Blood in the urine (hematuria) – symptoms, causes, therapies

Red colored urine is often a shock for those affected and should never be taken lightly. Even if there is not always something bad behind it, red urine should always be clarified with a doctor. Sometimes it is only the coloring in food that is to blame, for example as a result of eating beetroot, and medications that, for example, thin the blood, can also lead to blood in the urine. However, there can also be a serious illness behind it. Bloody urine is called hematuria. This can have a variety of causes, ranging from a slight irritation of the mucous membrane in the urogenital tract to cancer.

Table of Contents

  • Visible and invisible blood in the urine
  • Blood in the urine – a brief overview
  • definition
    • Macro hematuria
    • Microhematuria
  • How does the blood get into the urine?
  • Possible sources of bleeding
  • Blood-like residues in the urine
    • March hemoglobinuria
    • Porphyria and myoglobinuria
  • The kidneys as the cause
    • Inflammation of the kidney (pyelonephritis)
    • Kidney stones
    • Inflammation of the kidneys
    • Kidney tumor
    • Renal tuberculosis
    • Renal vein thrombosis
    • Renal infarction
    • Cystic kidneys
    • Injuries to the kidney
    • Renal papillary necrosis
  • Bladder and urinary tract as the cause
    • Cystitis
    • Symptoms of a urinary tract infection
    • Bladder and ureter stones
    • Diverticulum
    • Bladder schistosomiasis
    • Bladder tumors
  • Causes only in men
    • Prostate cancer
    • Inflammation of the prostate and seminal vesicles
    • Prostate variceal bleeding
  • Cause only in women (endometriosis)
  • Systemic and autoimmune diseases
    • Panarteritis nodosa
    • Lupus nephritis
    • Purpura-Schoenlein-Enoch
    • Granulomatosis with polyangiitis
    • Goodpasture syndrome
  • Medications as a cause of bleeding
    • Sickle cell anemia
  • A visit to the doctor is essential
  • diagnosis
  • therapy
  • Prevention
    • Drink plenty and regularly
  • Naturopathy for blood in the urine

Blood in the urine – a brief overview

There are numerous causes that can be responsible for bloody urine. The individual possible causes and further information on diagnosis, therapy, prevention and naturopathy will be explained in more detail below. Here is a brief overview:

  • Definition: The technical term for blood in the urine is hematuria. This means an abnormal excretion of red blood cells (erythrocytes) in the urine.
  • Shapes: A hematuria is further divided into macro and micro hematuria. In the case of a macro hematuria, the blood admixture is visible, while a micro hematuria can only be determined by laboratory tests.
  • Possible causes: The causes are roughly divided into three areas. The source of bleeding can lie behind the kidney (postrenal), in the kidney (renal) or outside the kidney area (prarenal). Numerous diseases can cause blood to build up in the urine.
  • Diagnosis: urine test, blood test, X-ray, bladder examination, CT, MRI, ultrasound, prostate examination.
  • Therapy: Treatment depends heavily on the cause. Antibiotics are used more often. Some causes also require special diets or diets.
  • Prevention: Physical exercise, healthy eating, relaxation exercises and stress relief , no smoking, drinking little alcohol, reducing excess weight, drinking lots of low-sugar liquids.
  • Naturopathy for support: autologous blood therapy , homeopathy, phytotherapy , acupuncture , foot reflexology massage.


Hematuria (blood in the urine) is the pathological excretion of red blood cells (erythrocytes) in the urine. Since a small amount of blood can also be found in the urine of healthy people, hematuria only occurs when there are more than five to ten red blood cells per microliter of urine. Bloody urine may or may not be associated with other symptoms such as pain and discomfort when urinating. Depending on the amount of blood contained, the hematuria is divided into macro and micro hematuria.

Macro hematuria

With a macro hematuria, the blood is immediately recognizable, which is quite a shock to many patients. However, this is not immediately an indication of a specific disease, but must be clarified. For example, a macro hematuria is caused by:

  • Kidney stones,
  • Tumors of the urinary tract or kidneys,
  • Tuberculosis of the urogenital tract,
  • Cystic kidneys,
  • Cystitis,
  • hemorrhagic diathesis (increased bleeding tendency),
  • Trauma (e.g. through catheterization),
  • Endometriosis (disease of the womb lining).

Blood in the urine must be checked by a doctor. (Image: angellodeco /


In microhematuria, the blood in the urine is not visible to the naked eye, but is discovered during a microscopic examination or with the help of a test strip. This can be a coincidental finding in which those affected do not feel any symptoms. Microhematuria can occur for all of the causes of macrohematuria mentioned, and also for:

  • Pyelonephritis (inflammation of the kidneys),
  • interstitial nephritis (inflammation of the kidneys with involvement of the urinary tubules and the surrounding connective tissue),
  • mechanical load (or overload),
  • Glomerulonephritis (inflammation of the kidney corpuscles).

How does the blood get into the urine?

Filtering the blood creates urine in the kidneys. This is concentrated via the ureters to the bladder and from there via the urethra to the outside. This fluid does not normally contain any blood components, but various diseases can cause blood residues to be released in the urine. However, reddish discoloration of the urine does not necessarily have to be caused by blood. Some foods such as beetroot or blueberries can temporarily leave traces of color in the urine. In this case, the problem should be resolved after a few toilets. If there is actually blood in the urine, this can be the cause of a sometimes serious illness that should urgently be checked with a doctor. Possible causes are explained below.

