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Bloody Urine

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Last updated June 19, 2022

Bloody urine quiz

Take a quiz to find out what's causing your bloody urine.

Learn 10 bloody urine causes and common questions.

9 most common causes

Interstitial Nephritis
Pyelonephritis
Urinary Tract Infection
Prostate Infections
Kidney Stone
BPH
Illustration of a doctor beside a bedridden patient.
Prostate neoplasm
Illustration of a health care worker swabbing an individual.
Rhabdomyolysis
Illustration of a health care worker swabbing an individual.
Urethritis

Bloody urine quiz

Take a quiz to find out what's causing your bloody urine.

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Bloody urine symptoms

The body eliminates excess water and waste through urine. Normal urine can take on a broad spectrum of hues. Urine is typically yellow in color. Depending on the amount of water in the urine, this yellow color can range from pale (diluted) to deep gold or amber (concentrated).

Even with this broad range of normal colors, bright red or bloody urine (also known as hematuria) is a sign of an underlying systemic problem. Hematuria in itself is the most common cause of red-colored urine.

Common characteristics of bloody urine

Macrohematuria is the term for visible blood in the urine. However, there are conditions of bloody urine where the blood can only be detected by microscopic examination (microhematuria). In most cases, macrohematuria is the triggering symptom that causes worry; however, microhematuria can also have symptoms similar to macrohematuria.

Common accompanying symptoms of bloody urine

Symptoms associated with both macrohematuria and microhematuria may include:

  • Abdominal pain
  • Fatigue
  • Back pain
  • Increased urinary urgency: This is an increased desire to urinate.
  • Increased urinary frequency: This is increased urination.
  • Dysuria: This is painful urination.

Usually the underlying problem is not life-threatening; however, you should always follow-up with your healthcare provider if you notice any of the symptoms above.

Bloody urine causes

To understand what may be causing your bright red urine, let's first discuss the process of the kidneys. The kidney first makes and filters the urine. The urine passes from the kidneys into the bladder through two tubes called the ureters. The urine then exits the bladder through another tube called the urethra. Changes in urine color can often signal a problem with the kidney and its components; however, there are many non-kidney associated causes of hematuria as well.

Inflammatory

Infection is the primary inflammatory cause of bright red or bloody urine. A variety of pathogens can infect any of the components of the urinary system (kidney, bladder, etc.) causing a urinary tract infection (UTI). Many types of outside bacteria and fungi can enter the body easily via the urinary tract, including sexually transmitted bacteria such as gonorrhea and chlamydia. These infections can inflame and injure the kidney to the point that function is impaired.

Obstructive

Obstructive causes of bright red or bloody urine include the following.

  • Kidney stones: The kidney is prone to developing stones of hardened material that can irritate not only the kidney but also the entire urinary tract, leading to bloody urine in addition to many associated symptoms such as dysuria and back pain.
  • Cancer: Although comparatively uncommon, cancers of the bladder, kidney or prostate can also cause bloody urine. This symptom is especially worrisome in older adult patients.

Medical Conditions

Other medical conditions can lead to bright red or bloody urine.

  • Blood disorders: Conditions that cause breakdown and destruction of blood cells can turn urine dark brown or bloody. Any blood disorder that involves the breakdown of hemoglobin — a major component of the blood — will be excreted by the kidneys, turning the urine dark brown or bloody.
  • Systemic disease: Diseases that affect other organs such as the liver can seriously affect the processes that filter and excrete urine. Such conditions can include cancer, hepatitis, and cirrhosis.

Environmental

Environmental causes of bright red or bloody urine include the following.

  • Trauma: Blunt or penetrating injury to the kidneys, whether via a fall or motor vehicle accident, can cause bruising and sometimes laceration of the kidney. This type of intense injury can result in bright red, bloody urine.
  • Drugs: There are many drugs including antibiotics, NSAIDs, and diuretics that can cause injury and irritation to the kidneys and result in bloody urine. Furthermore, overuse of drugs that thin the blood (anticoagulants) can also result in hematuria.
  • Exercise: Overly strenuous exercise can cause the serious breakdown and damage of muscle cells. The kidneys filter and excrete toxic products broken down by the muscles and released into the bloodstream. These breakdown products turn the urine dark brown or red and injure the kidneys.

This list does not constitute medical advice and may not accurately represent what you have.

