Blood in the urine, medically termed hematuria, always warrants a medical checkup. This symptom manifests in two distinct ways. Gross hematuria occurs when the urine appears visibly pink, red, or dark brown. Microscopic hematuria involves red blood cells present in amounts so small they are only detectable during a laboratory urine test, often during routine screening. Regardless of visibility, hematuria signals an underlying issue somewhere in the urinary tract—from the kidneys down to the urethra—that requires professional diagnosis.
Immediate Emergency: When to Head to the ER
Certain symptoms accompanying blood in the urine indicate a condition that requires immediate emergency medical intervention. These situations suggest a potentially life-threatening event or an acute obstruction that must be resolved without delay. You should seek emergency care immediately if you are unable to pass any urine at all, a condition known as acute urinary retention.
Immediate action is also necessary if you are passing large, stringy blood clots, which can create blockages in the urinary tract. Severe, unrelenting pain, especially if it is sharp and localized in the side, back, or abdomen (flank pain), may signal an acute kidney stone that is causing an obstruction.
Hematuria accompanied by systemic signs of severe infection also mandates an emergency room visit. These symptoms include a high fever, shaking chills, persistent nausea, and vomiting, which can indicate that a urinary tract infection has spread to the kidneys or entered the bloodstream, leading to sepsis. Any blood in the urine following a recent significant blow or trauma to the back or abdomen should be evaluated immediately due to the risk of internal injury. Furthermore, signs of severe blood loss or shock, such as extreme dizziness, fainting, or a rapid heart rate, require immediate emergency treatment.
Urgent Care: When to Contact Your Doctor Soon
In many cases, blood in the urine requires urgent evaluation but does not necessitate a trip to the emergency room. If you notice visible blood in your urine without any severe pain, fever, or difficulty passing urine, you should schedule an appointment with your primary care physician or visit an urgent care center within 24 to 48 hours.
This category includes microscopic hematuria discovered incidentally during routine physical examinations. It also applies to visible hematuria that is isolated (occurs once and clears up) or recurring without other concerning symptoms. However, visible blood should never be ignored, as it can signal a serious condition, particularly in older adults.
If you suspect a mild urinary tract infection (UTI), characterized by symptoms like a burning sensation during urination, increased urgency, or frequent urination, but you do not have a fever or significant back pain, a prompt appointment is appropriate. These symptoms often point to a bladder infection that can typically be treated with oral antibiotics. If the condition worsens and any of the symptoms requiring an ER visit develop, seek emergency care immediately.
Common Reasons for Blood in Urine
The presence of blood indicates bleeding somewhere within the urinary system. One frequent cause is infection, such as a urinary tract infection (UTI) in the bladder, or a kidney infection. These infections cause inflammation and irritation of the urinary tract lining, leading to red blood cells leaking into the urine.
Another common cause involves solid masses, most notably kidney stones or bladder stones. These stones are crystallized minerals that can scrape the lining of the urinary tract as they move or grow, resulting in visible or microscopic bleeding.
Other potential reasons for hematuria include strenuous exercise, such as long-distance running, which can cause temporary bladder irritation. Certain medications, such as blood thinners or some pain relievers, can also increase the risk of bleeding. Less common but more serious causes include inherited disorders like polycystic kidney disease, or malignancies such as bladder or kidney cancer.
Expected Medical Evaluation
The diagnostic process begins with a thorough physical examination and a review of your medical history. The initial test is a urinalysis, which confirms the presence of blood and checks for signs of infection, such as white blood cells or bacteria. If infection is suspected, a urine culture may be performed to identify the specific type of bacteria present.
Blood tests are often ordered to assess overall kidney function and look for signs of systemic issues. If initial tests do not clearly identify the source of the bleeding, imaging studies may be recommended to visualize the internal structures of the urinary tract. These commonly include an ultrasound of the kidneys and bladder or a computed tomography (CT) scan.
For patients at higher risk, such as those over age 35 or with specific risk factors, a specialist evaluation may be necessary. This often involves a referral to a urologist, who may perform a cystoscopy. This procedure uses a narrow tube with a camera inserted into the urethra to directly examine the lining of the bladder and urethra for sources of bleeding or abnormal growths.