What is Hematuria?

September 10,2020 |
Doctor touching patient shoulder.

Using the bathroom is a regular part of life—you relieve yourself multiple times a day, every day. While the vast majority of times that you use the bathroom, you will produce a normal output, there are certain instances that can cause alarm. One of these instances is when you see a different color of urine in the bowl. While we’ve all experienced the fluctuating color changes that occur with varying liquid intake, most of us haven’t looked down to see something alarming. However, it’s more common than you think. While sometimes the changing color of your urine isn’t cause for concern, other times it is. This is the case for hematuria. Hematuria is the scientific term for blood in your urine. Sometimes it’s harmless, but you need to see your doctor to be sure. In this article, we’ll answer the question: what is hematuria? We’ll also go into some detail about underlying causes, diagnostic testing, and treatment.


Understanding Hematuria

As we’ll see, there are many causes for hematuria, which makes it fairly common among people who have the risk factors. With that being said, there are two different types of hematuria—microscopic hematuria and gross hematuria. Microscopic hematuria occurs when you have blood in the urine that can only be seen through a microscope.2 Since you cannot see microscopic hematuria when you use the bathroom, this tends to be diagnosed after other symptoms present themselves. Gross hematuria is when you use the bathroom and your urine appears red or the color of tea or cola.2 Gross hematuria is seen without a microscope and is fairly obvious to whoever it occurs to. In either case, it’s important to see your doctor and get a proper diagnosis to better understand the underlying cause.


Symptoms of Hematuria

If you have microscopic hematuria, your symptoms will include a frequent and persistent urge to urinate that’s paired with a burning sensation during urination and very strong-smelling urine. Since you cannot see this type of hematuria, you might mistake the symptoms for other common urologic conditions. To make sure that you don’t experience any complications, it’s important to see a urologist to get a proper diagnosis.

Gross hematuria is a little different. Since you can visibly see the color change of your urine, your primary symptoms are going to be pink, red, or cola-colored urine.1 This is an indication that red blood cells are present and can vary in intensity. This type of hematuria typically occurs with no other signs or symptoms.1  

Regardless of if you’re experiencing symptoms of microscopic hematuria or gross hematuria, it’s important to see your doctor for a proper diagnosis.


Causes of Hematuria

Hematuria happens when your kidneys allow blood cells to leak into the urine.1 However, there are a number of different reasons that this can occur. The causes of hematuria include the following:

Urinary Tract Infection

We’ve all suffered through at least one urinary tract infection and understand how uncomfortable, if not painful, they can be. In some instances, urinary tract infections can include hematuria as a symptom. Many times, this is microscopic hematuria and your doctor will be able to confirm the cause. This is one of the reasons that symptoms of microscopic hematuria present themselves in similar ways to UTIs. Other symptoms of UTIs include a persistent urge to urinate, even after just using the bathroom, pain or burning while urinating, and strong- or foul-smelling urine. Talk to your doctor if you have any symptoms of a UTI as it could be an indication of microscopic hematuria.

Kidney Infection

When a kidney infection occurs, bacteria travels up from your ureters or in through your bloodstream. This can cause problems with how your kidneys filter, which can lead to hematuria. Aside from hematuria, kidney infections are often accompanied by a fever and flank pain.1

Kidney Injury

Similarly, if you have any sort of kidney injury, whether it be from an infection or trauma, hematuria may appear as a symptom. If you were in an accident or suffered from a fall that hit your kidney, it could cause hematuria to occur. Always see your doctor after an injury or trauma to make sure that there are no internal damages.

Bladder or Kidney Stones

Bladder and kidney stones cause people a lot of pain. They’re created when minerals in your urine form crystals. While this isn’t a cause for concern in itself, these crystals can build over time and turn into large, painful stones. Other people experience kidney stones without even realizing they have them. It depends on how big the crystals are. In either case, kidney stones, whether you notice them or not, can cause hematuria.

Enlarged Prostate

Enlarged prostate or benign prostatic hyperplasia (BPH) is when your prostate gland grows in a way that causes a disruption to your urinary system. The prostate is one of the only organs that never stops growing, which is why it’s common among older men. As the prostate gets larger, it can cause a strain on the entire urinary tract system and result in hematuria. Enlarged prostate can cause both gross and microscopic hematuria.

Kidney Disease

Kidney diseases occur when you gradually lose the function of your kidneys. It can occur for a number of different reasons and be either acute or chronic. In every instance, hematuria can occur. When a kidney loses its function, whether permanently or temporarily, it can no longer efficiently filter your blood.


As many types of cancers progress, they wreak havoc on your entire body. If kidney, bladder, or prostate cancer is advanced, it can lead to hematuria. Since this is usually a symptom of later stages, it’s important to regularly get screened to take a proactive approach.


Some medications can cause urinary bleeding as a side effect. In many instances, the popular anti-cancer drug cyclophosphamide causes hematuria.1 Penicillin and anticoagulants, like aspirin, can also cause bleeding in your bladder.1

Strenuous Exercise

In less serious instances, hematuria can be caused by extreme or strenuous exercise. While doctors are unsure as to why this happens, many believe it is due to a combination of dehydration or the breakdown of red blood cells that occur naturally during long-term aerobic exercises.1


Risk Factors of Hematuria

Hematuria can happen to anyone, regardless of age, but some people are more prone to it than others. Your risk of hematuria goes up if you:1

  • Are a male older than 50
  • Have had a recent kidney infection or inflammation
  • Have a medical history of kidney disease or kidney stones in the family
  • Take certain medications
  • Are a long-distance runner

How to Diagnose and Treat Hematuria

If you have gross hematuria, you’ll be able to see it when you urinate. However, your doctor will still need to diagnose you for the proper treatment plan. Most diagnostic visits start with a basic physical examination. Your doctor will then move on to a urine test or urinalysis to determine if your urine contains red blood cells. It’s also not uncommon to confirm a diagnosis with imaging tests or a cystoscopy. For more information on the details of testing for hematuria, click here.

Treatment plans depend on the underlying condition that’s causing you to experience hematuria. Since hematuria is more-so a symptom than a disease or serious condition in and of itself, you’ll move forward with a treatment plan that focuses on the cause. Some examples include antibiotics for a UTI, shock wave therapy for kidney stones, prescriptions or lifestyle changes for enlarged prostate, or taking a rest from strenuous activity. In some cases, your doctor will recommend no treatment, and simply have you monitor your hematuria. Regardless of what your treatment plan looks like, it’s important to follow up with your urologist to ensure that the hematuria is gone or that your underlying condition has been treated.


If you notice any signs or symptoms of hematuria, contact your urologist immediately. The best way to address a problem is to catch it before it gets too serious. If you have any symptoms of a urologic problem, call your doctor immediately. If you need any urological supplies or additional educational resources, visit our educational support page or our product selection guide. If you’re looking for personalized, confidential services, our teams of knowledgeable urological customer service specialists are here to help.


1 https://www.mayoclinic.org/diseases-conditions/blood-in-urine/symptoms-causes/syc-20353432

2 https://www.kidney.org/atoz/content/hematuria-adults