Why There Might Be Red Blood Cells In Your Urine
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Medically reviewed by Alexandra Dubinskaya, MD
Red blood cells in the urine, also termed hematuria, is a condition characterized by blood entering your urinary tract and being expelled along with your urine. Your urine might turn pink, brown, or red due to the presence of red blood cells (RBCs). However, in some cases, the amount of RBCs is too low and can be detected only under a microscope.
Along with changes in urine color, you might also experience pain during urination, fever, weight loss, abdominal pain, and joint pain. The presence of red blood cells in urine in addition to these other symptoms is usually a sign of an underlying condition.
You may want to see a healthcare provider to determine what is causing you to have hematuria. They might recommend a urine test along with other tests to determine the exact cause and provide an accurate treatment approach.
Symptoms of Hematuria
Hematuria can be symptomatic or asymptomatic (no symptoms) depending on the type you have. The two types of hematuria are:
Microscopic hematuria: This is when you cannot see the blood in your urine, but it can be detected under the microscope or through urine tests.
Gross hematuria: This is when you can see the blood in your urine.
Gross hematuria can cause your urine to look pink, brown, or red. You might also notice the passage of blood clots in your urine.
You might also experience other associated symptoms such as:
Pain during urination
Loss of weight
Abdominal pain
Fever
Joint pain
Frequent need to urinate
Back pain
Many conditions can cause one or more of these symptoms. To get an accurate diagnosis, visit your healthcare provider if you notice any changes in the color of urine along with one or more of these symptoms.
Causes
Red blood cells can appear in urine due to various causes, with some being more serious than others. A few common causes that result in RBCs in urine are:
Urinary tract infections (UTIs): UTIs occur when bacteria enter and multiply in the urinary tract (the bladder through the urethra) and are more common among women than men. UTIs can lead to RBCs in urine as well as other symptoms such as pain during urination, urgency to urinate, and inability to start urination.
Vigorous exercise: Excessive exercise can damage tissues and cause internal injuries resulting in RBCs in urine.
Prostate disorders: Prostate disorders such as prostatitis, benign prostatic hyperplasia (BPH), or prostate cancer can lead to RBCs in urine.
Kidney infection: Kidney infections (pyelonephritis) begin mostly in the urinary bladder and ascend to the kidneys can also result in the occurrence of RBCs in urine.
Kidney or bladder stones: Kidney or bladder stones can lead to infections and obstruction to the flow of urine and cause RBCs to occur in urine.
Trauma: Kidney or bladder injuries due to severe accidents can also cause RBCs to occur in urine.
Other, less common causes of red blood cells in urine include:
Sickle cell disease (SCD): A group of rare inherited red blood cell disorders that causes red blood cells to have a distorted shape, making it easier for them to break down.
Kidney or bladder cancer: When cancer occurs in the kidney(s) or bladder.
Endometriosis: A condition that occurs when tissue that is similar to the lining of the uterus (known as the endometrium) grows outside the uterus.
Certain medications such as blood thinners: These can cause blood to seep into your urinary tract and exit your body when you pee.
Keep in mind: some foods can also cause your urine to appear red or bloody, but it's not actually bloody urine. For example, eating foods like rhubarb and beets can often make your urine look red or pink in color.
Related: Why Am I Peeing Blood—And Is It an Emergency?
How Are Red Blood Cells Detected in Urine?
Your healthcare provider may ask questions about your medical history and carry out a physical examination for an initial diagnosis. Your primary care provider may also refer you to a urologist (a doctor who specializes in the genitourinary system) or an OB-GYN (a doctor who specializes in the female reproductive system). They might perform a digital rectal exam for men or a pelvic exam for women as part of the physical examination.
Several tests can confirm the presence of red blood cells in your urine as well as determine the cause. A urinalysis (a urine test) is most often the first recommended test. It analyzes a sample of your urine for the presence of red blood cells as well as other contents.
Trace amounts of RBCs in your urine is normal. But if your urinalysis shows that you have an above-average amount of RBCs in your urine, further testing may be performed. These additional tests include:
Blood tests: Blood tests can help to identify kidney problems, autoimmune diseases, or other conditions such as prostate cancer.
Cystoscopy: This procedure uses a long, thin instrument with a camera (called a cystoscope) to visualize the bladder and urethra to detect any potential abnormalities.
Kidney biopsy: This procedure involves the extraction of one or more tissues from the kidney followed by an examination under a microscope to detect any signs of kidney disease or kidney damage.
Imaging test: Imaging tests such as ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI) can help create images of internal organs and detect kidney stones, tumors in the urinary tract, or other kidney abnormalities.
What to Expect From the Test
You don’t need any special preparation for getting tested for red blood cells in urine. You might need to follow certain steps for using the "clean catch" method during urine collection, which prevents germs from the skin from entering the sample. These steps include:
Washing your hands with soap and water and drying them properly before opening the container that will be provided for collection
Opening the container without touching the inside of it
Cleaning the urethral area prior to urinating
Collecting the urine in the container, closing the lid, and returning it for the test
Keep in mind that you may need to fast (not eat) or complete other instructions before a blood test.
Understanding Your Results
Four or fewer red blood cells per high power field (RBC/HPF) is indicative of a normal result. However, this range can vary slightly among different laboratories. Your results sheet should list what they define as a "normal" range for their laboratory equipment.
The presence of more than four red blood cells per high power field (RBC/HPF) might be indicative of underlying kidney or urinary tract abnormality.
Treating Hematuria
In some cases, red blood cells can appear in urine due to various problems such as strenuous activities, taking certain medication, or menstruation, which are generally nothing to be concerned about. However, it can also be a sign of severe conditions such as:
Bladder, prostrate, or kidney cancer
Inflammation of the kidney, bladder, or urethra
Polycystic kidney disease
Viral infections including hepatitis
There is no specific treatment for red blood cells in urine. Your healthcare provider will treat red blood cells in your urine by treating its underlying cause.
A Quick Review
Blood in urine (hematuria) is a condition that can be caused by kidney or bladder stones, kidney infection, urinary tract infection, vigorous activities, and trauma, among other potential contributors. In some cases, it causes a change in urine color while in others it remains asymptomatic. Having trace amounts of red blood cells in your urine is normal and should not cause concern.
Visit a healthcare provider if you notice red blood cells in your urine, especially if accompanied by any concerning symptoms. This will help you and your provider identify a diagnosis early on so you can treat the underlying cause right away.
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