Seeing blood in the toilet or on toilet paper can be alarming. Even when the blood is visible only under a microscope, known as microscopic hematuria, it signals that something in the urinary tract is causing red blood cells to appear in urine. Not every case represents a serious disease, but understanding the possible causes, risk factors, evaluation steps, and when to act quickly helps remove uncertainty and leads to the proper care.
Hematuria means red blood cells are present in the urine. It is described as gross (visible to the naked eye) or microscopic (detected on urinalysis or urine microscopy). Gross hematuria often prompts immediate concern because the change is obvious, while microscopic hematuria is frequently discovered on routine testing.
Red urine doesn't always come from the urinary tract: foods (like beets), certain medications, or menstrual blood can create the appearance of hematuria. A clinical evaluation clarifies whether true hematuria is present and what its source might be.
How Common Is It?Estimates vary, but microscopic hematuria is commonly found on routine urine tests, with prevalence in different studies ranging widely depending on age, sex, and testing threshold. Gross hematuria is less common but more likely to indicate an underlying condition that needs evaluation. Because data and screening practices differ, any new or unexplained blood in urine warrants attention.
Blood in urine can arise from many points along the urinary tract, including the kidneys, ureters, bladder, prostate (in people assigned male at birth), and urethra. The most common causes include:
UTIs are a frequent cause, especially in women. Infection leads to inflammation and irritation of the bladder or urethra, which can cause bleeding. UTIs are often accompanied by symptoms such as pain or burning with urination, increased frequency, urgency, and sometimes fever.
Stones that form in the kidneys or ureters can scrape and injure the urinary tract lining as they move, producing sharp pain and visible blood in the urine. Pain from stones is typically severe and comes in waves, often located in the flank or lower abdomen.
Blunt injury to the abdomen or pelvis, sexual activity with friction, catheter insertion, or recent urologic procedures can cause bleeding that ends up in the urine. A clear history of trauma is an important clue in the evaluation.
In people assigned male at birth, an enlarged prostate (benign prostatic hyperplasia) or prostatitis can cause hematuria and urinary symptoms such as a weak stream, incomplete emptying, or urgency. Prostate procedures and instrumentation may also introduce blood into the urine.
Cancers of the kidney, bladder, ureter, or prostate can occasionally present with painless gross hematuria. This is why unexplained visible blood or persistent microscopic blood warrants careful follow-up, especially in people with risk factors such as smoking or occupational exposures.
Certain medications, anticoagulants (blood thinners), antiplatelet drugs, and some antibiotics, can increase bleeding risk. Medical conditions such as kidney disease, bleeding disorders, and vascular conditions can also produce hematuria.
Intense endurance exercise has been associated with transient hematuria, usually resolving without specific treatment. Menstrual contamination and ingestion of red or purple foods (beets, blackberries) can mimic hematuria and should be excluded in the evaluation.
Several features make a serious cause more likely and prompt a more urgent workup:
Persistent or recurrent gross hematuria (visible blood).
Hematuria in people older than 35–40 years, especially with a smoking history.
Unexplained weight loss, night sweats, or systemic symptoms.
Prior pelvic radiation or chemical exposures, linked to bladder cancer.
Significant clotting, blood in clots, or symptoms suggesting major blood loss.
A stepwise approach helps identify the source. Initial evaluation is often suitable through telehealth for guidance and initial testing, and Doctronic.ai provides a free AI doctor assessment plus affordable video visits with clinicians if needed. Through an online visit, symptoms, medication history, and risk factors can be reviewed promptly to decide next steps.
Typical diagnostic steps include:
A clinician will ask about timing and amount of blood, associated symptoms (fever, pain, urinary frequency), recent activities, medications (including over-the-counter and supplements), and any history of kidney disease or cancer. A physical exam may include abdominal and flank palpation and, when appropriate, a genital and prostate exam.
Urinalysis detects red blood cells, white blood cells, nitrites, and signs of infection or proteinuria. Microscopy quantifies red blood cells and may show casts or other elements suggesting kidney-origin bleeding. A repeat urine test can confirm persistent hematuria and reduce the chance of a false-positive from contamination.
If there are signs of infection, a urine culture identifies the causative bacteria and guides antibiotic choice. Prompt treatment of UTIs often resolves hematuria that’s caused by infection.
Imaging helps visualize stones, tumors, or structural abnormalities. Ultrasonography is useful as an initial, radiation-free test for the kidneys and bladder. Computed tomography (CT) scans, particularly CT urograms, are more sensitive for stones and many urologic cancers and are commonly used in the diagnosis of gross hematuria.
A cystoscopy (scope of the bladder and urethra) allows direct visualization. This is especially important if initial testing doesn’t explain visible hematuria or if there is concern for bladder cancer. Urologists perform cystoscopy and can then recommend biopsy or additional targeted testing if needed.
Some scenarios require urgent in-person care or emergency department evaluation:
Heavy bleeding with large clots that obstruct urine flow.
