Important Notice
Haematuria — whether visible or detected on testing — requires urgent urological assessment. Do not wait for symptoms to resolve.
Clinically reviewed by
Mr Bijan Khoubehi
Chairman & Consultant Urological Surgeon · Reviewed June 2026 · Review due June 2027
What is Haematuria?
Blood in the urine (haematuria) is a symptom, not a diagnosis. It requires investigation because it can be an early sign of bladder cancer, kidney cancer, or other serious urological conditions. Even a single episode of visible blood in the urine must be taken seriously.
Haematuria can occur at any age and in both men and women. In many cases, a thorough investigation reveals a benign or treatable cause — but the investigation itself is essential to rule out anything more serious.
Our dedicated rapid-access haematuria clinic is designed to provide a complete, efficient workup and give you answers as quickly as possible.
Types of Haematuria
Visible (Frank / Gross) Haematuria
Urine that appears visibly red, pink, or brown. This is always an indication for urgent urological investigation — even if it occurs only once and resolves spontaneously.
Non-Visible (Microscopic / Dipstick) Haematuria
Blood detected on urine dipstick testing or laboratory urinalysis that is not visible to the naked eye. Symptomatic non-visible haematuria (occurring alongside lower urinary tract symptoms) also warrants a full urological investigation. Persistent asymptomatic non-visible haematuria, particularly in patients aged 60 and over, also requires investigation.
Note: Red or discoloured urine is not always caused by blood. Certain foods (such as beetroot), some medications, and food dyes can cause similar discolouration. A urine dipstick or laboratory test will confirm whether blood is truly present.
NHS Urgent Referral Criteria (NICE NG12)
Your GP should refer you urgently (within 2 weeks) if you have:
- ›Aged 45 or over with unexplained visible haematuria
- ›Aged 60 or over with unexplained non-visible haematuria and either dysuria or a raised white cell count
Common Causes
There are many possible causes of blood in the urine, ranging from benign to serious. Identifying the exact cause requires investigation — haematuria alone cannot be attributed to a benign cause without first excluding the more significant ones.
Bladder Cancer
The most important diagnosis to exclude. Painless visible haematuria is the classic presentation.
Kidney Cancer
Renal cell carcinoma can present with haematuria and must be excluded with upper tract imaging. Upper tract urothelial carcinoma (cancer of the renal pelvis or ureter) is a distinct and important cause that is also assessed during investigation.
Prostate Cancer
Although less common as an initial presentation, prostate cancer can cause haematuria and should be considered, particularly in men with a raised PSA or abnormal prostate on examination.
Urinary Tract Infection (UTI)
A common cause, particularly in women. Often associated with burning, frequency, and urgency.
Kidney Stones
Stones can irritate and damage the lining of the urinary tract, causing bleeding, often with loin or flank pain.
Enlarged Prostate (BPH)
An enlarged prostate can cause bleeding from engorged blood vessels within the gland or bladder neck.
Urethral Stricture
Narrowing of the urethra can cause bleeding alongside difficulty passing urine or a reduced stream.
Kidney Disease (Glomerulonephritis)
Inflammation of the kidney's filtering units can cause microscopic or visible blood, often alongside protein in the urine.
Trauma
Injury to the kidney, bladder, or urethra following an accident or surgical procedure.
Vigorous Exercise
Strenuous physical activity (such as long-distance running) can occasionally cause transient haematuria. This is benign but requires confirmation.
Anticoagulant Medication
Warfarin, DOACs (apixaban, rivaroxaban etc.) — haematuria in anticoagulated patients still requires a full urological investigation to exclude an underlying structural cause.
Benign Idiopathic Non-Visible Haematuria
An incidental finding of red blood cells on urine testing (typically ≥3 RBCs per high-power field) with no identifiable cause after thorough investigation, and no symptoms. This diagnosis is only made after a full workup has excluded significant pathology. It is relatively common — affecting 0.5–5% of the general population — and becomes more frequent with age. Slightly more common in women, although urological malignancy remains more common in men.
