Did you know that blood in your urine can originate from anywhere along your urinary tract, from kidneys to urethra? Blood in urine, medically termed haematuria, appears either visibly as pink, red, or cola-colored urine (gross haematuria) or detectably only through laboratory testing (microscopic haematuria). The color and timing of bleeding provide diagnostic clues: bright red blood typically indicates lower urinary tract sources, while darker or brownish blood suggests kidney or upper tract origins. Accompanying symptoms like pain, fever, or urinary changes help narrow potential causes.
If you notice these symptoms, it’s important to consult a best urologist in Singapore for proper evaluation and management. Haematuria originates from anywhere along the urinary tract — kidneys, ureters, bladder, or urethra. While some causes prove benign, haematuria warrants medical evaluation as it may signal conditions requiring treatment.
Immediate Actions Upon Discovering Blood
- Document the urine appearance immediately — take a photo if possible.
- Note whether the blood appears at the beginning, throughout, or end of urination, as this pattern helps localize the bleeding source.
- Initial stream blood suggests urethral origin, terminal bleeding indicates bladder neck or prostate sources, while continuous bleeding throughout urination points to bladder or kidney involvement.
- Collect a midstream urine sample in a clean container before taking any medications.
- Refrigerate the sample if you cannot reach medical care within two hours.
- Record all current medications, particularly blood thinners like acetylsalicylic acid, warfarin, or clopidogrel, as these affect bleeding risk and management decisions.
- Monitor for accompanying symptoms that indicate urgency: severe flank or abdominal pain, inability to urinate, passage of clots larger than 1 cm, fever above 38 °C, or dizziness suggesting significant blood loss.
- These symptoms require emergency department evaluation rather than waiting for an appointment.
Common Causes and Risk Factors
Urinary tract infections cause haematuria through bladder wall inflammation, typically accompanied by burning urination, frequency, and urgency. Women experience UTIs more frequently due to shorter urethral length. Kidney infections (pyelonephritis) produce upper tract bleeding with flank pain and systemic symptoms.
Kidney stones generate bleeding through mechanical trauma as they move through the urinary system. Calcium oxalate stones, forming in acidic urine with pH below 6.0, are one type. Stone-related haematuria often coincides with colicky pain radiating from loin to groin.
Benign prostatic hyperplasia in men causes haematuria through enlarged prostate blood vessel rupture. The prostate volume increases significantly, creating friable tissue prone to bleeding. Associated symptoms include weak stream, incomplete emptying, and nocturia.
⚠️ Important Note
Exercise-induced haematuria occurs in runners and athletes after intense activity, resolving within 72 hours with rest. However, persistent bleeding after exercise cessation requires investigation.
Bladder and kidney cancers present with painless haematuria as an early symptom. Transitional cell carcinoma is one type of bladder cancer, with smoking increasing cancer risk. Renal cell carcinoma may remain asymptomatic until advanced stages, making haematuria investigation important.
Glomerulonephritis, inflammation of kidney filtering units, produces dark or tea-colored urine with protein. IgA nephropathy is one form, often manifesting after upper respiratory infections. Urinalysis shows dysmorphic red blood cells and red cell casts distinguishing glomerular from other bleeding sources.
Diagnostic Process
Initial evaluation begins with detailed history covering medication use, recent infections, trauma, family history of kidney disease, and occupational chemical exposures. Physical examination includes blood pressure measurement, abdominal palpation for masses or tenderness, and in men, prostate examination.
Urinalysis with microscopy remains an important diagnostic test. The presence of > 3 red blood cells per high-power field confirms microscopic haematuria. Concurrent findings guide diagnosis: white blood cells suggest infection, protein indicates glomerular disease, while isolated haematuria raises concern for structural abnormalities or malignancy.
Urine culture identifies bacterial infections requiring antibiotic treatment. Cytology examination detects abnormal cells suggesting malignancy, though sensitivity remains limited. The laboratory processes fresh morning samples for optimal cellular preservation.
Blood tests assess kidney function through creatinine and estimated glomerular filtration rate (eGFR). Normal creatinine ranges from 60–110 μmol/L in men and 45–90 μmol/L in women. Complete blood count evaluates for anemia from chronic bleeding. Coagulation studies check for bleeding disorders in patients with recurrent haematuria.
Imaging and Procedures
CT urography provides comprehensive urinary tract visualization from kidneys to bladder. This combines non-contrast, nephrographic, and excretory phase imaging to detect stones, masses, and collecting system abnormalities. The radiation dose approximates 10–15 mSv, equivalent to 3–5 years of background radiation exposure.
Ultrasound offers radiation-free evaluation particularly suitable for pregnant women and young patients. While effective for detecting hydronephrosis and large renal masses, ultrasound may miss small urothelial tumors and stones under 3 mm.
💡 Did You Know?
Flexible cystoscopy, performed under local anesthesia in clinic settings, allows direct bladder visualization with minimal discomfort. The procedure duration and recovery time should be discussed with a healthcare professional.
MRI urography provides detailed soft tissue evaluation without radiation exposure, though imaging time is longer and availability may be limited.
Next Steps
Document your symptoms immediately and seek prompt medical evaluation. Blood in urine requires urinalysis, imaging studies, and potentially cystoscopy to determine the underlying cause. Collect a urine sample and note any accompanying symptoms like pain, fever, or changes in urination patterns.
If you are experiencing blood in your urine with accompanying symptoms like pain, fever, or changes in urination patterns, schedule an appointment with a urologist for comprehensive evaluation and appropriate treatment.
