Blood in urine: causes, what to do and when to worry

The NHS says blood in your pee could come from anywhere in the urinary tract, which is the bladder, kidneys or urethra (the tube that carries pee out of the body). If you have other symptoms, they may give an idea of the cause, but the NHS says not to self-diagnose.

The NHS table below lists common causes. Cancer is also a possible cause, which is why every episode needs checking.

Treatment depends on the cause, which is why assessment comes first. The NHS says a GP may ask for a pee sample or arrange a blood test, prescribe antibiotics if they think you have an infection, or refer you to a specialist for tests.

For a urinary tract infection, the NHS says antibiotics are sometimes needed, and you can ease symptoms by taking paracetamol, resting and drinking enough fluids. For kidney stones, the NHS says most can be treated at home with plenty of water and medicines for pain, sickness and helping the stone pass, while larger stones may need a procedure or surgery in hospital. Where the cause is a serious condition such as cancer, treatment is led by a specialist team.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have blood in your pee or think you may have blood in your pee. This applies even if there is only a small amount, it is the first time it has happened, or you are not sure it is blood.

The NHS also says to ask for an urgent GP appointment or call NHS 111 if you think you have kidney stones and you are in severe pain, or have a high temperature or feel hot, cold or shivery.

The NHS says blood in your pee may be bright pink, red or dark brown. Sometimes there is no visible colour change and blood is only found on a urine test, which the NHS covers under tests a GP may arrange.

It may not be blood. The NHS says to consider whether you recently ate beetroot, which can turn pee pink, are taking a new medicine, since some medicines turn pee red or brown, are bleeding from your bottom instead, or whether it is happening during your period or you are bleeding from your vagina between periods. If you are not sure, the NHS still says to get it checked.

It can be, though most causes are not cancer. The NHS says blood in your pee must be checked out because it can be a sign of cancer. Bladder cancer is one example, and the NHS says its main symptom is blood in the pee.

NICE guideline NG12 sets out when a GP should use a suspected cancer pathway referral. It includes people aged 45 and over with unexplained visible blood in the urine without a UTI, or visible blood that persists or recurs after successful treatment of a UTI, and people aged 60 and over with unexplained non-visible blood in the urine with pain on peeing or a raised white cell count.

The NHS says a GP will ask about your symptoms and may need to check inside your bottom (rectal examination) or your vagina. They might also ask for a pee sample or arrange a blood test, prescribe antibiotics if they think you have an infection, or refer you to a specialist for tests.

For suspected bladder cancer the NHS says the main test is a cystoscopy, where a thin camera is passed through the urethra into the bladder. Scans such as ultrasound, CT or MRI may also be used.

The NHS says pregnancy increases the risk of bacteria getting into the bladder and causing a urinary tract infection, which is one cause of blood in the urine. Blood in your pee still needs checking whether or not you are pregnant. Tell your GP or midwife promptly if you see blood in your pee in pregnancy, and ask whether a pee sample should be tested.

On the NHS the route is an urgent GP appointment or NHS 111, then urine tests, blood tests and, where needed, referral to a urology specialist for a cystoscopy or scans.

Some people choose to arrange tests privately, for example a scan or cystoscopy, for speed. In general terms the same tests apply. The key points are to make sure a cause is found, that results are shared with your GP, and that any blood that persists or comes back after treatment is followed up rather than assumed to be the original infection.