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The presence of blood in the urine is medically called hematuria and is an important clinical finding associated with the urinary tract, kidneys, or systemic diseases. This condition may indicate a wide range of pathologies, from infections to stone disease.
Among the causes of blood in the urine, urinary tract infections, kidney stones, and trauma stand out. In these conditions, additional symptoms such as burning, frequent urination, or pain are usually present, and early diagnosis reduces the risk of complications.
The distinction between macroscopic and microscopic hematuria plays a determining role in the diagnostic process. While the presence of visible blood may indicate more serious pathologies, conditions detected only through laboratory examination may be an early sign of systemic diseases.
Laboratory tests, imaging methods, and, when necessary, cystoscopy are used in the evaluation of hematuria. Correctly identifying the underlying cause is critically important for creating an appropriate treatment plan and excluding possible malignant conditions.
Infection-Related Hematuria
One of the most common causes of blood in the urine is urinary tract infections (UTIs). These infections may affect different parts of the urinary tract, such as the bladder (cystitis), urethra (urethritis), ureter, or kidney (pyelonephritis). Inflammation and tissue damage that occur in the presence of infection may cause injury to the capillaries in the urinary tract. As a result, blood cells appear in the urine. Especially in women, cystitis is quite common due to the short urethral structure and often occurs together with hematuria.
Infection-related hematuria is usually accompanied by complaints such as a burning sensation, frequent urination, pain while urinating (dysuria), pressure in the lower abdomen, and cloudy or foul-smelling urine. This picture is more pronounced especially in conditions such as acute cystitis or pyelonephritis. In some patients, fever and flank pain may also accompany the condition. The presence of visible or microscopic blood in the urine together with these symptoms indicates the presence of infection.
In UTI-related hematuria, diagnosis is usually made through urinalysis and culture. In urinalysis, the presence of leukocytes (inflammatory cells), nitrite positivity, and erythrocytes (blood cells) is noteworthy. For definitive diagnosis, urine culture should be performed and the microorganism causing the infection should be identified. When the infection is brought under control with appropriate antibiotic treatment, hematuria usually disappears as well. However, if bleeding continues despite treatment, other causes must be ruled out.
The Relationship Between Kidney Stones and Hematuria
Kidney stones are one of the most common problems in the urinary tract and may often cause blood in the urine. Stones usually form in the kidneys, but over time they may move toward the urinary tract. During this movement, stones rub against the inner surface of the urinary tract and damage these sensitive tissues. When the thin blood vessels in the damaged areas open, blood begins to appear in the urine. Especially large or sharp-edged stones increase irritation and therefore bleeding.
Bleeding due to kidney stones is not visible in some cases; it is only detected in urinalysis. However, during the movement of the stone, the urine may turn pink, red, or tea-colored. This color change usually indicates that the stone is moving in the urinary tract and damaging the tissues. If the stone leaves the kidney and gets stuck in the ureter (the channel between the kidney and the bladder), both pain and bleeding become more pronounced due to the narrowing in this area.
In some patients, inflammation may also develop together with the stone. This condition may increase bleeding and may also cause additional complaints such as burning, fever, and foul odor in the urine. This situation may recur especially in people who have previously had kidney stones or received stone treatment. Therefore, when blood is noticed in the urine, the possibility of stones must definitely be investigated.
Can Tumors in the Bladder Cause Bleeding in the Urine?
One of the important causes of blood in the urine is bladder-related problems. Bladder tumors are among the leading causes of these problems. Bladder tumors are more common especially in individuals over the age of 50, smokers, and people who have been exposed to certain chemicals for a long time. Painless bleeding in the urine usually appears as the first symptom. This bleeding may sometimes be intermittent; the patient may see blood in the urine for a while and then think it has returned to normal. However, this is a temporary improvement and may be a sign of a serious underlying disease.
Bleeding caused by bladder tumors is usually macroscopic, meaning the patient notices a clear change in the color of the urine. Blood may color the urine in different shades from light pink to dark red. While some of these tumors grow slowly, others may progress aggressively and spread rapidly. Therefore, early diagnosis is of great importance. Bladder cancer detected at an early stage responds much better to treatment.
The most notable feature of tumor-related bleeding is that it is usually painless. This may cause patients not to take it seriously at first. However, if blood in the urine recurs or is accompanied by clots, bladder evaluation should be performed without delay. Methods such as ultrasound, urinalysis, and cystoscopy are used in this evaluation. Cystoscopy is a reliable procedure that allows the bladder to be viewed from the inside with a camera.
Even benign tumors in the bladder may cause bleeding and progress over time. Therefore, when blood is noticed in the urine, only stones or infection should not be considered; especially in older individuals, the possibility of a bladder tumor must definitely be evaluated.
Is Blood in the Urine a Symptom of Prostate Diseases?
The prostate gland is located in the lower part of the bladder in the male body and surrounds the urinary canal. As age advances, enlargement of the prostate is a common condition, and this enlargement may lead to some urinary problems over time. One of these problems is blood in the urine. Some types of prostate diseases may cause bleeding by putting pressure on the urinary tract or causing irritation on the inner surface.
Benign prostatic hyperplasia (BPH) is one of the most common prostate problems. Although this enlargement does not directly indicate cancer, it may cause the prostate vessels to dilate and these vessels to rupture. As a result, the patient may notice blood in the urine during or after urination. This blood is usually painless and may turn the color of the urine pinkish or dark red.
Prostate cancer may also be an important cause of blood in the urine. Although it does not always cause bleeding as a symptom, in some cases mild or heavy bleeding may occur when the tumor affects the urinary tract. Bleeding may sometimes be the first symptom, so it should not be neglected.
