Hematuria: Blood in Urine, Why It Happens and What to Do

One morning you look into the toilet and notice a pink or reddish color to your urine, and you ask yourself, with worry, what is happening. Hematuria, meaning blood in urine, is a symptom, not a disease in itself. Behind it can hide anything from entirely benign causes, such as a urinary infection or intense physical effort, all the way to serious conditions that require fast evaluation. There is no need to panic, but you cannot ignore such a sign either. In this guide we explain clearly what hematuria is, the most common causes at different ages, what tests are needed, how you can support your kidneys at home and when to get urgent medical help.

Table of Contents

• What hematuria is
• Types of hematuria
• Common causes
• Associated signs
• Investigations and diagnosis
• Medical treatment
• Natural support and lifestyle
• Useful herbs and foods
• What to avoid
• Frequently asked questions
• When to seek urgent care

What hematuria is

Hematuria means red blood cells in the urine. The blood can come from anywhere along the urinary path: kidney, ureter, bladder, prostate or urethra.

There are two kinds:

• Macroscopic: urine is visibly red, pink, brown or contains clots
• Microscopic: blood is present but not visible to the naked eye, detected only in urine tests

A single episode of blood in urine is enough reason to see a doctor. We do not wait for a second one.

When red does not mean blood

Sometimes urine turns reddish without actual blood. Possible reasons:

• Eating beets, blackberries, rhubarb, blueberries
• Certain medications such as rifampin, phenazopyridine, nitrofurantoin, senna laxatives
• Myoglobinuria after very intense exercise
• Bilirubinuria in liver disease

A doctor confirms or rules out blood through urine analysis.

Types of hematuria

By its moment during urination:

• Initial: blood at the start of the stream, suggesting urethral or prostatic origin
• Terminal: blood at the end of the stream, often bladder origin, particularly the bladder neck
• Total: blood present throughout, suggesting bladder or upper urinary tract origin

There is also clot hematuria, indicating heavier bleeding and often bladder origin.

Common causes

Causes differ greatly by age, sex and context.

In younger adults and women

• Urinary infections and cystitis
• Kidney or bladder stones
• Endometriosis involving the urinary tract
• Intense physical effort, marathons, long-distance running causing exercise-induced hematuria
• Menstruation contaminating the sample

In adults over 50, especially men

• Enlarged prostate
• Bladder, kidney or prostate cancer
• Stones
• Urinary infections
• Recent surgery or catheterization

Renal causes

• Acute and chronic glomerulonephritis
• IgA nephropathy
• Polycystic kidney disease
• Thin basement membrane disease
• Papillary necrosis

Systemic causes

• Clotting disorders
• Anticoagulant therapy with warfarin or direct oral anticoagulants
• Hemolytic anemia
• Autoimmune disease, vasculitis

Mechanical and traumatic causes

• Blows to the lumbar or lower abdominal area
• Recent urinary catheter
• Surgical interventions

Associated signs

Symptoms around the hematuria can point toward a cause:

• Flank pain and colic, suggesting stones
• Painful urination and frequency, suggesting infection
• Weak stream and a feeling of incomplete emptying in men, suggesting prostate issues
• Weight loss and poor appetite, suggesting tumoral cause
• Swelling, high blood pressure, protein in urine, suggesting renal disease
• Fever and chills, suggesting kidney infection

Investigations and diagnosis

Hematuria evaluation includes:

• Complete clinical examination including rectal exam in men for the prostate
• Urine test: confirms blood, evaluates protein and sediment
• Urine culture: to rule out infection
• Blood tests: complete blood count, creatinine, urea, coagulation tests, PSA in men
• Ultrasound of kidneys, bladder and prostate
• CT scan with contrast: to evaluate kidneys and urinary tract
• Cystoscopy: direct inspection of the bladder, the gold standard to rule out bladder tumors in patients over 40 or at high risk
• Urine cytology: to look for malignant cells
• Renal biopsy: in selected cases, if a glomerular disease is suspected

Sometimes after all investigations no cause is found. In such cases the patient is monitored with periodic tests and imaging.

Medical treatment

Treatment follows the cause:

• Antibiotics for urinary infections
• Procedures for stones: lithotripsy, ureteroscopy, percutaneous nephrolithotomy
• Surgical treatment for tumors
• Anticoagulation monitoring and dose adjustments
• Specific treatment for glomerular disease, sometimes with corticosteroids or immunosuppressants
• Treatment of enlarged prostate with medication or surgery

During a significant hematuria episode, bed rest and generous hydration are sometimes advised, if the doctor agrees.

Natural support and lifestyle

Natural support never replaces investigations, but it can help healing and prevention, especially once the cause is clarified.

