Blood in your urine? Here’s what you need to know

Blood in the urine is referred to as hematuria. This condition is broken up into two different categories: microscopic hematuria and gross hematuria. Microscopic hematuria is blood in your urine that you do not see. It is only visible under a microscope and detected on a urinalysis that your doctor has ordered. Gross hematuria is blood that is visible to you.


There are many causes of blood in your urine, and some can be serious. The most frequent reasons a person may have blood in their urine include urinary tract infections, enlarged prostate (in an older man), kidney or bladder stones, kidney disease, bladder cancer, or kidney cancer or trauma.

Most often, no specific cause is found for microscopic hematuria. If the blood in your urine is associated with pain in your flank or bladder, this could be a sign of a kidney stone or infection. Only about three or four people out of every 100 with microscopic hematuria are found to have cancer. Cancer is found in over 20% of patients experiencing gross hematuria.


If your doctor finds microscopic blood in your urine, or if you visualize blood in your urine, the typical workup includes an office cystoscopy (a procedure to look inside your bladder with a small camera) and a CT scan with contrast. If no specific cause is found, it’s a good idea to get a urinalysis every year for the next three to five years. If no further microscopic blood in your urine is found, no further workup is needed. If continued blood is found, further tests may be indicated.

If a reason the hematuria is discovered, treatment depends on that specific condition.

Risk factors

Risk factors that can increase a person’s chance of developing kidney or bladder cancer include the following:

  • Older age
  • Male gender
  • Visible blood in your urine (gross hematuria)
  • Cigarette smoking (past or current)
  • Chemicals in the workplace
  • Prior pelvic radiation for cancer
  • Prior urological disorder or disease
  • Pain when urinating
  • Chronic urinary tract infections

Smoking is the biggest risk factor for bladder cancer. Smoking is responsible for 50% of all bladder cancer cases. Former smokers are twice as likely to develop bladder cancer compared to nonsmokers, and current smokers are four times more likely!

Quitting isn’t easy, but it is one of the most important things you can do for your health, bladder or otherwise. If you have ever been told you have microscopic blood in your urine or if you have ever seen blood in your urine, ask your doctor about a referral to a urologist. This may be a sign of bladder cancer.

Gabriel Fiscus, MD, is a urologist with Regional Urology, a practice of Prisma Health. For more information about Regional Urology, click here.

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