In addition, infectious conditions such as prostatitis may also cause bleeding in the urine. These types of bleeding are usually accompanied by complaints such as burning, groin pain, and frequent urination.
Trauma-Related Blood in the Urine
One of the important causes of blood in the urine is trauma. Trauma is the physical effect that occurs as a result of the body being exposed to an external blow, accident, or pressure. Especially blows to the waist and abdominal area may damage urinary tract organs such as the kidneys or bladder and cause bleeding. This bleeding may be noticed as a light pink or red color change in the urine. In some cases, bleeding with clots may also be observed.
Sports injuries, falls from height, motor vehicle accidents, or lifting heavy objects are among the common causes of trauma-related hematuria. Trauma sometimes affects internal organs rather than muscles or bones directly, and in this case, even if there is no external sign, blood excreted through urine may be a sign of internal damage. Since kidney tissue is especially rich in blood vessels, blood leaking from these vessels during trauma can easily mix with the urine.
Blood in the urine occurring after mild blows is usually short-term and may resolve spontaneously. However, if the amount of bleeding is high, pain accompanies it, or clots are seen in the urine, this may indicate more serious internal damage. In such cases, the kidneys and urinary tract are usually evaluated with methods such as ultrasound, computed tomography (CT), or urine analysis.
Some surgical procedures, insertion of a bladder catheter, and interventions such as cystoscopy may also cause temporary and trauma-related hematuria. Such bleeding is usually short-term and does not require intervention.
Medications and Blood Thinners That Cause Blood in the Urine
Some medications, especially those with blood-thinning properties, may cause blood in the urine. These medications are generally used in patients with cardiovascular diseases, clot-preventing treatments, or risk of stroke. The main purpose is to reduce blood clotting and prevent vascular blockages. However, because these medications make the blood more fluid, bleeding may occur easily even with small injuries in the body.
Some active ingredients with blood-thinning effects are used long-term with a doctor’s recommendation. These medications may cause even small injuries occurring in the delicate vessels of the urinary tract to turn into noticeable bleeding. For example, mild irritation that may occur in the kidneys, bladder, or urethra may lead to a visible change in urine color due to the effect of these medications.
In addition, some types of painkillers and anti-inflammatory medications may indirectly cause blood in the urine by affecting the kidneys when used long-term. This effect may occur by creating sensitivity in kidney tissue or weakening kidney functions. Chemotherapy drugs and some antibiotic groups may also have similar effects.
When individuals using these medications notice a color change, pinkness, or redness in the urine, medical evaluation is required even if there are no other symptoms. Because this condition may sometimes be a sign of serious internal bleeding.
Which Diseases Cause Blood in the Urine?
Some diseases may affect not only one organ but all body systems. Among such diseases, especially those related to the immune system and vascular structure may affect the kidneys and cause blood in the urine. In this case, the bleeding is usually not visible to the eye but is detected in urine tests.
Glomerulonephritis occurs when the small filters of the kidneys that perform the filtering function become inflamed. In this disease, blood cells may also be excreted with urine. In addition to blood in the urine, symptoms such as foamy urine and swelling on the face or ankles in the morning may accompany it. Glomerulonephritis may usually develop after throat infections in children, but it can also be seen in adults.
Diseases that affect the immune system, such as lupus, may also involve the kidneys and cause a similar picture. This condition is called “lupus nephritis.” Here, the body perceives its own tissues as foreign and attacks them. During this process, kidney tissue is damaged and blood cells mix with the urine.
Vascular structures may also be affected in some rare diseases. For example, in blood diseases such as sickle cell anemia or in small vessel inflammations, the vessels inside the kidney become sensitive. As a result of this sensitivity, blood may be seen in the urine. Patients may also experience different complaints such as weakness, skin rash, and fever together with this condition.
In such diseases, bleeding is usually intermittent and may increase over time. The presence of other systemic symptoms in addition to blood in the urine suggests that these types of causes may be present.
Is It Necessary to See a Doctor Immediately If There Is Blood in the Urine?
Seeing blood in the urine may not always indicate a serious problem. However, in some cases, this symptom may be a sign of an important underlying disease. Therefore, it is important to know which symptoms should be taken into consideration.
If the blood seen in the urine is clearly noticeable, meaning the urine color has turned pink, red, or brown, this condition should be taken seriously. The presence of clots along with blood may indicate a larger bleed. Such bleeding usually does not resolve on its own and definitely requires medical evaluation.
If there are other complaints together with blood in the urine, the condition becomes even more important. For example, symptoms such as a burning sensation, frequent urination, flank or groin pain, fever, chills, and nausea may be seen together with diseases such as urinary tract infection, stones, or kidney inflammation. In such cases, it is necessary to be examined without delay.
In addition, if blood is noticed in the urine during the use of blood-thinning medication, this may indicate that the medication dose needs to be readjusted. In individuals with a history of kidney disease, tumor history, or systemic disease, even the slightest color change in the urine should be carefully monitored.
Seeing blood in the urine should never be completely ignored. Especially if this condition occurs for the first time, recurs, or is accompanied by other symptoms, a doctor should be consulted. In this way, the problem is detected early and the treatment process is started if necessary.
Prof. Dr. Berkan Reşorlu, born in Ankara in 1979, completed his medical education at Ankara University between 1997 and 2003, and his specialization in urology at Ankara University Faculty of Medicine between 2003 and 2008. Academically, he received the title of associate professor in 2013 and professor in 2022.
He has conducted extensive case series studies in the field of endoscopic stone surgery, contributed surgeries performed on children under the age of 1 to the literature, and has gained international recognition with his stone scoring system and experimental surgical models.