Urinary tract infection

A urinary tract infection, or UTI, can involve any or all parts of the urinary system but most often affects the bladder and urethra.

Bacteria from the gastrointestinal tract – especially Escherichia coli (E. coli) – are the most common cause of UTIs. These bacteria spread from the anus to the urethra. Sexual activity can do this, but a UTI is not considered a sexually transmitted disease.

Women are more at risk for UTI than men. Due to female anatomy, the urethral opening is a short distance from the anus. Anyone who uses catheters to urinate is also prone to UTIs.

Common symptoms of less-serious UTIs include lower abdominal discomfort and pressure; burning or discomfort on urination; and cloudy or discolored urine.

Left untreated, the infection could spread to the kidneys and cause a medical emergency.

Diagnosis is made by having the patient describe the symptoms and by testing a urine sample for bacteria.

UTIs are caused by bacteria and so can be treated with antibiotics.

Prevention involves good hygiene and drinking plenty of water.

Bloody urine quiz

Take a quiz to find out what's causing your bloody urine.

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Urethritis

Urethritis is an infection of the urethra, which drains urine out of the body from the bladder. The urethra may be involved alone or with other structures in an overall urinary tract infection.

Urethritis is not a sexually transmitted disease (STD) in itself, but the same bacteria and viruses that cause STDs can also infect the urethra. Another common cause is the E.coli bacteria, found in feces.

Most susceptible are sexually active women, but anything that allows bacteria (especially E. coli) to travel into the urinary tract can cause an infection.

The most common symptoms are burning on urination and a cloudy discharge.

Diagnosis is made through urine test and a swab taken from the urethra. A urethritis patient should be tested for sexually transmitted diseases as well.

Treatment involves antibiotics, if the urethritis is caused by bacteria. Taking cranberry supplements can also be helpful, as long as the patient is not also taking the blood thinner called warfarin.

Rarity: Common

Top Symptoms: painful urination, penis pain, fluid leaking, pink/blood-tinged urine, cloudy urine

Urgency: Primary care doctor

Rhabdomyolysis

Rhabdomyolysis is a syndrome most commonly resulting from muscle injury following extreme exertion such as endurance exercise or weight lifting or following a severe accident. Sometimes rhabdomyolysis may result from medications - most commonly medications to treat elevated cholesterol such as statins. Severity can range from mild to life threatening kidney disease from muscle enzymes entering the circulation.

You should get immediate attention and may need laboratory tests and intravenous fluid treatment.

Rarity: Rare

Top Symptoms: fatigue, nausea, muscle aches, being severely ill, change in urine color

Urgency: Emergency medical service

Prostate neoplasm

The prostate gland sits under the bladder, near the rectum (end of the large intestine), and it makes the fluid that carries sperm. Prostate cancer is the most common cancer among men in the United States. It is different from other cancers because small areas of cancer within the prostate are actually very common, especially in older men.

You should visit your primary care physician who will be able to coordinate your care with a cancer specialist (oncologist). Prostate cancer is treated in a variety of ways, including chemotherapy, radiation therapy, hormone therapy, and surgery.

Rarity: Uncommon

Top Symptoms: frequent urination, waking up regularly to pee at night, painful urination, constant but weak urination stream, feeling of not getting everything out when urinating

Urgency: Primary care doctor

Kidney stone

A kidney stone, also called renal lithiasis or nephrolithiasis, is a solid deposit that forms inside the kidney. Stones may form if the urine becomes too concentrated for any reason, allowing the minerals in it to crystallize.

There are several possible causes:

  • Not drinking enough water.
  • Family or personal history of kidney stones.
  • Diets high in protein, salt, or sugar.
  • Obesity.
  • Digestive diseases and conditions, including gastric bypass surgery.
  • Urinary tract infection.
  • Metabolic conditions and/or hereditary disorders.

Symptoms include severe pain in the side, back, and abdomen; pain on urination; urine that is pink, red, brown, and/or foul-smelling; nausea and vomiting; and sometimes fever and chills.

Diagnosis is made through blood test, urine test, and imaging.

For smaller stones, the patient may only need to drink extra water and take over-the-counter pain relievers. Medication may be given to help pass the stone. Larger stones may require the patient to be hospitalized for surgical procedures.

