Clinically Reviewed By
Honorary Associate Professor Jeremy Ockrim MD BSc(Hons) FRCS(Urol)
Consultant Urological Surgeon · Reviewed June 2026 · Review due June 2027
Important Notice
Haematuria — whether visible or detected on testing — requires urgent urological assessment. Do not wait for symptoms to resolve.
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 is common in women and can occur at any age. In many cases, a haematuria assessment is unremarkable (essential haematuria) or 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.
Note for women: (Post-menopausal) vaginal bleeding can sometimes be confused with haematuria. It is important to distinguish between urinary and vaginal sources of bleeding. Your consultant will help clarify this during your assessment, and a urine dipstick test will confirm whether blood is truly present in the urine.
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.
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
- ›Consider non-urgent referral for bladder cancer in people aged 60 or over with recurrent or persistent unexplained urinary tract infection
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.
Urinary Tract Infection (UTI)
The most common cause of haematuria in women, owing to a shorter urethra and greater susceptibility to bacterial infection. 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, although stones may develop without other symptoms.
Urethral Conditions
Urethral caruncle, diverticulum, or urethritis can all cause bleeding in women and may be identified on clinical examination, imaging, or cystoscopy.
Atrophic Vaginitis
Post-menopausal oestrogen deficiency can cause vaginal and urethral tissue thinning, leading to bleeding that may be mistaken for haematuria.
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 (most commonly catheterisation).
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.
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.
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.
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.
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.
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 physical examination is performed — including checks of the abdomen and pelvis, along with a vaginal examination where appropriate. A urine sample will be sent for testing, and your consultant will discuss which investigations are most appropriate for you.
Flexible Cystoscopy (Rapid Access)
A rapid-access flexible cystoscopy appointment will be arranged within a very short timeframe.
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.
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, and follow-up cystoscopy at appropriate intervals if required. 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. For recurrent UTIs, further specialist management may be required.
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
Frequently Asked Questions
Noticed Blood in Your Urine?
Blood in the urine should always be assessed by a specialist, even if it occurs only once or disappears. Book a consultation for prompt investigation and expert advice.