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What Causes Hematuria (blood in the urine)? Possible Reasons Explained


Hematuria, or blood in the urine, is a common symptom that can signify different underlying medical conditions. Some causes of hematuria are benign, while others can be more serious. Detecting blood in urine, even if microscopic, warrants medical evaluation to determine the cause and appropriate treatment. This article will discuss the 11 leading causes of hematuria.

11 Common Causes Of Hematuria

Hematuria (blood in the urine)

1. Urinary Tract Infection

A urinary tract infection (UTI) is a common cause of hematuria, especially in women. Bacteria, most often E. coli from the gastrointestinal tract, infect the urethra and travel up to the bladder. This leads to inflammation and bleeding into the urinary tract.

Symptoms of a UTI include burning with urination, frequent and urgent need to urinate, fever, and abdominal and flank pain. Treatment involves antibiotic medications. Prompt treatment can prevent the infection from spreading to the kidneys.

2. Kidney Stones

Kidney stones are solid masses that form from crystals in concentrated urine. As kidney stones travel down the urinary tract, they can scratch and damage tissue, causing bleeding. Large kidney stones may completely obstruct urine flow.

Symptoms include severe abdominal, flank, and groin pain, nausea, vomiting, painful urination, blood in urine, and inability to pass urine. Small stones can pass on their own while larger ones may require lithotripsy, a procedure that breaks up stones, or surgery for removal.

3. Kidney Infections

A kidney infection, also called pyelonephritis, affects one or both kidneys. It often starts as a bladder infection that travels up to the kidneys. Bacteria multiply in the kidneys and renal pelvis causing tissue inflammation, bleeding, and possible kidney damage.

Symptoms include fever, chills, nausea, vomiting, flank and abdominal pain, painful urination, foul-smelling urine, and blood or pus in the urine. Antibiotics are used to treat kidney infections which can become serious if left untreated.

4. Glomerulonephritis

Glomerulonephritis refers to inflammation of the tiny filters in the kidneys called glomeruli. This causes bleeding into the urine. There are different types of glomerulonephritis with various causes including infections, autoimmune disorders, and medications.

Symptoms may include puffiness around the eyes, ankles, and feet, foamy urine, fatigue, and high blood pressure. Treatment depends on the specific type of glomerulonephritis but may involve medications, diet changes, and dialysis.

5. Cancer of the Bladder, Kidneys, or Prostate

Cancers involving the urinary system structures are a serious cause of hematuria. Bladder cancer is the most common and presents with painless hematuria. Renal cell carcinoma is a kidney cancer that can cause abdominal pain and hematuria.

Prostate cancer in males may spread to the bladder and cause bleeding. Diagnosis is made with a CT scan, cystoscopy, and biopsy. Treatment options include surgery, radiation therapy, immunotherapy, and chemotherapy. Early diagnosis is key to improving outcomes.

6. Exercise-Induced Hematuria

Vigorous exercise can cause temporary bleeding into the urinary tract, known as exercise-induced hematuria. It tends to occur with high-impact activities like long-distance running.

The exact mechanism is unknown but causes may involve kidney movement, increased blood flow, or bladder trauma. The condition is harmless and resolves with rest. Athletes should stay well-hydrated before and after exercise. Recurrent or persistent hematuria warrants medical assessment.

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7. Menstruation

In menstruating females, small amounts of blood from the vagina can enter the urinary tract and tinge the urine red. This harmless cause typically resolves after menstruation ends. The blood is from the uterus rather than the urinary system.

However, hematuria that occurs independently of menses should not be assumed as menstrual and requires evaluation.

8. Trauma

Direct blows or injury to the kidneys, bladder, or prostate can damage tissues and vessels causing bleeding and hematuria. Examples include car accidents, sports injuries, surgical procedures in the pelvic area, kidney biopsy, and prostate biopsy.

Hematuria from trauma is often accompanied by pain and bruising over the injured site. Imaging and urologic assessment are recommended. Most cases resolve without specific treatment.

9. Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate gland. The prostate surrounds the urethra just below the bladder. As BPH worsens, it obstructs urine flow and causes bladder changes.

This can lead to hematuria, especially following exercise or sexual activity. BPH may also mimic bladder cancer symptoms. Treatment options for BPH include medications, prostate surgery, and minimally invasive procedures.

10. Endometriosis

In endometriosis, tissue similar to the uterine lining grows outside the uterus and can spread to the bladder or urinary tract. This ectopic endometrial tissue is influenced by female hormones and sheds during menstruation.

This results in blood in the urine around the time of menses. Patients also experience severe menstrual cramps and pain with urination and intercourse. Treatment involves pain medications and hormonal therapies.

11. Coagulation Disorders

Hematologic conditions that impair blood clotting can cause or contribute to hematuria. Examples are hemophilia and Von Willebrand disease. The anticoagulant medications warfarin and heparin can also lead to excessive bleeding.

With coagulation problems, bleeding occurs from fragile vessels anywhere in the body including the urinary tract. Treatment requires managing the underlying clotting disorder.


In summary, hematuria has many potential causes ranging from benign to life-threatening. Although alarming to patients, microscopic hematuria does not always signify serious disease. For persistent or heavy bleeding, a prompt urologic workup is advised.

The evaluation aims to pinpoint the source of bleeding and guide appropriate treatment. Certain causes like UTI, kidney stones, and prostate enlargement are very common. Cancer is a concern with risk increasing above age 50.

With an accurate diagnosis and proper management, the outlook for hematuria is often favorable. Patients should follow up to ensure complete resolution.


1. Can hydration status affect hematuria?

Yes, concentrated urine from dehydration makes traces of blood more obvious. Well-hydrated urine appears less red.

2. Does hematuria always require a urine culture?

Not necessarily. But a culture helps diagnose an infection if leukocytes and bacteria are also present.

3. Can certain medications cause blood in urine?

Yes, anticoagulants, penicillins, cyclophosphamide, and some NSAIDs can cause drug-induced hematuria.

4. Can you treat hematuria at home?

Symptomatic home treatment like drinking fluids may help transient cases. But clinical evaluation is still necessary to determine underlying cause. 

5. Is blood in urine normal during early pregnancy? 

Yes, temporary benign hematuria can occur in pregnancy and is not concerning unless heavy.

In summary, discuss any hematuria episodes with your physician, especially recurrent or painless bleeding, to guide appropriate diagnostic testing based on individual risks and presentation. Proper treatment resolves most underlying causes.

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Dr. Harold Gojiberry is not just your ordinary General Practitioner; he is a compassionate healthcare provider with a deep commitment to patient well-being and a passion for literature. With extensive medical knowledge and experience, Dr. Gojiberry has made a significant impact in the field of healthcare, particularly in the area of liver diseases and viral hepatitis.

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