Prevention involves drinking more water and restricting certain foods, including animal protein, calcium, and salt. Sometimes prescription medications will be used.

Kidney infection (pyelonephritis)

A kidney infection, or pyelonephritis, is actually a type of urinary tract infection (UTI) that begins in the urethra or bladder and spreads to the kidneys.

The infection is caused by bacteria that either travel into the urethra or spread from an infection elsewhere in the body.

Women, especially pregnant women, are most susceptible. Anyone who has had a urinary tract blockage, or uses a catheter, or has a weakened immune system is also at risk for a kidney infection.

Symptoms include fever; chills; back and abdominal pain; and frequent, painful urination. If there is also nausea and vomiting and discolored, foul-smelling urine, take the patient to the emergency room or call 9-1-1.

Left untreated, pyelonephritis can cause permanent damage to the kidneys. Bacteria can also enter the bloodstream and cause a life-threatening infection elsewhere in the body.

Diagnosis is made through urine test, blood test, and sometimes imaging such as ultrasound, CT scan, or x-ray.

Treatment includes antibiotics and sometimes hospitalization.

Rarity: Uncommon

Top Symptoms: abdominal pain (stomach ache), nausea, pelvis pain, back pain, vomiting

Symptoms that never occur with kidney infection (pyelonephritis): mid back pain from an injury

Urgency: Hospital emergency room

Interstitial nephritis

The tissue of the kidneys can become inflamed for many different reasons, ranging from medications to infection to our own immune system

You should go to your primary care physician(PCP) tomorrow for a sick visit.

Bladder cancer

Bladder cancer refers to a tumor that begins growing within the lining of the urinary bladder, rather than cancer that begins elsewhere and later spreads to the bladder.

Risk factors include smoking; exposure to industrial chemicals and fumes; ongoing bladder inflammation, as from chronic infections or catheter use; and not drinking enough water. Most patients are men over the age of 55, but bladder cancer can affect anyone.

Symptoms include urinary frequency; pain during urination; and blood in the urine, though there are many other causes for all of these. Later symptoms may include low back pain, inability to urinate, bone pain, and swollen feet.

Diagnosis is made through patient history; physical examination, including rectal examination for men and pelvic examination for women; urinalysis, to test for traces of blood and cancerous cells; imaging, such as ultrasound; and sometimes biopsy.

Treatment involves some combination of chemotherapy, radiation therapy, surgery, and supportive care, to ease symptoms and improve quality of life.

Benign prostatic hypertrophy (BPH)

The prostate is a gland in men that helps produce semen, the fluid that contains sperm. Over many years, the cells of this gland have a tendency to become enlarged (or hypertrophy). Fortunately, this enlargement is not itself dangerous. As the name “benign” implies, BPH is not prostate cancer and does not increase the risk of prostate cancer. In fact, usually affect males over 50 and is rarely harmful, usually more of an inconvenience than anything else.

The problems it does cause result from compression of the urethra, which passes through the prostate as it carries urine out of the body. An enlarged prostate can obstruct the flow of urine making it difficult to empty the bladder, which in turn leads to frequent urination and nighttime awakening to urinate.

BPH is a chronic, progressive disease, meaning that the symptoms are mild at first and slowly get worse over many years. Serious complications can occur when there is significant obstruction of the urinary tract, though this is relatively uncommon.

Rarity: Common

Top Symptoms: sudden urgency to urinate, waking up regularly to pee at night, frequent urination, constant but weak urination stream, feeling of not getting everything out when urinating

Urgency: Primary care doctor

Acute prostatitis

Acute prostatitis is a sudden-onset bacterial infection of the prostate gland in men.

Bacteria can spread to the prostate through a urinary tract infection, or through a sexually transmitted disease such as gonorrhea or chlamydia. Infection can also start after a medical procedure such as a urinary catheter insertion.

Most susceptible are younger or middle-aged men with a urinary tract infection or STD (sexually transmitted disease;) a pelvic injury from trauma or from bicycling or other sport; an enlarged prostate; or a recent prostate biopsy.

Symptoms include pain and difficulty when trying to urinate; pain on ejaculation; pelvic and abdominal pain; fever; chills; and nausea and vomiting.

These symptoms should be evaluated by a medical provider, because untreated prostatitis can lead to bacteremia of the blood ("blood poisoning,") prostatic abscess, and infertility.

