Blood in the urine (also known as hematuria) can be non-visible (microscopic hematuria) and only noted on a urine test such as urine analysis or it can be visible (gross hematuria). It may be non-visible and also may not be associated with any symptoms and yet may be an indication of a life threatening urologic condition(s) such as bladder cancer, kidneys cancer, etc hence the importance of routine urine analysis by primary care or other health care provider(s). Blood in the urine is often a sign that something in the urinary system needs attention. Sometimes the cause is straightforward and benign and easily managed; other times, it can indicate a significant and life threatening urinary tract condition and it requires an immediate treatment. Either way, recognizing hematuria (blood in the urine) and understanding what the cause is comes next as the first step toward appropriate care.
In cases of invisible blood in the urine (microscopic), evaluation typically begins with a primary care provider, who can order initial urine testing and then should refer you to a urologist immediately.
Understanding Hematuria (Blood in the Urine)
Blood in the urine can appear in different ways. Some people notice a visible color change — such as pink, red, or tea-colored urine — while others have no outward signs at all and learn about it through routine urine testing such as urinalysis. Both situations are serious enough to see a urologist immediately for further evaluation.
There are two main types of hematuria:
Gross hematuria
This refers to blood that is visible to the naked eye. Urine may appear pink, red, or brown (tea color) due to the presence of blood in the urine. In some cases, small clots may be seen as well.
Microscopic hematuria
With microscopic hematuria, no visible blood or discoloration of urine, but blood is detected on a urine test such as a urinalysis. This is often identified during routine checkups or routine testing which should be done by primary care and/or other healthcare provider(s) and subsequent immediate urologic referral and evaluation are recommended and warranted.
Whether blood is visible or only detected on a urinalysis (urine test), whether it is associated with symptom(s) or no symptoms, seeing a urologist immediately for further evaluation is warranted to ensure no significant or life threatening urinary system condition(s) is overlooked.
Common Causes of Blood in the Urine
Hematuria can occur for a variety of reasons, ranging from temporary and benign to more complex and life threatening and malignant urinary system condition(s). Common causes include:
- Urinary tract infections (UTIs), which are common and often treatable with medication
- Kidney stone(s), which can irritate the urinary tract as they move
- Kidney infection or medical kidney disease(s)
- An enlarged prostate, particularly in aging men
- Prostate infection, particularly in younger men
- Certain medications, including blood thinners
- Strenuous or prolonged exercise
- Injury or trauma to the kidneys or urinary tract
- Urinary tract cancer(s) such as bladder, kidney, ureteral and/or prostate cancer(s) and early urologic evaluation by a urologist plays an important role, as they can often be more treatable and cured when identified early.
When to See a Urologist for Hematuria
Whether you see blood (gross hematuria) or if detected on a urine test (microscopic), you should see a urologist immediately for further evaluation by additional testing(s).
A urologist specializes in the urinary tract system and can help determine the underlying cause of hematuria through more detailed evaluation. A urologist may recommend diagnostic steps such as imaging studies including ultrasound and/or CT scan, additional urine testing(s), endoscopic evaluation such as cystoscopy and other testing(s) tailored to your individual situation.
Referral to a urologist is especially important when hematuria is associated with risk factors such as age, smoking history, certain occupations that expose a person to toxic fumes, dyes, paint, etc or history of prior urinary conditions. In particular, earlier detection of urologic cancers such as bladder, kidney, ureteral, prostate cancers can lead to less invasive treatment options and better outcomes and increased chance of cure.
What to Expect During a Urology Evaluation
During a urology visit, your provider will review your medical history, symptoms, and any prior test results. Additional testing may be recommended to better understand the source of the bleeding and rule out potential concerns. The goal is to provide clear answers and, when needed, create a treatment or monitoring plan that fits your needs.
Even if blood in the urine is visible or non-visible (on urine test), if it occurs only once and/or without discomfort or any symptoms, immediate evaluation by a urologist is warranted and when treatment is needed, timely care supports better long-term outcomes.
Blood in the Urine: Taking the Next Step
If you have noticed blood in your urine or have been informed that non-visible (microscopic) blood has been detected on your urine test, Dr. Nowzari is here to help. We focus on thoughtful evaluation, clear communication, and personalized care — so you can move forward with confidence and adequate understanding of the care plan. Contact us today to schedule an appointment and learn more about your next step(s).