding into your urinary tract can occur when a stone is being passed, as the stone rubs against the inside of your urethra. It is common to have pain from your back and across your tummy towards your groin when this occurs. Some people with kidney stones only have blood in their urine, which is picked up by a dipstick test.
Although many stones do not need any treatment as they will pass by themselves, some people need to have specific treatment to remove any kidney stones.
Tumours in the bladder or kidney
The most common early sign of bladder cancer or kidney cancer is blood in the urine, usually without any other symptoms. However, the vast majority of people who have blood in their urine do not have cancer.
The outlook for people with bladder and kidney cancer is better the earlier it is diagnosed. It is therefore very important that certain people have tests to look for bladder cancer if they have blood in their urine. For example, a person aged over 45 years with no infection causing blood in their urine would be referred for tests. These may include an ultrasound scan or a procedure where a small thin telescope is passed into your bladder (a cystoscopy).
Inflammation in the kidney
There are various conditions which can lead to inflammation in your kidneys. These can then result in blood in your urine, which is usually only found when a dipstick test of your urine is performed. This inflammation of the kidneys is called glomerulonephritis. Other symptoms such as tiredness and swelling around your eyes and legs can also sometimes occur.
The inflammation leads to glomerulonephritis which is usually due to a problem with your body’s immune system. This can sometimes be triggered by an infection. Glomerulonephritis is the most common cause of blood in the urine of children and young adults. However, it can occur in people of any age.
There are some conditions which can cause problems with the way your blood clots in your body. An example of this is haemophilia. This is an uncommon but important cause of blood in your urine. If you are taking a blood-thinning tablet (for example, warfarin), it is important that you have your blood checked promptly if you develop blood in your urine. This is because your dose of warfarin may be too high.
There are also other, more uncommon conditions that can lead to blood in your urine. These include sickle cell disease, injuries to your urinary tract and polycystic kidney disease
Note: some people notice their urine turns red but do not actually have blood in their urine. The urine can turn red in some people after eating beetroot and also after taking some medications, for example the antibiotic rifampin.
What investigations may be advised?
The investigations you may need usually depend on many different factors, such as if you have other symptoms, if you have any other illnesses or conditions and your age.
It is likely that you will need to provide a sample of urine which will be sent to the local laboratory to be tested for infection. You may have a blood tests and X-rays or scans.
A cystoscopy may be performed to assess your bladder. Having a cystoscopy entails a doctor or nurse looking into your bladder with a special thin telescope called a cystoscope. The cystoscope is passed into your bladder via your outlet for your urine (urethra). A cystoscopy which is done just to look into your bladder is usually carried out under local anaesthetic.
More details about the different tests can be found in the separate individual condition leaflets, mentioned above.
What treatment is necessary?
The treatment will obviously depend in the underlying cause for the blood in your urine. More information can be found in the separate individual leaflets on the various conditions that can cause blood in your urine.
If no cause can be found then you should still report any further bleeding to your GP who may want to you to undergo more tests. You should not ignore any blood in your urine even if you have had normal tests in the past.