You stopped to go to the bathroom before heading out the door. But the color of your urine isn’t quite what you expected. Now you’re wondering, “Why am I peeing blood, and is it serious?”
Blood in urine (hematuria) is a common problem that happens to children and adults of all genders. And the good news is that the most common causes of blood in urine – like a urinary tract infection – are easily treatable.
Still, it’s generally not normal to see blood in your urine (or blood in your stool). And bloody urine can sometimes be a sign of a more serious condition. So it’s important to see a doctor as soon as you can, especially if you’re in pain or are having difficulty urinating.
Below, we share more information about how and why blood shows up in urine, and what you should do about it.
Are you really peeing blood? Here’s what blood in urine looks like
Normal pee color is pale to medium yellow and clear. If you have urine that’s pinkish, red or rusty brown, you may have blood in your urine. But keep in mind that blood isn’t the only reason your urine may change colors. The natural and artificial colors in foods like beets and rhubarb, and medications like phenazopyridine, can make urine look red, orange or pink.
It’s also possible to have blood in your urine that you can’t see.
Blood in urine that you can see is called gross hematuria
Blood in urine doesn’t always come out in liquid form. You may see blood clots in your urine – clots can look like coffee grounds, globs or worm-like strings. The size and number of clots are usually related to the severity of your condition. It’s also possible that your toilet paper may have spots of blood after urinating and wiping.
It doesn’t take a lot of blood to change the color of urine – so it probably looks worse than it is. But it’s best to make a doctor’s appointment if you have bloody urine, especially if there’s a lot of blood or if you notice blood clots in the toilet.
Microscopic blood in urine isn’t visible to the naked eye
Often the amount of blood in a person’s urine isn't enough to change the color of their pee. This is called microscopic hematuria, and you won’t know you have it unless you have a urine test (urinalysis) either as part of an annual physical or any of the reasons you’d go to a primary care doctor. Microscopic hematuria is usually nothing to worry about, but it’s likely your doctor will recommend additional tests to make sure.
Differences between blood in urine and menstrual blood
For women and others who menstruate, it’s common to see blood in the toilet during a menstrual period. While menstrual blood can look like bloody pee in the toilet, it’s not the same.
Menstrual blood comes from a different part of the body and is totally normal. During menstruation, cells shed from the lining of the uterus and leave the body through the vagina. It doesn’t travel through your urinary system, so it can come out even when you’re not peeing. Bloody urine is caused by bleeding somewhere in the urinary system and is worth talking to a doctor about.
Here’s what causes blood in urine
If you have blood in your urine, it means you’re bleeding somewhere inside your body. Bloody urine can be a symptom of infection or medical conditions that affect your kidneys, bladder, reproductive organs or blood. It’s also possible for certain activities to cause bloody urine.
Urinary tract infections are a main cause of blood in urine
A urinary tract infection (UTI) is one of the most common causes of blood in urine, for both children and adults.
A UTI starts when bacteria get into the body and multiply in the bladder or kidneys. The bacteria irritate the urinary tract and can cause red blood cells to pass into your urine. Bleeding from a UTI can make urine look red, pink or brown.
If you have a UTI, you’ll likely have other symptoms. Chances are that your urine will look cloudy and smell foul. It may also hurt to pee – and you may need to pee more frequently or have to go without warning. Also, you may have a fever or pain in your lower back.
UTIs will usually go away quickly when you take a prescription antibiotic or antiviral medications. If you think you have a UTI, a virtual clinic like Virtuwell can be a way to get immediate treatment. You can also make an appointment with your primary care doctor.
Medications can cause bloody urine
Certain medications can irritate or inflame your stomach, kidneys, bladder or urinary tract – and if the irritation causes bleeding, you may have blood in your pee. Medications that thin your blood or keep it from clotting also increase your chances of having blood in your urine.
Talk to your doctor if you noticed blood in your urine after starting a new medication or you use a lot of over-the-counter pain medication like ibuprofen or aspirin.
Kidney conditions can cause blood in urine
Your kidneys filter your blood and turn waste into urine. If they aren’t working correctly, or if you have a condition that’s causing kidney inflammation, it’s possible for blood cells to leak into your urine. These conditions include:
Kidney stones
Minerals can collect and harden in the kidneys, forming kidney stones. If kidney stones are small, they may pass through the kidneys without causing any symptoms. But if larger stones get stuck, it can irritate the lining of the kidney. Stuck kidney stones can also cause a sharp, cramping pain in the back or side, the need to urinate frequently and painful urination.