Hydration

Still water, 2 to 2.5 liters per day, unless restricted. Diluted urine reduces infection risk and helps flush the urinary tract.

Rest

Especially after episodes with visible bleeding, 2 to 3 days of rest is useful. Avoid intense exercise.

Gentle nutrition

• Cooked vegetables, clear soups, rice, plain pasta, plain yogurt
• Avoid very spicy foods, alcohol and strong coffee
• Reduce salt during the acute period

Cold or warm compresses

If lumbar pain is present, local warm compresses can help. Cold compresses are used for recent trauma.

Useful herbs and foods

After confirming there is no serious cause and with the doctor’s approval:

• Corn silk: gentle tea, soothing to the urinary tract
• Horsetail: in short courses, with mild local hemostatic and mineralizing effect
• Shepherd’s purse: traditionally used for mild bleeding, gentle hemostatic effect
• Nettle: tea with mild hemostatic effect, caution in advanced chronic kidney disease
• Calendula: gentle anti-inflammatory infusion
• St John’s wort: mind drug interactions
• Blueberries: fresh fruit for antioxidant support
• Cranberries: for associated urinary infection, if no interstitial cystitis or oxalate stones

Teas are used in short courses, no more than 2 to 3 weeks.

What to avoid

• Self-medication with non-steroidal anti-inflammatory drugs that can worsen bleeding
• Aspirin without medical indication
• Intense physical activity during the acute period
• Alcohol, which irritates mucous membranes
• Very concentrated beverages, strong coffee
• Delaying investigations even if symptoms have gone

Frequently asked questions

Is a single hematuria episode reason to worry?

Yes. Even if blood appears once and urine returns to normal, a full medical evaluation is needed. Many important conditions can start with a single episode.

Can stress or fatigue cause it?

Stress alone does not cause hematuria. Very intense physical effort can, especially in endurance runners, but even then evaluation is needed.

Does it always mean cancer?

No. Most cases have benign causes: infections, stones, enlarged prostate. Cancer is a possible cause, especially after 50, which is why complete investigation is mandatory.

What is microscopic hematuria?

Red blood cells in the urine, not visible to the naked eye, identified only in the lab. It can have the same causes as visible hematuria and needs evaluation.

Can menstruation be confused with hematuria?

Yes. That is why urine samples in women are ideally taken outside of menstruation or repeated later.

Can I drink hemostatic teas at home?

Shepherd’s purse or nettle tea can be used for short courses once the doctor has established the cause. They do not replace treatment.

What tests are mandatory for hematuria?

Urine test with sediment, urine culture, renal and bladder ultrasound. Others are added based on age and context.

Does hematuria go away on its own?

Sometimes yes, especially with infections or after exercise. But the symptom disappearing does not mean the disease is gone. Investigations remain necessary.

When to seek urgent care

Go to the emergency room right away if:

• You pass large blood clots
• You cannot urinate
• You have severe flank pain
• You have high fever and chills
• You feel weak, dizzy, with a racing heart
• You are on anticoagulants and notice blood in urine
• You recently had a blow to the lumbar or lower abdominal area

Hematuria is a signal your body sends. You receive it, investigate it, treat it. With calm and attention, most cases resolve well. And when the cause is serious, early discovery is the key to success.

After the diagnosis: prevention and follow-up

Once the cause of hematuria has been identified and treated, a structured follow-up helps ensure the problem does not return quietly.

• Repeat the urinalysis at 1, 3 and 6 months after the episode
• Schedule a yearly urology check-up for two to three years
• Keep a note of any medications, especially blood thinners or anti-inflammatories
• Drink consistently through the day rather than in large single volumes
• Maintain a healthy body weight, since obesity is a risk factor for several urinary conditions
• If you smoke, consider quitting: smoking doubles the risk of bladder cancer

Living with an inconclusive result

Sometimes every test comes back clean and the cause remains unknown. This can be frustrating. Your doctor may still recommend periodic monitoring, especially after age 40. A calm, regular check-up rhythm is much more reassuring than waiting anxiously for the next episode.

Support for families

If hematuria appears in a child, stay calm and bring them to a pediatric urologist. Most pediatric cases are benign: mild infections, small mucosal irritation or post-exercise bleeding. Once the cause is established, follow-up is usually simple.

For elderly relatives, help them describe symptoms clearly: when the blood appeared, how often, whether it is painful or painless, any associated weakness. A clear history accelerates the diagnosis and reduces the number of unnecessary tests.

Medical warning: this article does not replace a medical consultation. Hematuria is always a symptom requiring specialist evaluation, ideally by a urologist or nephrologist. Do not take medications and supplements without your doctor’s approval, especially if you are on anticoagulant therapy.