Even a single episode needs assessment. Painless blood in urine is the one people most often ignore.
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Visible blood in the urine always needs assessment — even a single episode, even if it settles, and particularly if it was painless.
Go to A&E for blood in the urine with severe loin pain and vomiting, an inability to pass urine, or a high fever with shivering.
Painless visible blood is the pattern that matters most, especially over 45. It is easy to dismiss precisely because nothing hurts, and it is the classic presentation of bladder cancer — which is highly treatable when found early.
This warrants an urgent NHS two-week-wait referral, which your NHS GP can access and we cannot. We will write to them the same day.
Blood in the urine comes in two forms. Visible — pink, red or cola-coloured — and non-visible, picked up only on a urine test.
Both need explaining, but the visible kind more urgently. Most causes turn out to be infection or a stone. The reason it is never simply watched is the minority that are not.
Common — urinary infection, usually with burning and frequency; kidney or bladder stones, causing severe loin pain radiating to the groin; enlarged prostate in men.
Not blood at all — beetroot, some food dyes, and rifampicin all discolour urine. Worth ruling out before alarm, though a test settles it.
Kidney — glomerulonephritis, often after a throat infection, typically with cola-coloured urine and ankle swelling.
The reason for urgency — bladder and kidney cancer. Risk rises with age, smoking and certain occupational exposures. Painless visible blood in someone over 45 is the presentation that must not be dismissed.
After exercise — marathon running and other endurance exercise can cause transient blood. Still worth checking once.
If you have seen blood in your urine, it needs investigating — even if it happened once and has completely stopped.
Bleeding from a bladder tumour is characteristically intermittent. It appears, alarms you, disappears for weeks, and by the time an appointment comes round everything looks normal and the episode feels like an overreaction. It was not an overreaction. Visible blood in urine is investigated on the history, not on whether it is still happening.
Write it down with the date. Photograph it if you can — the colour is genuinely useful and difficult to describe accurately afterwards.
If there is any doubt at all, treat it as blood.
The consultation covers colour, whether it is throughout the stream or only at the start or end, pain, urinary symptoms, and risk factors including smoking history.
We arrange urine testing and culture, kidney function, and PSA in men. Imaging — usually ultrasound or CT — can be arranged privately alongside.
Where the blood is visible and painless, particularly over 45, the right route is your NHS GP and the urgent haematuria pathway. We will say so plainly rather than starting a private workup that delays it, and write to them the same day.
Yes — and this is the question that matters most. Bleeding from a bladder tumour is typically intermittent: it comes, it goes, and the gap is often weeks. Visible blood in urine is investigated on the basis that it happened at all, not on whether it is still happening at the appointment. Many delayed bladder cancer diagnoses follow exactly this pattern of one alarming episode that resolved.
No — the reverse. Painful bleeding usually means infection or a stone. Painless visible blood in the urine is the classic presentation of bladder cancer, and the absence of pain is precisely why people wait.
It might be — but a UTI causes stinging, urgency and frequency alongside the blood. Blood without those symptoms is not a UTI, and neither is blood that persists after an infection has been treated. Repeat urine testing after treatment is important, because "it was just a UTI" is another route by which serious diagnoses get missed.
No, and this is a common and costly misunderstanding. Anticoagulants do not cause bleeding from healthy tissue; they unmask a source that was already there. Bleeding on an anticoagulant is investigated exactly as it would be otherwise — arguably with more attention, not less.
Exercise-related blood in the urine is a genuine phenomenon, particularly in long-distance runners. But it is a diagnosis made after investigation, not instead of it. Get the first episode checked; if everything is clear and it recurs only after hard exercise, that becomes a reasonable explanation.
It matters less, but it is not nothing. Non-visible (microscopic) blood found on testing warrants a check of kidney function and blood pressure, and further investigation if you are over 60 or have other symptoms. Visible blood is in a different and more urgent category altogether.
Typically urine testing to exclude infection, kidney function and a full blood count, and in men a PSA. Visible blood generally leads to urology referral for a cystoscopy and a scan of the kidneys and bladder — a camera test of the bladder, which is the only thing that reliably settles it.
Visible blood in the urine at any age warrants urgent assessment, and over 45 it usually triggers an urgent suspected-cancer referral. We can take the history, arrange the bloods and urine tests, and make that referral — which is often the most useful thing, because getting onto the right pathway quickly is what changes the outcome.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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