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Health condition · Clinically reviewed

Haematuria, blood in the urine - when it matters and what the work-up looks like.

Visible or non-visible, transient or persistent. In adults, blood in the urine sits on a defined UK pathway - and that pathway starts with a clear conversation.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG12, BAUS and EAU standards you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK urology pathways including the 2-week wait bladder cancer route.

Key facts

Haematuria at a glance.

The essentials, in plain English - what haematuria is, the two forms it takes and the UK pathway that follows.

  • What it is

    Blood in the urine, visible to the eye (macroscopic) or picked up only on dipstick or microscopy (non-visible).

  • Two forms

    Visible haematuria (VH) is red or brown urine. Non-visible haematuria (NVH) is trace, small or large blood on dipstick.

  • Transient causes

    Post-exercise, catheter trauma, sexual activity, menstruation and dehydration can all cause a brief, harmless finding.

  • Persistent causes

    Any haematuria that keeps showing up needs a proper look. Bladder cancer is the concern that drives urgent referral.

  • Red flag pathway

    Visible haematuria at any age, and non-visible haematuria in adults over 45, trigger a 2-week wait urology referral under NICE NG12.

  • Investigations

    CT urogram or ultrasound of the urinary tract plus flexible cystoscopy is the standard work-up for adults.

Why this guide matters

A pathway, not a panic.

Most haematuria has a treatable cause. The three points below shape the whole UK approach.

  • Bladder cancer must be excluded

    The single most important reason for the 2-week wait pathway. Visible bleeding in an adult and persistent non-visible bleeding over 45 need urology.

  • Not every cause is cancer

    Stones, infection, an enlarged prostate and glomerular kidney disease account for the majority. A structured work-up finds them.

  • Anticoagulation is not the answer

    Warfarin, DOACs and antiplatelets can uncover bleeding but do not cause it. Haematuria on a blood thinner still needs investigation.

How the diagnosis is made

From first sample to a clear answer.

The steps a UK GP and urologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and risk factors

    Smoking (the strongest bladder-cancer risk), occupational exposure to aromatic amines, travel to schistosomiasis regions, family history, anticoagulants and recent trauma.

  2. 02

    Assessing

    Urine dipstick and MSU

    Confirm blood, exclude infection with a midstream sample sent for culture. Treat any UTI first and re-check the dip.

  3. 03

    Assessing

    Bloods

    Renal function (U&E and eGFR), full blood count and coagulation. Add urinary protein-to-creatinine ratio if a glomerular cause is possible.

  4. 04

    Confirming

    Urology 2-week wait referral

    Visible haematuria at any age, or non-visible haematuria over 45, meets NICE NG12 criteria for urgent suspected-cancer referral.

  5. 05

    Confirming

    Imaging the upper tract

    CT urogram is the gold standard for kidneys and ureters. Ultrasound of the kidneys and bladder is an alternative for lower-risk patients.

  6. 06

    Confirming

    Flexible cystoscopy

    A slim scope passed into the bladder under local anaesthetic. The gold standard for finding bladder tumours, stones and inflammation.

  7. 07

    Specialist

    Specialist next steps

    Urine cytology, urothelial FISH markers, kidney biopsy for glomerular disease, or a haematuria-clinic MDT review depending on the findings.

Typical timeline: urgent referral to answer within a fortnight under the 2-week wait pathway.

Symptoms

What haematuria actually looks like.

From frankly red urine to a trace on dipstick, and the features that push a case towards urgent referral.

  • Visible haematuria (VH)

    Red, pink or brown urine you can see. Any single episode in an adult needs referral, even if it settles.

  • Non-visible haematuria (NVH)

    Blood found on dipstick or microscopy. Persistent NVH needs work-up, especially over 45.

  • Clots or debris

    Passing clots is always significant and points strongly to a bladder or upper-tract source.

  • Loin or flank pain

    Colicky loin pain with blood suggests a stone. A dull, persistent ache raises concern for a kidney lesion.

  • Lower urinary tract symptoms

    Frequency, urgency, burning or a poor stream alongside blood can point to cystitis, prostate disease or bladder tumour.

  • Systemic features

    Rash, joint pain, breathlessness or reduced kidney function can flag glomerulonephritis or a vasculitis.

  • Transient triggers

    Recent hard exercise, a catheter change, sexual activity or menstruation can each mimic pathology.

  • Red flag - clots plus weight loss

    Painless visible haematuria, clots or weight loss in a smoker is bladder cancer until proven otherwise.

Treatment

How haematuria is treated in the UK.

Treatment always follows the diagnosis. Cancer, stones, infection, prostate disease and glomerular disorders each have their own specialist route.

  • Treat the underlying cause

    Every plan follows the diagnosis. Cancer, stones, infection, glomerular disease and coagulopathy each have their own pathway.

  • Bladder cancer pathway

    Transurethral resection of bladder tumour (TURBT), intravesical BCG, cystectomy or systemic chemotherapy and immunotherapy, led by a specialist urology MDT.

  • Stone disease

    Shockwave lithotripsy (ESWL), ureteroscopy with laser, or percutaneous nephrolithotomy (PCNL) depending on stone size and location.

  • Urinary tract infection

    Targeted antibiotics guided by culture. Recurrent infection warrants imaging and a look for an underlying cause.

