Blood in the urine (or as medical professionals call it, hematuria) may be an alarming sight for anyone. At the Austin Urology Institute, we perform a thorough work-up to see where the blood is coming from and how it ended up in your urine. Treatment and management is then based upon those findings

Hematuria Information

What is hematuria?

Hematuria is presence of red blood cells in the urine. There are many reasons why a woman can have blood in her urine. Hematuria can be an indication of a serious problem or may prove to be a benign or non-threatening finding.

What are the common causes of hematuria?

Studies have shown that between 9-18% of normal, healthy women can have some degree of hematuria, with no problems or diseases. For others, the causes may include:

  • Kidney stones
  • Urinary tract infections (UTIs)
  • Cystitis (inflammation of the bladder)
  • Bladder Cancer
  • Kidney Cancer
  • Injury to the kidneys, ureters, or bladder

How is hematuria diagnosed?

It can be characterized as “microscopic” (visible only under the microscope) or “gross” (visible to the naked eye).

Microscopic hematuria may be discovered on urine tests as part of a routine medical evaluation, whereas gross hematuria that you can see, should prompt a visit to the a specialist. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, and the urethra.

Which tests are typically done?

Any female patient with gross hematuria or significant microscopic hematuria should have further evaluation of the urinary tract. The first step is a careful medical history review and a physical examination. Other testing includes:

  • Urine analysis – a quick office procedure done by a dipstick test, which is able to detect blood.
  • Urine culture – if there is an indication that there may be bacteria growing in the urine, this test will confirm and tell us specifically which bacteria is present.
  • Imaging – imaging typically involves either an ultrasound or CT scan, which allows us to evaluate for kidney stones, masses, tumors, or other abnormalities that could be contributing to blood in the urine.

If these common tests come back negative, or we need further evaluation of the source of bleeding, we may perform additional procedures.

  • Urine cytology – a look for abnormal cells in the urine. This test is done in our office with a urine sample that you leave. Within 30 minutes the test will turn positive or negative for abnormal cells. If it is positive, we will do further testing to rule out diseases such as bladder cancer.
  • Cystoscopy – involves a small camera advanced through the urethra into the bladder, to look for irregularities in the inner lining of the urethra and bladder. This is a short procedure done in our office, which takes 1-2 minutes to do on average. A topical analgesic is applied to the urethra before we begin. Since the camera is attached to a video screen, you can look along with us.


Treatment for blood in the urine depends on the cause and source of the blood. For less complex causes such as the presence of kidney stones or infection, care involves simply treating the condition. Kidney stones may be treated by observation, medications, and surgery. Simple urinary tract infections are treated with oral antibiotics. In more complex causes such as bladder or kidney cancer, the blood in the urine is an indication of a larger problem that needs to be properly managed.

What if no abnormality is found?

  • In an estimated 8-10% of cases, no cause for hematuria is found. Unfortunately, studies have shown that urologic malignancy is later discovered in 1-3% of patients with negative work-ups. Therefore, some form of follow-up is recommended.
  • Consideration should be given to repeating the urinalysis and urine cytology every six months for two-to-three years. Immediate re-evaluation with possible cystoscopy and repeat imaging should be performed in the face of gross hematuria such as visible blood in the urine, abnormal urine cytology, or irritating urinary symptoms such as pain with urination or increased frequency of urination. If none of these symptoms occur within three years, no further urologic testing is required.
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