Visible and invisible blood
Visible (frank) hematuria turns urine pink, red or cola-coloured. Invisible (microscopic) hematuria shows only on a urine test done for another reason. Both need evaluation; visible blood carries the higher risk and should be seen promptly.
Possible causes
Ranging from the harmless to the serious, and they cannot be told apart by how the bleeding looks.
- Urinary infection
- Stones in the kidney, ureter or bladder
- Prostate enlargement
- Bladder tumour or kidney tumour
- Kidney disease affecting the filters, such as glomerulonephritis
- Trauma, or strenuous exercise
- Blood thinners — which may unmask an underlying cause rather than being the whole explanation
The evaluation
Urine routine and culture, urine cytology, a CT urogram to image the kidneys and ureters, and cystoscopy to inspect the bladder from inside. Cystoscopy is the only test that reliably sees a small bladder tumour, and it is a few minutes in the OPD with local jelly.
Being on aspirin or a blood thinner does not exempt you from evaluation. Anticoagulation makes bleeding visible; it is not usually the cause.
One episode of painless visible blood in an adult over forty deserves a full evaluation even if everything looks normal the next day.
Blood in Urine (Hematuria) Evaluation — common questions
Blood in urine but no pain — is that more worrying?
Painless bleeding is more likely to come from a tumour, while stones and infections usually hurt. That is why painless hematuria is taken seriously.
Can exercise cause blood in urine?
Yes, intense exercise can cause transient hematuria. It should be confirmed to have resolved rather than assumed.
Is cystoscopy painful?
It is uncomfortable for a minute or two. Flexible cystoscopy with local anaesthetic jelly is well tolerated as an OPD procedure.
What if all the tests are normal?
That is a good outcome and reasonably common. Periodic urine checks are usually advised, with repeat evaluation if the bleeding returns.
Reviewed by Dr. Kinjal Banerjee, MBBS, MS (General Surgery), DNB (Urology) — Urologist, Renal Transplant & Robotic Surgeon, Faridabad. This page explains blood in urine (hematuria) evaluation in general terms; your own treatment plan depends on your reports and examination.