Seeing pink, red or brown urine can be alarming. Blood in the urine, medically known as hematuria, has many possible causes, ranging from urinary tract infections and kidney stones to kidney disease and, less commonly, cancers of the urinary tract. Because the cause cannot be determined from the colour of the urine alone, visible blood in the urine should be medically assessed even if it happens only once or does not cause pain.
If you have noticed blood in your urine, see a doctor promptly. Seek urgent care if you cannot pass urine, have severe pain, or have a fever with chills or dizziness.
Hematuria (also spelled haematuria) is the medical term for blood in the urine, meaning red blood cells (RBCs) have entered the urine somewhere along the urinary tract. That tract includes the kidneys, ureters, bladder, and urethra, and, in men, the prostate can also be a source. Hematuria is a sign of an underlying issue, not a disease on its own.
There are two types:
Both visible and microscopic hematuria may require medical evaluation, depending on the circumstances and risk factors.
Visible blood can make urine look pink, red, or tea or cola coloured. In many cases there are no other symptoms, and passing blood is painless. Microscopic hematuria usually causes no symptoms at all.
Sometimes blood in the urine comes with other clues that point to a cause:
Red urine is not always blood. Foods such as beetroot, rhubarb, and blackberries can tint urine, as can some medicines. Very concentrated urine from dehydration can also look dark. A urine test can tell the difference, which is one more reason not to guess.
Many conditions can cause blood in the urine. Some are common and treatable, such as urinary tract infections or urinary stones, while others involve the kidneys, prostate or urinary tract and may require further investigation. The likely cause depends on factors such as your age, sex, symptoms, medical history and medications. Possible causes include:
Taking a blood thinner can make bleeding more likely, but it should not be assumed to be the cause. Doctors still recommend finding out why the bleeding happened.
In women, urinary tract infections are one common cause of blood in the urine and may occur with burning, frequency or lower abdominal discomfort. Kidney stones, kidney infection and, after menopause, changes in the tissues of the urinary tract are other possible causes. If you are menstruating, tell the clinic, because period blood can mix with a urine sample, and your doctor may repeat the test after your period.
In men, possible causes include urinary infection, kidney stones and an enlarged prostate, particularly in older men, sometimes with a weak stream or difficulty emptying the bladder. Prostate infection and, less commonly, cancers of the prostate, bladder or kidney may also be considered, particularly when relevant risk factors are present.
Blood in the urine does not have to be painful to require medical attention. Painless visible hematuria can occur with several urinary tract conditions and is also an important possible sign of bladder or kidney cancer, particularly in people with relevant risk factors. Most people with hematuria will not necessarily have cancer, but unexplained visible blood should still be assessed rather than ignored.
A few points worth knowing:
A urinalysis is often part of the initial assessment. Depending on the clinical situation, urine testing may include a dipstick test and microscopic examination:
What the results generally mean:
A positive dipstick that is not confirmed under the microscope, or a sample contaminated by menstrual blood, can look like hematuria without being one, which is why some tests are repeated.
A properly collected sample helps avoid misleading results. Follow the collection instructions provided by your clinic or laboratory. A typical midstream clean-catch method is:
Tell the clinic if you are menstruating, taking any medicines, or have exercised heavily in the last day or two.
If blood is confirmed, the next steps depend on your age, symptoms, and risk factors. They can include blood tests for kidney function, imaging such as an ultrasound or CT scan of the kidneys and urinary tract, and, if needed, a cystoscopy, where a doctor uses a thin camera to look inside the bladder. In a number of cases, no specific cause is found, and follow-up testing may be advised for people at higher risk.
There is no single treatment for blood in the urine, because it depends entirely on the cause. Once the cause is found, treatment is often straightforward:
Exercise-related blood usually settles with rest. Avoid taking antibiotics left over from a previous illness, since treating without knowing the cause can mask a problem that still needs attention.
See a doctor for any blood in your urine, even if it happened only once, has stopped, or does not hurt. Book an appointment soon if you have:
Seek urgent medical attention if you have:
For a life-threatening medical emergency in Singapore, call 995 or go to an Emergency Department.
Hematuria is the medical term for blood in the urine. It can be visible, with pink, red, or brown urine, or microscopic, found only on a urine test.
Possible causes include urinary tract infections, kidney or bladder stones, prostate conditions, kidney disease, strenuous exercise, injury and some medicines. Less commonly, blood in the urine can be associated with cancers of the urinary tract, which is one reason unexplained hematuria should be assessed.
Not always. Some causes are common and treatable, but blood in the urine can also be associated with kidney disease or cancers of the urinary tract. Because the cause cannot be determined from the appearance of the urine alone, unexplained hematuria should be medically assessed.
Painless blood can be caused by things such as stones, prostate problems, exercise, medicines, or, less commonly, bladder or kidney cancer. Because it may not cause any pain even when the cause is important, a doctor should check painless blood in urine.
It means red blood cells have been detected in the urine. The significance depends on the number of cells, how the sample was collected and your clinical circumstances. Your doctor may interpret the result alongside other urine findings and decide whether repeat testing or further assessment is needed.
White blood cells in urine can occur with infection or inflammation. If a urinary infection is suspected, a urine culture may be used to help identify the organism and guide treatment.
Dehydration can make urine darker or more concentrated, but visible blood should not simply be assumed to be caused by dehydration. If your urine looks pink, red or brown and you are unsure whether blood is present, speak to a doctor.
The blood may stop, but the cause can still be there. It is still worth getting checked.
Blood in the urine can have many causes, from urinary infections and stones to kidney or urinary tract conditions that need further investigation. Whether the blood is visible or found on a urine test, the next step depends on your symptoms, risk factors and test results. Some people need initial urine and blood tests, while others may need imaging, cystoscopy or specialist assessment.
If you notice blood in your urine, you can consult a doctor through MaNaDr for an initial assessment of your symptoms and medical history. The doctor can advise whether you need urine testing, an in-person examination, imaging or specialist care. Seek urgent medical attention instead if you have severe symptoms or heavy or uncontrolled bleeding.
