Your guide to Hematuria or Blood in Urine

Elizebeth O’Neill
Elizebeth O’Neill
January 23, 2023
min read
Technically reviewed by: 
H. Ali, Ph.D.
Your guide to Hematuria or Blood in Urine

What is hematuria or blood in the urine?

Blood in the urine (medically termed hematuria) refers to the abnormal presence of blood in the urine. Hematuria is of two types, gross (visible with the naked eye) and microscopic (visible only under the microscope).

Visibly red urine
Visibly pink, red, or brown urine could be due to gross hematuria (i.e., visible blood in the urine), severe dehydration, or due to the intake of pigment-rich foods.

What is gross hematuria?

If your urine color is visibly pink, red, or dark brown, it is a sign of 'gross' or 'visible' hematuria.

What is microhematuria?

In some instances, the urine color remains normal, but a microscopic examination shows red blood cells in the sample. This is called microscopic or microhematuria. At times microscopic hematuria appears in the form of red blood cell casts in urine due to some kidney disease.

What are the symptoms of hematuria?

The physical symptoms of gross or visible blood in the urine are a change in the urine color to pink, red, or brown. Microscopic or microhematuria does not cause a visible change in urine color. Blood clots in the urine, however, cause bladder or back pain. There are no other signs or symptoms directly attributed to hematuria. Symptoms generally associated with diseases like urinary tract infections, kidney stones, or enlarged prostate could provide some clue about the cause of urinary blood.

What are the causes of blood in urine?

Some major causes of blood in the urine include:

  • High-intensity sports activity that results in exercise-induced hematuria.
  • Infection/inflammation of the kidneys or any other part of the urinary tract, including the bladder, kidneys, or urethra.
  • Stones in the kidney or bladder when they cause a blockage or when passed out.
  • Cancers of the kidney, bladder, prostate, or urinary tract lining.
  • Inherited disorders like sickle cell disease or polycystic kidney disorder.
  • Prostate enlargement or infection.
  • Viral liver infections such as Hepatitis B and C.
  • Injury or accidental blow to the kidneys.
  • Bladder trauma due to strenuous physical exercise.
  • RBC dehydration or breakdown caused by a tough physical activity.
  • Interstitial Cystitis, which is a chronic bladder condition.
  • Sexually transmitted diseases, such as chlamydia and gonorrhea.
  • Ulcers in the urinary tract (Hunner's ulcers) can also cause blood in the urine.

How is blood in urine related to your health?

Blood in urine could have benign or concerning health indications depending on the underlying physiology.

Non-alarming indications:

False Hematuria

Reddish urine could be due to pigments from certain drugs and foods (like beetroot or rhubarb), which get excreted into the urine and falsely mimic hematuria.

Runner's bladder or marathoner's hematuria is observed in professional athletes who engage in high intensity workouts for extended periods. These acute episodes of blood in urine due to intense athletic activity generally resolve on their own.

Acute exercise-induced Hematuria

Severe physical exertion, e.g., due to long and intense workouts or athletic activity, can result in short episodes of blood in the urine. Also referred to as runner's bladder or marathoner's hematuria, it is most commonly observed in swimmers and those running marathons 10,000 meters or above. The severity of exercise-induced hematuria is linked to the intensity and duration of physical exertion.

The exercise-induced hematuria could be caused by renal or bladder trauma (repeated rubbing of bladder walls resulting in vascular lesions) or due to non-traumatic factors such as increased filtration pressure on kidneys or due to damage to the nephrons (filtering units of the kidneys). Generally, exercise-induced blood in urine resolves on its own within 72 hours after the intense stress event, and your urine will run clear. These benign conditions generally do not require clinical intervention. However, it is essential to ensure that no other pathological conditions contribute to hematuria.

Recurring episodes of hematuria should be reported to the healthcare provider for further investigation. Exercise-induced hematuria can also be accompanied by the excretion of protein in urine and white blood cells (leukocytes) in urine and can be worsened due to dehydration.

Blood in urine in menstruating women

Menstrual bleeding in women is also sometimes mistaken for blood in the urine. In such instances, the urine regains its normal color after two or three episodes of urination.

Acute episodes of blood in the urine do not usually indicate a severe problem, but the risk of a major disease exists. You must report it to your doctor to find out the underlying cause.

Alarming Indications:

Urinary tract infections, kidney or bladder stones, blockage in the urinary tract, and cancers of the kidney, bladder, prostate, or urinary tract all require prompt medical interventions. In addition, blood in urine could be associated with serious diseases such as chronic bladder conditions, such as interstitial cystitis, ulcers of the urinary tract, and sexually transmitted infections, all of which require treatment. In some cases, mucus in urine combined with blood in urine could be an indication of bladder cancer.

You must report the presence of blood in urine to your healthcare provider to find out the underlying cause.

