Haematuria (Blood in Urine): What It Means and What to Do
Disclaimer: This content is for educational purposes only and is not a substitute for professional clinical advice from a healthcare provider.
Haematuria is the medical term for blood in the urine. While it can be alarming to notice, it is not always a sign of something serious – but it should never be ignored. Haematuria can arise from a range of conditions affecting the urinary tract, from minor infections to kidney disease. Understanding what it means, what causes it, and when to seek medical attention is the first step towards protecting your health.
Table of Contents
What Is Haematuria?
Under normal conditions, urine should not contain red blood cells. Haematuria occurs when red blood cells leak into the urine from anywhere along the urinary tract, which includes the kidneys, ureters, bladder, and urethra. Depending on the quantity of blood present, haematuria may be visible to the naked eye or detectable only under a microscope.
Types of Haematuria
Microscopic Haematuria
In microscopic haematuria – also known as microhaematuria – the amount of blood in the urine is so small that the urine appears completely normal. It can only be detected using a dipstick urine test or by examining the urine under a microscope. It is often discovered incidentally during routine health screenings, pre-employment medical examinations, or National Service check-ups in Singapore.
Gross Haematuria
Gross haematuria – also called macrohaematuria – is visible to the naked eye. The urine may appear pinkish, red, or smoky brown (tea-coloured). Even a few millilitres of blood can turn an entire bladder full of urine visibly red, so the degree of discolouration does not necessarily reflect how serious the underlying cause is. Gross haematuria requires prompt medical evaluation.
What Causes Haematuria?
Haematuria can result from any condition that causes inflammation or injury along the urinary tract. Common causes include:
- Kidney stones – stones passing through the urinary tract can cause irritation and bleeding
- Urinary tract infections (UTIs) – bacterial infections of the bladder or kidneys are a frequent cause, particularly in women
- Glomerulonephritis – inflammation of the kidney filters (glomeruli), one of the more common kidney-related causes; it is the second most common cause of kidney disease in Singapore, according to the Annals, Academy of Medicine Singapore [1]
- Growths in the urinary tract – both cancerous and non-cancerous growths in the bladder, kidneys, or urethra can cause blood in the urine
- Inherited conditions – such as polycystic kidney disease
- Medications – blood-thinning medications such as warfarin, as well as some pain relievers and laxatives, can cause haematuria
- Enlarged prostate – common in older men; an enlarged prostate compressing the urethra can cause bleeding
- Strenuous exercise – in rare cases, intense physical activity can trigger temporary haematuria
It is also important to note that urine can appear pink or red without actual bleeding from the urinary tract. This may be caused by foods such as beetroot and blackberries (due to their anthocyanin pigment), certain medications such as phenothiazines, or menstrual blood accidentally contaminating a urine sample.
Symptoms Associated With Haematuria
Blood in the urine is itself a symptom. However, depending on the underlying cause, other symptoms may also be present. These include:
- Pain in the back, lower abdomen, or groin
- A burning sensation or pain when passing urine
- Frequent or urgent need to urinate
- Fever
- Nausea or vomiting
The presence or absence of these additional symptoms can help your doctor narrow down the cause of the haematuria.
How Is Haematuria Diagnosed?
Because haematuria can result from many different conditions, your doctor will need to conduct a series of investigations to identify the underlying cause. It is important to give your doctor a full account of your medical history, any medications you are taking, and the circumstances surrounding the bleeding. Commonly ordered tests include:
- Urine protein test – using dipstick strips or a laboratory test to measure the amount of protein in the urine
- Urinalysis – to examine the urine for white blood cells and chemical constituents
- Urine culture – to identify any bacterial infection
- Blood tests – to assess kidney function
- Radiological investigations:
- Intravenous pyelography (IVP) – a dye is injected into a vein and a series of X-rays is taken to visualise the kidneys and urinary tract
- Ultrasound scan – uses high-frequency sound waves to examine internal structures; safe for use during pregnancy as it involves no radiation
- CT scan – provides more detailed images than a standard X-ray
- Cystoscopy – a flexible tube with a camera is inserted into the bladder to examine its inner lining; performed by a urologist under local anaesthetic
- Renal biopsy – may be recommended if moderate to severe kidney inflammation (glomerulonephritis) is suspected; involves taking a small piece of kidney tissue for examination under a microscope; requires hospital admission
How Is Haematuria Treated?
Treatment depends entirely on the underlying cause. There is no single treatment for haematuria itself – investigation to identify the cause is essential before treatment can begin. Depending on the diagnosis, treatment may include:
- Antibiotics for urinary tract infections – complete the full course as prescribed
- Increased fluid intake and pain relief for kidney stones – drinking plenty of water helps pass smaller stones; larger stones may require medical intervention
- Medication review – if a medication is causing haematuria, discuss stopping or adjusting it with your healthcare provider
- Long-term monitoring and management for glomerulonephritis – this condition can lead to kidney failure, so early control is essential
- Surgical or specialist intervention for growths, structural problems, or prostate issues
When Should You See a Doctor?
You should seek medical attention promptly if:
- You notice visible blood in your urine, even if it is painless
- Blood in the urine is detected during a routine urine test
- You experience pain when urinating, lower back pain, or fever alongside haematuria
- You are on blood-thinning medication and notice haematuria
- You have a family history of kidney disease, polycystic kidney disease, or glomerulonephritis
Do not attempt to self-diagnose or delay seeking medical care. Early investigation can identify serious underlying conditions – including kidney disease and urinary tract cancers – at a much more treatable stage.
Frequently Asked Questions About Haematuria
What is haematuria? Haematuria is the presence of red blood cells in the urine. It may be visible to the naked eye (gross haematuria) or detectable only under a microscope (microscopic haematuria).
What is the most common cause of haematuria? Urinary tract infections are among the most common causes, particularly in women. Kidney stones and glomerulonephritis are also frequent causes; according to the Annals, Academy of Medicine Singapore, glomerulonephritis is the second most common cause of kidney disease in Singapore. [1]
Is haematuria serious? It depends on the cause. Some causes are minor and easily treated, while others – such as glomerulonephritis, kidney disease, or urinary tract cancers – require prompt and ongoing management. Any case of haematuria warrants medical evaluation.
Can haematuria go away on its own? In some cases, such as haematuria triggered by strenuous exercise or a minor infection that resolves with treatment, blood in the urine may clear up. However, haematuria should never be assumed to be harmless without proper investigation.
How is haematuria detected if I cannot see the blood? Microscopic haematuria is detected through a dipstick urine test or urinalysis, which may be carried out during routine health screenings, insurance medicals, or National Service examinations in Singapore.
Your Kidney Health Matters
Haematuria is often the first visible sign that something may be affecting your kidneys or urinary tract. Whether it is a treatable infection or an early indicator of kidney disease such as glomerulonephritis, getting checked early makes a significant difference to your long-term health outcomes.
If you have been diagnosed with kidney disease and require dialysis, the Kidney Dialysis Foundation (KDF) provides subsidised treatment and wrap-around support for needy kidney patients across Singapore. Contact KDF to find out more about our programmes and financial assistance schemes.