Polycystic kidney disease
Polycystic kidney disease (PKD) is a genetic disorder that causes cysts (fluid-filled growths) to form in the kidneys. PKD can be a cause of unexplained weight gain since a kidney with lots of cysts can weigh as much as 30 pounds.
PKD is usually diagnosed in people between the ages of 30 and 50 years old, but there’s a rarer type of PKD that causes symptoms in babies. Early symptoms include blood in urine, pain in the back or sides, UTIs, kidney stones, high blood pressure and headaches.
Glomerular disease
Glomerular diseases interfere with the filtering units of the kidney (the glomeruli) and allow protein and red blood cells to leak into urine. These diseases can also affect how a person’s body removes the waste products made by the kidneys.
Glomerular disease can make urine look pink and foamy. Other symptoms include high blood pressure and swelling of the face, hands, ankles or feet. Glomerular diseases can be caused by infections, drug reactions and diseases that affect the whole body, such as diabetes or lupus.
Kidney cancer
It’s possible, but unlikely, that kidney cancer is the reason for the blood in your urine. The chance of getting kidney cancer in your lifetime is 1% for women and 2% for men.
Kidney cancer occurs when kidney cells grow out of control, forming a lump called a tumor. Kidney cancer is most commonly diagnosed in people who are 65-74 years old. It’s very uncommon in people under the age of 45 years old.
In its earliest stages, kidney cancer usually doesn’t have any symptoms. As the cancer grows, common symptoms can be blood in pee, a lump in the lower back or side of the waist, back pain, unexplained weight loss, night sweats, fever and tiredness.
Doctors often find kidney cancer at an early stage when it’s most treatable – usually when you’re getting imaging tests for another reason. But it’s always a good idea to talk to your doctor about any unusual symptoms.
Bladder conditions can also cause blood in urine
Your bladder is the organ that stores your urine. So it’s no surprise that if you have bleeding in your bladder, it can come out in your pee. Here are bladder conditions that can cause bloody urine:
Bladder stones
Bladder stones form when minerals build up in your bladder. People often pee out small bladder stones without noticing, but larger bladder stones can irritate the bladder and urethra, causing bloody urine and making it difficult to pee. Other symptoms of bladder stones can include stomach pain and difficulty emptying the bladder.
If you have bladder stones, your doctor will be able to provide the best treatment plan for you.
Bladder cancer
Bladder cancer is an unlikely cause of bloody pee – the lifetime risk is 1% for women and 3.6% in men. Bladder cancer often has noticeable symptoms, making it more likely to be found when it’s small and easy to treat. Symptoms of bladder cancer include bloody pee, pain or burning when peeing, and the need to go often.
Conditions that affect your reproductive organs may cause blood in urine
Our reproductive organs are connected to our urinary system. So if there’s a condition that causes irritation and bleeding to your uterus or prostate, that blood may end up in your toilet. Conditions include:
Irregular menstruation due to hormonal imbalance
Estrogen and progesterone regulate the menstrual cycle. If these hormones are out of balance, it can cause spotting between periods. These imbalances can happen if your ovaries or thyroid aren’t working correctly, or if you just started or stopped taking birth control pills.
Pregnancy complications
If you’re pregnant and have bloody urine, you should contact your doctor right away. It may not be a cause for concern – but you’ll want to find out for sure. Bloody urine and blood clots can be signs of miscarriage or that the embryo started growing outside the uterus (an ectopic pregnancy).
Abnormal growths on the uterus (uterine fibroids)
Uterine fibroids are growths that develop in or on the uterus. Fibroids are usually noncancerous and common – it’s estimated 20-80% of people with a uterus have at least one. Fibroids don’t always come with symptoms, but they can cause heavy bleeding during or between menstrual cycles. Other symptoms can include blood clots in urine, pain in the pelvis or lower back, and pain during intercourse.
Overgrowth of uterus tissue (endometriosis)
Endometriosis is a disease in which tissue that’s similar to the lining of the uterus grows outside the uterus. Extra tissue may grow on ovaries, fallopian tubes or on the tissues lining the pelvic area. The main symptom of endometriosis is pelvic pain, often during menstruation. It can also cause heavy periods and pain when peeing or having a bowel movement.
Enlarged prostate (BPH or benign prostatic hyperplasia)
In male anatomy, the prostate is just below the bladder and above the urethra. It’s common for it to grow bigger as you pass middle age. An enlarged prostate puts pressure on the urethra, partly blocking your urine flow. BPH makes it harder – and sometimes painful – to pee and can cause blood in the urine.
