Hematuria is a medical term that refers to the presence of blood in the urine. Even if this symptom occurs only once and is not accompanied by pain, it should not be ignored, as it may be a sign of serious disease. Timely evaluation allows the cause to be identified at an early stage and effective treatment to begin.
Doctors divide hematuria into two main types:
• Gross hematuria — blood is visible to the naked eye. The urine may appear red, pink, or brownish. It is important to understand that as little as 1 ml of blood per liter of urine can change its color, so the intensity of discoloration does not always directly reflect the volume of blood loss.
• Microscopic hematuria — the urine appears normal, but laboratory testing (microscopic examination of sediment) reveals 3 or more red blood cells per high-power field. It is often an incidental finding during a routine medical check-up.
Hematuria is not a disease but a symptom. Its causes may range from harmless to serious and always require proper evaluation. The main causes include:
• Infections: inflammation of the bladder (cystitis) or kidneys
• Kidney stones: stones can damage the lining of the urinary tract
• Prostate conditions: in older men, hematuria is often associated with benign prostatic hyperplasia (BPH)
• Tumors: growths in the kidneys, ureters, or bladder
• Kidney diseases: damage to the kidney’s filtering units (glomerulonephritis)
• Trauma and physical strain: significant lower back injury or extreme physical exertion
Special attention is required if:
• You are over 35 years old — the risk of malignancy increases with age
• You are a smoker (smoking is a major risk factor for bladder cancer)
• There are visible blood clots in the urine — this often indicates active bleeding in the lower urinary tract
• Hematuria is accompanied by difficulty urinating or flank pain
Visible discoloration of urine does not always mean blood is present. Urine may turn red or brown after consuming certain foods (such as beets or berries) or medications (rifampicin, ibuprofen, etc.). Additionally, “tea-colored” or “cola-colored” urine may suggest glomerular bleeding (a kidney-level problem), whereas bright red blood more often indicates bleeding from the ureter or bladder. Only laboratory testing can confirm the presence of red blood cells.
To determine why blood appears in the urine in adults, physicians recommend a comprehensive evaluation:
• Urinalysis with microscopic examination — the gold standard to confirm the presence of blood, even if not visible
• CT urography (contrast-enhanced CT scan) — the preferred imaging method for detailed visualization of kidneys, ureters, and bladder to exclude stones and tumors
• Ultrasound — often used as an initial diagnostic step or when CT is contraindicated (e.g., pregnancy)
• Cystoscopy — direct visualization of the bladder using a thin camera. This is the only method that allows direct identification of the bleeding source in the bladder or urethra
What Should a Patient Do? Step-by-Step Plan
• Do not self-medicate. Taking herbal remedies or antibiotics without medical advice may mask symptoms and complicate diagnosis
• Schedule an appointment with a urologist. Inform your doctor about all associated symptoms, medications, recent infections, or physical exertion
• Exclude temporary factors. Women should mention if the test was performed during menstruation. If you exercised intensely before the test, inform your doctor
Complete the full evaluation. Even if blood disappears the next day, this does not mean the issue is resolved. Many serious conditions may present with intermittent hematuria. Timely diagnosis of hematuria significantly increases the chances of successful treatment. In most cases, the causes are benign (such as infections or stones), but the risk of serious underlying pathology requires careful attention.
You should urgently consult a doctor if:
• You notice blood in your urine even once
• Microscopic hematuria persists in repeated tests
• Blood in urine is accompanied by pain or fever