Blood in urine during pregnancy

Women can also experience blood in urine in pregnancy. Hematuria in pregnant women could be a sign of a Urinary Tract Infection (UTI) and should be reported to the healthcare provider immediately for further diagnosis.

Blood in urine due to sexually transmitted diseases

Sexually Transmitted Diseases (STDs) or Sexually Transmitted Infections (STIs), specifically chlamydia and gonorrhea, are often reported to cause blood in the urine.

Since blood in urine can be caused by benign or non-benign health conditions, getting a proper diagnosis of the underlying cause is essential to get the appropriate treatment. Blood in the urine is not a normal finding and a sign from our bodies to take preemptive actions to fix the underlying cause.

Who is at a greater risk of hematuria?

Hematuria is neither gender- nor age-specific. However, certain factors increase its risk:

  • Prostate enlargement in men over fifty.
  • Kidney inflammation in the wake of a kidney infection.
  • UTIs, especially during pregnancy.
  • Family history of kidney disease or stones.
  • Urinary and bladder stones.
  • Chronic consumption of certain medications like blood thinners, aspirin, painkillers, and antibiotics.
  • Strenuous exercise, workout, or long-distance running.
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How is hematuria diagnosed?

There are many ways and approaches to diagnose hematuria and its cause(s). These include:

  1. Physical Symptoms and examination of medical history,
  2. Physical examination, and
  3. Chemical analysis with urinalysis.

The role of physical symptoms and clinical history:

Physical symptoms along with your medical and family history, can provide important clues to the cause of blood in the urine. Your physician may therefore ask a range of related questions. You must carefully notice your symptoms and provide accurate information to your doctor about your condition, any recent medication, etc. You may be asked about:

  • Any medical condition(s) you are getting treatment for;
  • Medicines you are currently taking;
  • Hematuria episodes in the past;
  • Recent food intake or dietary changes;
  • Recent events of strenuous exercise/workout;
  • Your periods (for women);
  • Any experience of pain while urinating;
  • Flank pain or bladder irritability;
  • Whether blood in the urine is in the initial or terminal part of the urine stream;
  • Fever, chills, sweats, bleeding from any other part;
  • Increase in the frequency of urinating;  
  • Nausea and vomiting coinciding with flank pains.

The information provided to the doctor will help them: a) determine the possible cause of hematuria; b) decide about further investigation and treatment.

Physical examination to aid in the diagnosis of the cause of blood in urine:  

Your doctor may examine your abdomen, back, flanks, and bladder area for any visible/palpable signs of an illness. For men over 50, a digital rectal examination may also be carried out for a possible prostate-related condition. For women, an examination of the pelvic organs could be conducted to diagnose the cause of blood in the urine.

Urinalysis to confirm the diagnosis of hematuria:

Visible or gross hematuria should immediately be reported to the doctor unless you are sure it is not due to benign conditions such as the intake of certain foods or drugs. The clinical diagnosis of a gross and microhematuria begins with a urinalysis test, which can be the key to tracing the source of blood in the urine.

How to test blood in urine?

A urine test can be performed in a laboratory or at home using blood in urine test strips. Also called hemastix, hematuria dipsticks, or simply dipsticks, these narrow strips for test in urine come with one or more reagent test pads to check the presence and quantity of blood in the urine. When dipped in the urine, the reagent pad changes color in response to the number of red blood cells detected in the sample. The color of the pad is then matched with the corresponding key to interpret the results. An at-home UA test is a quick and easy way to find the presence of urinary blood. A multiparameter urine dipstick test, like Urinox-10, tests ten different parameters, including blood, white-blood-cells, and protein in the urine.

Urinalysis Test Strips can be used to detect hematuria or blood in the urine.
Urinalysis Test Strips can be used to detect hematuria or blood in the urine. Once dipped in the urine sample, the reagent pad on the dipstick changes color depending on the chemical composition of the urine. By comparing colors of the reagent pads with the color key provided by the manufacturer, results can be inferred. The test results are ready in one minute.

Test strips for blood in the urine (also called hematstix or hematuria sticks) are an easy way to check hematuria.

What are normal and abnormal ranges of blood in the urine?

The range of up to 3 or 4 RBC/HPF (high-power field) is seen as the normal range when the urine sample is microscopically examined. Normal values may vary from lab to lab. If your urine test turns positive with an above-normal count of red blood cells, immediately discuss it with your doctor.

How to read and interpret the results of blood in urine dipstick test?

In a professional or at-home dipstick test, a bright yellow pad color indicates negative blood in urine results.

The reagent pad on the dipstick yields a bright yellow color for a negative result for blood in the urine.
The reagent pad on the dipstick yields a bright yellow color for a negative result for blood in the urine.