  • Prostate causes

    BPH-related bleeding responds to 5-alpha reductase inhibitors and, when needed, HoLEP or UroLift. Prostate cancer follows its own MDT pathway.

  • Glomerular disease

    Haematuria with proteinuria or reduced kidney function is a nephrology problem. Immunosuppression is used for selected glomerulonephritides.

  • Review anticoagulation

    Warfarin, DOACs and antiplatelets can unmask bleeding but do not explain it. Haematuria still warrants investigation on blood thinners.

  • MDT follow-up

    Complex cases are discussed between urology, nephrology and oncology in a haematuria clinic or specialist MDT.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or urologist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Suspected cancer: recognition and referral (NG12).

  • British Association of Urological Surgeons (BAUS). Haematuria guidance and patient information.

  • European Association of Urology (EAU). Guidelines on non-muscle-invasive and muscle-invasive bladder cancer.

  • Renal Association / UK Kidney Association. Joint consensus statement on haematuria.

Red flags

When haematuria needs urgent attention.

Most causes are treatable, but a small group of presentations always warrant a same-week or same-day route.

  • Visible haematuria at any age

    A single episode of frankly bloody urine in an adult meets the 2-week wait criteria under NICE NG12. It must not be ignored, even if it clears.

  • Non-visible haematuria over 45

    Persistent dipstick blood in adults over 45, once infection is excluded, is a 2-week wait indication.

  • Haematuria on anticoagulants

    Warfarin, DOACs and antiplatelets can uncover bleeding but do not explain it. Investigate as you would in anyone else.

  • Clots or weight loss

    Painless bleeding, clot passage, weight loss or a smoking history sharply raises the concern for urothelial cancer.

  • Loin pain with fever

    Pyelonephritis with bleeding or a stone with obstruction and sepsis is an emergency. Same-day urology and A&E review.

  • Reduced urine output or AKI

    Haematuria with an acute rise in creatinine points to a glomerular cause or obstruction. Urgent nephrology or urology input.

  • Systemic features of vasculitis

    Rash, joint pain, sinus disease or breathlessness with haematuria raises suspicion for ANCA-associated vasculitis. Same-week referral.

  • Travel to schistosomiasis regions

    Haematuria after exposure in Africa or parts of the Middle East warrants schistosomiasis testing alongside standard urology work-up.

  • Loin pain haematuria syndrome

    Recurrent loin pain with haematuria after other causes are excluded. A specialist diagnosis of exclusion in tertiary centres.

Living with it

A defined pathway, and a set of habits.

Four things that make the biggest difference - not dismissing a single episode, staying hydrated, tackling risk factors, and staying in follow-up.

A quiet reminder

One episode is enough to act on.

In an adult, a single episode of visible haematuria is a referral trigger. It is not something to watch and wait on.

  1. 01 Investigate

    Never dismiss a single episode

    Even one episode of visible haematuria in an adult deserves a full urology work-up. Waiting to see if it comes back is not a strategy.

  2. 02 Hydrate

    Drink well before and after tests

    Good hydration reduces catheter and cystoscopy discomfort and helps clear minor bleeding after procedures.

  3. 03 Risk factors

    Stop smoking, know your work risks

    Smoking is the biggest modifiable driver of bladder cancer. Occupational exposure to dyes, rubber or paint solvents matters too.

  4. 04 Follow-up

    Stay in the pathway

    A normal first work-up does not always end the story. Persistent NVH still needs annual blood pressure, urine dip and kidney-function checks.

Frequently asked

Everything we get asked about haematuria.

Quick answers on visible and non-visible blood in the urine, tests, and what happens next.

  • What is haematuria?

    Haematuria means blood in the urine. Visible haematuria (VH) is red, pink or brown urine you can see. Non-visible haematuria (NVH) is blood found only on dipstick or microscopy. Both need thinking about, and the persistent versions need investigation.

  • Is a single episode of blood in the urine serious?

    In an adult, yes. A single episode of visible haematuria in anyone aged 18 or over meets NICE NG12 criteria for an urgent 2-week wait urology referral, even if the urine clears after one flush. The most common serious cause is bladder cancer, particularly in smokers and people over 60.

  • What causes non-visible haematuria?

    Common causes include urinary tract infection, stones, an enlarged prostate, glomerular kidney disease such as IgA nephropathy, and, importantly, urothelial cancer of the bladder, ureter or kidney. Transient triggers include hard exercise, catheter change, sexual activity and menstruation.

  • What tests will I have?

    A urine dipstick and midstream urine, blood tests for kidney function, full blood count and clotting, and imaging of the urinary tract with a CT urogram or ultrasound. Adults will usually also have a flexible cystoscopy to look inside the bladder. Selected patients have urine cytology or a kidney biopsy.

  • I take warfarin or a DOAC. Does that explain the blood?

    No. Anticoagulants can unmask an underlying bleeding source but do not cause haematuria on their own. UK guidance is clear that haematuria on a blood thinner still needs the full work-up. Do not stop your medication without speaking to the prescribing team.

  • What if all my tests are normal?

    Reassuring, but not always the end of the story. Persistent non-visible haematuria warrants an annual review with blood pressure, urine dipstick, protein-creatinine ratio and kidney function. A new episode of visible bleeding always triggers a fresh referral.

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