Hematuria

Hematuria is the medical term for blood in the urine. Urine is the liquid waste product your kidneys make after they filter your blood.

There are two types of hematuria.

Illustration of urine colors containing increasing amounts of blood ranging from pale yellow to red.

Gross hematuria. You can see blood in the urine by just looking at it. The blood may turn the urine red or brown, and there may be clots. Gross hematuria is sometimes called macroscopic hematuria.
Microscopic hematuria. You cannot see the blood in the urine, and it may look normal. The blood can be seen only with a microscope. It may be discovered during routine urine tests like a urinalysis. We sometimes call this type microhematuria. It is more common than gross hematuria.

This article will discuss gross hematuria. More information about microhematuria can be found in a separate article.

You may feel anxious if you find blood in your urine, and that’s understandable. Sometimes, it isn’t anything to worry about. But you should still see your doctor, as it can be a symptom of a medical problem.

What are the symptoms of gross hematuria?

The clearest sign of gross hematuria is a change in urine color.

The clearest sign of gross hematuria is a change in urine color. You’ll see pink, red, or brown urine in the toilet instead of pale yellow. There might also be blood clots.

Depending on what’s causing gross hematuria, you may have other symptoms. If the following symptoms happen, see a doctor right away:

Pain in your abdomen, groin, side, or back
Needing to urinate more often or more urgently
Nausea or vomiting
Fever or chills

What causes gross hematuria? What are the risk factors?

Before we discuss causes, we should note that changes in urine color may not be from blood. If you’ve eaten beets, blackberries, rhubarb, or foods containing red dye or henna, your urine might become red or brown. Urine color changes can also be a side effect of certain medications, like ibuprofen and iron pills. Call your doctor or pharmacist with any questions.

Happy athletic couple having fun and communicating while participating in a trail race.

A variety of factors can lead to blood in the urine. Here are some examples:

Intense exercise, like long-distance running
Menstruation (having a period) or vaginal bleeding
A recent medical exam, such as a cystoscopy (procedure to view the bladder) or a Pap smear
Endometriosis
Sexual activity
Medications, such as blood thinners, aspirin, or antibiotics
Urinary tract infection (UTI)
Kidney infection
Infections in the bladder, prostate, or urethra (the tube that urine flows out of when you urinate)
Trauma to the urinary tract
Kidney stones
Bladder stones
Kidney cysts and polycystic kidney disease
Bladder cancer
Kidney cancer
Prostate cancer
Enlarged prostate (benign prostatic hyperplasia)
Benign (not cancerous) tumors
Hemophilia (a blood clotting disorder)
Sickle cell disease
Glomerulonephritis (a type of kidney disease)

In some cases, the cause is unknown.

If I have gross hematuria, what might my doctor do?

Your doctor will start by asking questions about your medical history and any other symptoms you’re having, like pain or nausea. They’ll also ask you about any medications or supplements that you take. It’s important to be open and honest when answering these questions, as they can help pinpoint the next steps.

You’ll also have a physical exam. Men might have a digital rectal exam (DRE) to check their prostate, although doctors have gradually moved away from DREs in recent years, and this exam rarely reveals the cause of gross hematuria. Women may have a pelvic exam.

From there, your doctor might order some tests to check for specific urological conditions, like kidney stones, infections, or cancer.

Illustration of normal, yellow urine and urine turned red with blood

Urine tests

Urinalysis. Specialists analyze your urine sample in three ways. First, they do a visual check to see what color your urine is. Next, they look at the sample under a microscope to check for bacteria, white blood cells, or crystals related to kidney stones. Finally, they do a dipstick test to check for certain chemicals, proteins, or sugars in the urine.
Urine culture. With a urine culture, lab experts place your urine sample in a dish and look for the growth of fungi or bacteria over time.
Urine cytology. Specialists look at your urine under a microscope and check for cancer cells.

Blood tests

Blood tests can tell doctors how well your kidneys are working and whether there are any signs of infection or kidney disease.

Men might have a PSA test. PSA stands for prostate-specific antigen, and elevated levels of PSA in the blood can signal prostate issues.

Imaging tests

Doctors use imaging tests to get a better view of internal organs, including the bladder and kidneys. The images can help diagnose stones, tumors, blockages, and other issues that affect the urinary tract. Such tests may include:

Ultrasound. This test uses sound waves to create images.
CT or MR urography. This approach uses computed tomography (CT) or magnetic resonance (MR) to make images of the urinary tract.

Cystoscopy

During a cystoscopy, your doctor uses a special tool called a cystoscope to see the inside of your bladder and urethra. The cystoscope is a long tube with a camera on the end. After you have been sedated and given anesthesia, the cystoscope is passed into your urethra and into your bladder.

Biopsy

A biopsy involves taking a small piece of tissue from an organ. When a biopsy is done for gross hematuria, the focus is most often the bladder — your doctor may take a small tissue sample during a cystoscopy. The tissue is sent to a lab, where a specialist checks it for cancer cells.

How is gross hematuria treated?

Treatment for gross hematuria depends on the cause. For example, if the blood in your urine is a medication side effect, your doctor may suggest trying another drug. (Do not make any changes to your medication without a doctor’s guidance.) If you have kidney stones, you might have a procedure to remove them. If you have a urinary tract infection, you might be given antibiotics.

Resources

Cleveland Clinic

“Cystoscopy”
(Last updated: January 29, 2024)
https://my.clevelandclinic.org/health/diagnostics/16553-cystoscopy

“Urine Culture”
(Last updated: July 10, 2024)
https://my.clevelandclinic.org/health/diagnostics/22126-urine-culture

National Institute of Diabetes and Digestive and Kidney Diseases

“Hematuria (Blood in the Urine)”
(Last reviewed: October 2022)
https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine

National Kidney Foundation

“Hematuria (Blood in the Urine) in Adults”
(Last updated: February 21, 2025)
https://www.kidney.org/kidney-topics/hematuria-blood-urine-adults

Radiological Society of North America

“Hematuria or Blood in Urine”
(Last reviewed: September 24, 2024)
https://www.radiologyinfo.org/en/info/hematuria

“Urography”
(Last reviewed: March 11, 2024)
https://www.radiologyinfo.org/en/info/urography

Urology Care Foundation

“Hematuria – What You Should Know”
(2025)
https://www.urologyhealth.org/educational-resources/hematuria-what-you-should-know

Patient Education Center