Signs of hemodynamic instability (dizziness, fainting, rapid heartbeat, low blood pressure).
Fever with severe flank pain, suggesting an infected obstructing stone.
Sudden onset of severe pain consistent with a stone alongside visible bleeding.
For many other cases, an initial telehealth visit can help triage urgency. Doctronic.ai provides quick access to an AI-driven free visit to help determine whether immediate emergency care is needed and can arrange follow-up telehealth video visits with clinicians for under $40 in all 50 states at any hour.
Treatment is highly specific to the underlying diagnosis. When bleeding stems from an infection, antibiotics usually resolve the problem. Kidney stones may require pain management, hydration, and sometimes urologic procedures. Bleeding from a tumor will prompt staging and a coordinated plan involving surgery, oncology, or other therapies. For bleeding related to medications, adjusting or reversing anticoagulation might be necessary under a clinician's guidance.
Follow-up tests and referrals are commonly needed to ensure the bleeding source is identified and treated appropriately. Telehealth can streamline the initial evaluation and arrange referrals or testing as needed.
Not all causes of hematuria are preventable, but several steps reduce risk and support urinary tract health:
Stay hydrated to reduce the concentration of urine and lower the chance of stone formation.
Avoid smoking; tobacco use is the most important modifiable risk factor for bladder cancer.
Manage chronic illnesses such as diabetes and hypertension to protect kidney health.
Use protective gear in sports to prevent trauma to the abdomen and pelvis.
Discuss medication risks with a clinician before starting or stopping blood thinners.
Telehealth provides fast, convenient access to care for the initial evaluation of hematuria. An AI-assisted visit can gather a complete symptom history, flag red flags that require urgent attention, and recommend appropriate testing or specialist referral. Doctronic.ai combines a free AI doctor that delivers a rapid, comprehensive assessment based on current medical research with optional low-cost video visits with licensed clinicians 24/7 across all 50 states.
Using online evaluation, many patients receive reassurance and a clear plan quickly, whether that means immediate emergency care, urgent in-person testing, or outpatient imaging and follow-up. For patients seeking immediate guidance, Doctronic.ai provides a first accessible step in care, eliminating the need for days-long wait times for appointments.
Stay calm: the cause is often treatable.
Note associated symptoms and timing: pain, fever, recent trauma, or new medications.
If bleeding is heavy, with clots, or accompanied by dizziness or fainting, seek emergency care.
For non-urgent cases, consider an online evaluation to triage care. A free AI assessment and affordable clinician video visits are available at Doctronic.ai to guide the next steps.
Scheduling a urinalysis and urine culture is a common immediate next step. If initial testing is reassuring but blood persists, a urology referral and imaging will usually follow. Early communication with a clinician helps avoid delays that could prolong symptoms or mask a treatable condition.
Being prepared for an evaluation makes the visit more efficient. Expect questions such as:
When did you first notice blood, and how much was present?
Is the blood mixed throughout the urine stream or only at the beginning or end?
Any pain, fever, urinary urgency, or changes in urinary stream?
Recent trauma, travel, new medications, or vigorous exercise?
Personal or family history of kidney disease, stones, or cancer?
Smoking history or occupational exposures to industrial chemicals?
Children with hematuria require careful assessment because congenital or infectious causes can differ from adult patterns. Pregnant people who notice blood in urine should be evaluated promptly because urinary infections and kidney stones are more likely to complicate pregnancy. In older adults, hematuria warrants especially careful workup because the risk of malignancy increases with age.
Even if initial tests are normal, persistent microscopic hematuria is not automatically benign. Follow-up with repeat urine testing, imaging, or a urology consult may be recommended, particularly for people with risk factors or ongoing symptoms. A clear plan for re-evaluation ensures that a slowly developing problem is not missed.
Your First Step Toward Clarity and CareBlood in the urine is a symptom that deserves attention. Many causes are benign and treatable, but some require prompt diagnosis and intervention. Fast access to evaluation matters; an AI-guided visit can accelerate the triage process and ensure appropriate next steps. Doctronic.ai offers a free AI doctor assessment and affordable clinician visits 24/7, allowing rapid guidance and continuity of care for this and many other primary care concerns.
When blood appears in the urine, a swift, informed response can clarify the cause and speed needed treatment. For a fast initial evaluation, visit Doctronic.ai for a free AI consultation that synthesizes the latest medical evidence. If a clinician visit is needed, you can schedule a telehealth video appointment around the clock for under $40 to arrange testing, prescriptions, or referrals.
If you’ve noticed blood in your urine and want fast, evidence-based next steps, try Doctronic, the #1 AI Doctor. Our free AI visit draws on the latest peer-reviewed medicine to triage your symptoms, flag red flags, and recommend tests or urgent care when needed; if you want live care, book an inexpensive telehealth video visit with our clinicians 24/7 in all 50 states for under $40. Over 10 million people have trusted Doctronic for smarter, faster, and more personal primary care. Skip the line. Talk to an AI Doctor Now, for free.
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