Inflamed prostate (prostatitis)
A prostate that’s swollen or inflamed can also block urine flow, causing many of the same symptoms as BPH, including bloody pee and difficulty urinating. If you have prostatitis, you may have pain in your groin, pelvic area and genitals. A main cause of prostatitis is a bacterial infection, but there are other causes too.
Prostate cancer
About 1 in 8 men will be diagnosed with prostate cancer in his lifetime. The chance of prostate cancer increases with age, and most of the time it’s found in men 65 years or older. Most men who get prostate cancer don’t die from it, but it can be serious.
Bloody urine can be a sign of prostate cancer, but this type of cancer doesn’t always cause symptoms so it’s important to get routine prostate cancer screenings. Routine screenings help find cancer earlier when it’s most treatable.
Inherited blood conditions can cause bloody urine
Sometimes the cause of bloody urine is the blood itself. If you have a disorder that changes how your blood works, you’re more likely to have blood in your urine. These disorders include:
Hemophilia
Hemophilia is a rare disorder where blood doesn’t have enough blood-clotting proteins – and it doesn’t clot as much as it should. Hemophilia is usually inherited, but it can be caused by problems with the immune system.
If you have hemophilia, you may bleed more than usual after trauma or surgery. You may also start bleeding when there doesn’t seem to be a reason. If you have bleeding in your urinary tract, it can end up in your pee.
Sickle cell disease
Sickle cell disease is a group of inherited disorders that affect the protein (hemoglobin) in the red blood cells. As a result, the red blood cells have a C-shape, die early and get stuck in small blood vessels.
Sickle cell disease causes pain and serious complications, including infections, stroke and lung problems. It’s also a cause of blood in urine.
Certain activities can increase your chance of having blood in urine
Some activities and experiences can increase inflammation and irritation of the organs and tissues in your body, causing bloody urine, including:
Recent urinary surgery
It’s normal to bleed a little for a few days after a urinary procedure. But if you’re noticing bright red blood or big clots of blood in your urine, you’ll want to seek immediate medical attention, especially if you’re unable to pee, you’ve got stomach cramps or a fever that’s higher than 101.4 degrees Fahrenheit.
Intense exercise
Blood in urine also can happen with high-intensity workouts and long-distance sports, such as marathon running. Exercised-induced hematuria is most common in long-distance runners, but it can happen with any intense physical activity. Most often the bloody urine will go away within a few days. If not, contact your doctor.
Trauma or stress to the urinary system
Bloody urine can happen if your body experiences physical trauma or stress as a result of an accident or planned activity. For example, you might get bloody urine if you get hit in the kidneys while playing sports. But it’s also possible for vigorous sex to cause bloody urine.
Smoking
Smoking introduces toxic chemicals into your body, and your kidneys have the job of filtering these chemicals out of your blood, so they can leave your body through your urine. These chemicals collect in the kidneys and bladder, causing irritation and inflammation that makes it more likely that you’ll have bloody urine, and serious medical conditions, including bladder cancer and kidney disease.
Exposure to radiation or chemicals
Exposure to radiation and certain chemicals increases inflammation in your body and your chance of developing serious medical conditions. People who work around metals, fumes, dyes and rubbers may be more at risk.
Treatment for blood in urine depends on the cause and can go away on its own
Sometimes all your body needs to recover is a little bit of time. For example, if the bleeding is caused by intense exercise, it will usually clear up on its own in a few days. But you’ll need medical treatment if your bloody urine is caused by a medical condition or an infection.
Doctors treat hematuria by treating what’s causing it. For example, if you have symptoms of an infection, your doctor may start with a course of antibiotics. Other causes may be treated with other medications or medical procedures.
Talk with your doctor if you pee blood
Even though having blood in your urine isn’t normal, it usually isn’t serious. However, if you’re seeing blood in your urine, and it’s not related to menstruation, you should seek medical care.
If you think you have a UTI, a quick and easy first step can be to start a Virtuwell appointment. If you’ve been treated for an infection but still are seeing blood in your urine, make another appointment with your doctor. They can run follow-up tests to determine if there are other reasons.
If you don’t have any other symptoms, it’s usually fine to wait a few days to see if your bloody urine goes away on its own. But you’ll want to make a doctor’s appointment if your symptoms stick around, or you have other concerning symptoms. If you're experiencing symptoms such as lightheadedness, inability to urinate or extreme pain, head to urgent care.