Investigations
A standard haematuria workup follows an established protocol designed to assess the entire urinary tract. The full investigation is typically completed within 2–3 clinic visits.
Urine Dipstick & Mid-Stream Urine (MSU) Culture
Confirms the presence of blood and screens for infection. An MSU culture identifies any bacterial infection requiring treatment before further investigation.
Urine Cytology
Analysis of cells shed into the urine for abnormal or cancerous appearances. Used as an adjunct to cystoscopy in the assessment of urothelial malignancy. It is not routinely used as a primary investigation for haematuria due to its relatively low sensitivity.
Blood Tests
Renal function (eGFR, creatinine), full blood count (FBC), and clotting screen where clinically relevant. These help to assess overall kidney health and guide further management.
CT Urogram or Renal Tract Ultrasound
Cross-sectional imaging of the kidneys, ureters, and bladder. A CT urogram provides the highest diagnostic accuracy for upper urinary tract pathology including tumours and stones. Ultrasound is an alternative for patients where radiation exposure must be minimised — typically those with non-visible haematuria who are young and have no smoking history.
Flexible Cystoscopy
A flexible cystoscopy is a key investigation that allows direct visualisation of the bladder lining and urethra using a thin, flexible telescope. It is performed under local anaesthetic gel, is well tolerated, and takes only a few minutes. Most patients describe it as uncomfortable rather than painful. It is often carried out on the same day as your initial consultation or at a rapid-access appointment.
What to Expect at Your Appointment
Our haematuria clinic is streamlined to minimise the time between your concern and your answers.
First Consultation
A thorough clinical history is taken, including onset, associated symptoms, medications, and past medical history. A urine sample will be tested immediately. Your consultant will discuss which investigations are most appropriate for you.
Imaging Arranged
CT urogram or ultrasound is arranged promptly. In some cases this can be performed the same day or within days of your initial appointment.
Flexible Cystoscopy (Same-Day or Rapid Access)
In many cases, flexible cystoscopy can be performed at the same consultation. Alternatively, a rapid-access appointment will be arranged within a very short timeframe.
Results and Management
All results are reviewed and explained to you fully. If any abnormality is identified, your consultant will discuss the findings, answer your questions, and outline next steps. If no cause is found, a monitoring and follow-up plan is put in place.
Treatment
Treatment depends entirely on the cause identified during investigation. There is no single treatment for haematuria — the goal is to diagnose and then manage the underlying condition appropriately.
No Cause Found (Idiopathic)
Monitoring, surveillance urinalysis, blood tests (renal function), and follow-up cystoscopy where recommended at appropriate intervals. Reassurance where findings are genuinely negative.
Urinary Tract Infection
A targeted course of antibiotics guided by urine culture sensitivity results. Haematuria should be re-assessed after infection has cleared.
Kidney or Ureteric Stone
Managed via our dedicated stone clinic pathway. Options include observation, ureteroscopy with laser fragmentation, or ESWL depending on stone size and position.
Bladder or Kidney Cancer
Immediate referral to our cancer clinic pathway with the full multi-disciplinary team. Treatment may include TURBT, immunotherapy, surgery, or other modalities as appropriate.
Meet your Specialists
Assessment and treatment of blood in the urine is led by our experienced consultant urologists. Your care will be personally overseen by one of our senior specialists.
Key Takeaways
Blood in the urine is a symptom that deserves prompt, expert assessment — regardless of whether it is visible or microscopic, painful or painless, a single episode or recurrent.
In the majority of cases it is caused by a benign or treatable condition, but early investigation is essential to exclude cancer and other significant pathology.
Our rapid-access haematuria clinic provides a complete workup — cystoscopy, imaging, and laboratory analysis — efficiently and with full consultant oversight at every step.
Further Reading — BAUS Patient Information
Noticed Blood in Your Urine?
Blood in the urine should never be ignored. Our experienced consultants provide prompt assessment to identify the cause and recommend the most appropriate next steps.