Seeing blood in your urine, medically termed hematuria, is a startling event that prompts immediate concern. Hematuria occurs when red blood cells from the kidneys or other parts of the urinary tract—the ureters, bladder, or urethra—enter the urine stream. While the cause can sometimes be minor, such as a simple infection, it always requires medical evaluation to rule out serious underlying conditions. This guidance helps you assess the severity of your symptoms and determine the appropriate level of care.
Immediate Triage: When to Seek Emergency Care
Certain symptoms accompanying visible blood in the urine signal an immediate medical emergency requiring a trip to the Emergency Room (ER). The most urgent situation is acute urinary retention, the sudden inability to urinate, often accompanied by pain in the lower abdomen. This obstruction can cause urine backup and potentially lead to kidney damage if not relieved promptly.
The presence of large blood clots is another serious sign, especially if they obstruct the flow of urine. These clots can look like stringy material or darkened chunks and may block the urethra or bladder outlet, leading to retention. Severe, sudden pain in the flank or side, often radiating to the groin, combined with fever, chills, and vomiting, suggests a severe kidney stone obstruction or a serious kidney infection (pyelonephritis).
Any visible blood following significant physical trauma, such as a car accident or a substantial fall, should be treated as an emergency. Even if the amount of blood appears small, it could indicate an injury to the kidneys or other urinary tract organs. Furthermore, if hematuria is accompanied by signs of shock—such as confusion, dizziness, a rapid heart rate, or pale, cool skin—seek emergency care immediately.
Assessing Causes That Require Prompt Follow-up
If you observe blood in your urine but lack the severe symptoms that mandate an ER visit, you still require a prompt medical evaluation within 24 to 48 hours. This urgency applies to visible blood (gross hematuria) that appears without associated pain or discomfort. Painless hematuria can indicate more serious underlying conditions, including certain urinary tract cancers, which need timely screening and diagnosis.
Hematuria occurring alongside milder symptoms of a urinary tract infection (UTI), such as a persistent urge to urinate or burning during urination, warrants an urgent care or primary care appointment. Blood noticed only after strenuous physical activity or intense sexual intercourse is often transient and less likely to be an immediate emergency, but still requires follow-up to confirm a benign cause. Heavy exercise, for example, can sometimes cause temporary microscopic trauma.
If you are taking new prescription medications, particularly blood thinners like anticoagulants, and notice blood in your urine, contact your prescribing physician or visit an urgent care center promptly. Certain drugs increase the risk of bleeding, and a medical professional must assess whether the medication dosage needs adjustment or if there is a separate underlying cause.
Understanding Hematuria: Visible Blood Versus Microscopic
Hematuria is categorized into two types based on detection. Gross hematuria is visible to the naked eye, causing the urine to appear pink, red, or a dark cola color. It takes only a small amount of blood to change the color of urine, which is why this symptom is often alarming.
Microscopic hematuria occurs when the amount of blood is too small to be seen without a microscope. This is often discovered incidentally during routine urine testing. Both types of hematuria stem from the same range of causes and warrant investigation by a medical professional.
It is important to recognize that not all red-colored urine is actual blood, a phenomenon called pseudohematuria. Certain foods, such as beets or rhubarb, can naturally change the urine color. Some medications, including the laxative senna or the urinary pain reliever phenazopyridine, can also mimic blood. A simple urine test quickly distinguishes between true hematuria and these false positives.
What to Expect During Medical Evaluation and Diagnosis
The medical evaluation for hematuria begins with a detailed history and physical examination. The first step in diagnosis is typically a urinalysis, performed on a urine sample to confirm red blood cells and check for infection. If infection is suspected, a urine culture identifies the specific bacteria and determines the most effective antibiotic.
Further investigation often involves blood tests to check kidney function and assess for systemic conditions that could cause bleeding. Imaging studies are frequently used to visualize the urinary tract, including the kidneys and bladder. These may include an ultrasound or a computed tomography (CT) scan, which provides cross-sectional images to look for kidney stones, tumors, or structural issues.
For a direct view of the bladder and urethra, a procedure called cystoscopy may be performed. This involves inserting a thin tube with a camera into the urethra and bladder to inspect the internal lining for sources of bleeding. Treatment is tailored to the final diagnosis; for example, antibiotics are prescribed for bacterial infections, while small kidney stones may require only pain management and increased fluid intake.