Blood in the urine is common. but it is not considered normal. Blood in the urine almost always deserves a full evaluation. Blood in the urine is called hematuria.

Blood may be visible to you. This is called gross hematuria (because it is grossly visible, not because it is gross). It will appear red, pink or rust colored. There can be clotting or flecks of red blood. You may see blood only one time or there may be repeat episodes. Any of these indicate there may be a problem. Gross hematuria always requires evaluation. A full evaluation of gross hematuria most often includes a cystoscopy, kidney imaging such as CT scan, and urine testing for infection and possibly cytology or FISH testing.

The blood may only be visible under a microscope (called, for obvious reasons, microscopic hematuria). The critical element for diagnosing microscopic hematuria is actually seeing red blood cells under a microscope. Microscopic hematuria can indicate just as serious of a problem as gross hematuria. That is worth repeating. Microscopic hematuria can indicate just as serious a problem as gross hematuria. Microscopic hematuria requires a similar evaluation in most cases with a cystoscopy, CT or Ultrasound, and possibly urine cytology or other urine testing. Some patients have low risk microhematuria that does not require invasive testing.

Common problems causing blood in the urine include infections, kidney stones, and cancers such as bladder or kidney cancer. The list of possibilities is long. The most concerning findings are when we find cancer or a stone that is actively causing a problem.

Blood in the urine may not reveal any problems at all. You may have blood in the urine without ever having any problem develop because of it. Many of the evaluations we do for blood in the urine, particularly microscopic hematuria, do not find any specific pathology that requires repair or correction.