Diagnosis is made through patient history, urinalysis, blood tests, and a physical examination which usually involves a digital rectal examination. Prostatitis does not cause prostate cancer.

Treatment is done with antibiotics, usually as an outpatient.

Rarity: Rare

Top Symptoms: penis pain, fever, urinary changes, painful urination, chills

Urgency: Hospital emergency room

Bloody urine quiz

Take a quiz to find out what's causing your bloody urine.

Take bloody urine quiz

Bloody urine treatments

At-home treatments

If you notice blood in the urine or have any of the associated symptoms, you should not try to treat your symptoms on your own. Follow-up with your healthcare provider first and get suggestions on how to alleviate your symptoms at home.

When to see a doctor

Your doctor will perform the following diagnostic tests in order to make the proper diagnosis. Treatment will be diagnosis-dependent and your doctor will discuss all of the appropriate options.

  • Urinalysis: Your doctor will take a urine sample in order to look for red blood cells, levels of protein, and excreted minerals and pigments in the urine that may indicate underlying kidney or urinary tract problems. Your doctor may also check for bacteria in your urine that may be causing infection.
  • Blood tests: Certain blood tests can measure the level of waste products that build up in your bloodstream when your kidneys are damaged and not filtering properly. Your doctor may also check for elevated levels of liver enzymes that indicate liver damage.

Depending on the findings, your doctor may prescribe or suggest the following treatment options:

  • Antibiotics: If your symptoms are due to bacterial infection, your healthcare provider will prescribe antibiotic pills.
  • Kidney stone removal: Most often, kidney stones pass without treatment. However, if your kidney stone persists, there are certain medications that can relax the ureter and make it easier for the stone to pass. If these treatment options do not work, surgery may be necessary.
  • Discontinue the offending drug: If a specific drug is causing your symptoms, your physician will discontinue the drug and discuss alternative options.

Prevention

While it is not entirely possible to prevent all causes of bright red or bloody urine, the following habits can help prevent the formation of kidney stones.

  • Drinking plenty of water: Drinking extra water dilutes the substances in the urine that lead to stones.
  • Reducing sodium intake: A high-sodium diet can trigger kidney stones because it increases the amount of calcium in your urine. Current guidelines suggest limiting total daily sodium intake to 2,300 mg. If you are experiencing kidney stones, try to reduce your daily intake to 1,500 mg.
  • Avoiding foods that can form stones: Beets, chocolate, spinach, rhubarb, tea, and most nuts are rich in oxalate, which can contribute to kidney stones. If you suffer from stones, your doctor may advise you to avoid these foods or to consume them in smaller amounts.

When it is an emergency

Go straight to the hospital if you experience the following symptoms:

  • Your painful urination persists
  • You have drainage or discharge from your penis or vagina
  • Your urine is foul-smelling or cloudy in addition to being bloody
  • You have a fever
  • You have back pain or pain in your side (flank pain)
  • You pass a kidney or bladder (urinary tract) stone

Bloody urine FAQ's

What is a urinary tract infection?

A urinary tract infection (UTI) is an infection in any part of the urinary system (kidneys, ureters, bladder or urethra). Most urinary tract infections involve the bladder or urethra (the components of the lower urinary tract).

Can both men and women get urinary tract infections?

Both women and men can develop UTIs; however, women are at a greater risk of developing UTIs than men given that their reproductive system is more open to infectious pathogens.

What is a kidney stone?

A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals (calcium, oxalate or uric acid) build up in the urine.

How do I know if I have microhematuria?

Since the blood is microscopic, you will not see bright red blood; however, you may experience symptoms including fatigue, back pain, increased urinary urgency (desire to urinate), increased urinary frequency (increased urination), and dysuria (painful urination).

How do I prevent kidney stones?

Kidney stones form due to the buildup of minerals in the urine. The main ways to prevent kidney stone formation include drinking plenty of water to dilute substances in the urine that lead to stones, reducing your sodium intake to no more than 2,300 mg per day or less as advised by your doctor, and, if need be, avoiding foods that are high in oxalate such as beets, chocolate, spinach, rhubarb, tea, and most nuts.

Questions your doctor may ask about bloody urine

  • Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
  • Do you feel pain when you urinate?
  • Any fever today or during the last week?
  • Are you sexually active?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

Share your story
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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References

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