A positive test is characterized by the following observations:

  • Green spots on the reagent pad if trace amounts of non-hemolyzed red blood cells are detected;
If the reagent pad shows green spots on a yellow background, it implies presence of trace levels of non-hemolyzed blood cells in the urine sample.
If the reagent pad shows green spots on a yellow background, it implies presence of trace levels of non-hemolyzed blood cells in the urine sample.

  • Change in the reagent pad color to light green if small amounts of blood are detected;
  • Change in the reagent pad color to dark green if large amounts of blood are found.
The reagent pad on the dipstick changes to green color if blood in the urine specimen is found.
The reagent pad on the dipstick changes to green color if blood in the urine specimen is found. The intensity of the color correlates with the quantity of blood cells in sample. Higher the quantity, deeper the color (i.e., deeper green).

Change in the pad color from yellow (negative) to positive (green) due to the presence of blood in the urine.
Change in the pad color from yellow (negative) to positive (green) due to the presence of blood in the urine.


Blood in the urine is not a normal finding, but it is neither uncommon nor necessarily a cause for alarm. In acute and benign cases, the normal color of the urine is restored after a few episodes of urination. If you continue to notice blood in the urine or your test repeatedly turns positive, it should be reported to the healthcare provider. Your healthcare practitioner will investigate further to determine the source and underlying cause. Your provider will conduct/order a urinalysis to confirm a diagnosis. Results from the urinalysis test may necessitate other tests such as blood urea nitrogen, urine culture, serum creatinine, and complete blood count. Your doctor may also order more advanced tests like a CT or MRI scan, ultrasound examination, or cystoscopy to examine the anatomy of the bladder and urethra to diagnose the cause and assess the health of your organs. The course of treatment depends on the subsequent findings.

  1. Mayo Clinic Staff, "Blood in the urine (hematuria)," Mayo Clinic. Accessed Jan. 1, 2022.
  2. NIH Staff, "Hematuria (Blood in the Urine)," National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. Accessed Jan. 1, 2022.
  3. JHM Staff, "Hematuria (Blood in the Urine)," John Hopkins Medicine, Accessed Jan. 1, 2022.
  4. Sokolosky, Mitchell C. (2001), "Hematuria," Emergency Medicine Clinics of North America, 19(3), 621–632.
  5. Strasinger, S. K., & Di Lorenzo, M. S. (2014). Chemical examination of urine. Blood. FA Davis, 83-85
  6. UCSF Staff, "Urinary casts," Medical Tests, University of California San Francisco (UCSF) Health. Accessed Jan. 1, 2022.
  7. Urology Health Staff, "What is hematuria?," Urology Care Foundation. Accessed Jan. 1, 2022.
  8. Abarbanel J, Benet AE, Lask D, Kimche D. Sports hematuria. J Urol. 1990 May;143(5):887-90.
  9. AMSSM Staff, "Exercise-induced hematuria," American Medical Society for Sports Medicine, Available Online. Accessed January 23, 2023

About the Author
Elizebeth O’Neill

Elizabeth O’Neill is a highly experienced nursing professional with a passion for educating others about important health issues. With a degree in nursing and extensive experience in the medical field, she has dedicated her career to helping others live their best, healthiest lives.

In her current role as a medical content writer for Diagnox, Elizabeth is able to utilize her knowledge and experience to inform and educate consumers on the importance of proactive screening and overall health. She is particularly passionate about women's health issues, and loves working with Diagnox to spread awareness about these important topics.

Throughout her career, Elizabeth has consistently demonstrated her dedication to helping others and improving the health of her community. She is highly respected by her colleagues and is known for her professionalism, compassion, and expertise. Whether she is working directly with patients or writing articles to educate the public, Elizabeth is always focused on making a positive impact on the lives of others.

About the Reviewer
This blog was
Technically reviewed by: 
H. Ali, Ph.D.

Hussnain Ali received his Ph.D. degree in EE in 2015 from the University of Texas at Dallas, USA. He is the co-founder and the Chief Executive Officer (CEO) at Diagnox Health, Plano, TX 75024, USA, and a visiting research scientist at the University of Texas at Dallas. His academic and industry experience spans over 15 years in organizations like the Center for Advanced Research in Engineering, The University of Texas at Dallas, and Harman/Samsung. He has served as a co-PI on an RO1 grant from the National Institutes of Health (NIH). His research interests include biomedical devices, auditory rehabilitation, and cochlear implants. He has authored and co-authored over 70 international publications and has been awarded multiple US patents. His latest work at Diagnox encompasses the development of innovative healthcare and wellness products/solutions that provide convenient and affordable at-home screening/diagnosis. He aims to bridge conventional clinical diagnostic products with Artificial Intelligence (AI) and contemporary data-centric technologies to modernize the healthcare and wellness industry.

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