Possible sources of bleeding

Bloody urine, in the form of so-called coagulum (special form of the blood clot), sometimes occurs when the bleeding source is behind the kidney (medical: postrenal). An example of this would be the bladder as a postrenal source. If the cause lies in the kidney itself, one speaks of renal hematuria. Other sources can also be outside the urological-nephrological area. These causes lying in front of the kidney are medically referred to as prerenal hematuria. This is the case with gynecological bleeding sites or with an increased tendency to bleed.

If blood is present in the urine, this is a shock for many of those affected. However, the causes are often easy to treat. However, a visit to the doctor should not be put on the back burner. (Image: demphoto /

Blood-like residues in the urine

With the naked eye it is not absolutely possible to clarify whether there is really blood in the urine. For example, it can also be a so-called hemoglobinuria. It is not the erythrocytes (red blood cells) in the urine but hemoglobin (red blood pigment). This can be the case with certain forms of anemia or with autoimmune diseases.

March hemoglobinuria

A special form of hemoglobinuria is marching hemoglobinuria. This is a disease that primarily affects people who exercise massively. The hemoglobin is literally “squeezed” out of the blood cells and therefore ends up in the urine. This is usually harmless, but should be clarified with a doctor.

Porphyria and myoglobinuria

A red colored urine can also develop with a so-called porphyria. This is a metabolic disorder that disrupts the production of the red blood pigment. Myoglobinuria can also stain the urine red. Myoglobin is the oxygen-binding muscle dye. Muscle injuries can get into the bloodstream and eventually into the urine, giving it a reddish color. This is possible, for example, in competitive sports or through the decline or death of muscles in a myocardial infarction.

The kidneys as the cause

As mentioned above, renal hematuria is when the cause of the bleeding is in the kidney itself. Some kidney diseases can be responsible for blood in the urine. These include:

  • Kidney inflammation,
  • Kidney stones,
  • Inflammation of the kidneys,
  • Renal tuberculosis,
  • Renal vein thrombosis,
  • Renal infarction,
  • Cystic kidneys,
  • Kidney injuries,
  • Kidney tumors,
  • Renal papillary necrosis.

Renal diseases are often the cause of bloody urine. (Image: benschonewille /

Inflammation of the kidney (pyelonephritis)

The pyelonephritis (medical pyelonephritis) is one of the most common kidney disease. This is usually caused by rising bacteria from the bladder. Its symptoms include fever , chills , nausea, vomiting, kidney pain , back pain , flank pain and hematuria.

Kidney stones

If there are too many of them, certain components of the urine can crystallize and stones can develop from them. In addition, other components such as the amount of drink and the pH of the urine play a role. Bacteria promote the development of kidney stones. The associated symptoms, when acute renal colic occurs, are massive cramp-like pain that can radiate to the back and genital area. There are also dysuria (problems and / or painful urination), blood in the urine, nausea and vomiting .

Inflammation of the kidneys

With a kidney infection, the so-called glomeruli is inflamed. This is a ball of blood in the renal cortex that is involved in blood filtering. The first stage of urine is formed here. Kidney inflammation is triggered, for example, by bacterial infections or inflammatory processes as a result of autoimmune diseases such as lupus nephritis. In addition, allergic reactions can also be responsible for inflammation of the urinary canals and the surrounding tissue. Signs of kidney infection are:

  • Increasing or decreasing urine volume,
  • Flank pain,
  • Fatigue,
  • Headache,
  • Body aches,
  • High blood pressure.

Kidney tumor

A benign kidney tumor is rare. These are usually found by chance, since they cause little to no complaints. Large kidney blood vessels that are at risk of bleeding are surgically removed. Malignant renal cell carcinoma is often symptom-free for those affected for a long time. Unfortunately, this means that the tumor is often only recognized at an advanced stage. Classic symptoms are micro or macro hematuria, which initially are completely painless and pain in the kidney or flank.

The picture shows the anatomy of the kidneys and the different stages of a kidney tumor. (Image: bilderzwerg /

Renal tuberculosis

Tuberculosis can affect not only the lungs but also other organs such as the kidney. This so-called extrapulmonary tuberculosis not only spreads in the kidney, but mostly in the entire urogenital tract. As a rule, those affected do not suffer excessively from the disease. Elevated temperatures (37.1 ° C to 37.9 ° C; temperatures immediately below the fever threshold), dysuria and hematuria are possible symptoms. However, even after a cured disease, the tuberculosis pathogens can survive in the body for years and cause a new outbreak.

Renal vein thrombosis

If a blood clot that is large enough to block the blood flow forms in the renal vein, then renal venous thrombosis is present. Inflammation, diabetes, tumors and injuries can promote the formation of such clots. Renal venous thrombosis often remains symptom-free for a long time. Sometimes there may be pain in the flanks, fever and hematuria.

Renal infarction

With a kidney infarction, a blood clot clogs the renal artery. The affected kidney tissue is undersupplied and dies. Depending on the extent, this disease is asymptomatic or causes massive pain in the abdomen and flanks, immune system tension, blood in the urine, fever and anuria (the amount of urine excreted is less than 100 ml / day). The causes of such an infarction can be of various types. A blood clot often detaches from a blood clot on the heart and is flushed through the bloodstream into the kidney, where it gets caught and clogs the artery. Atherosclerosis (vascular calcification), injuries, surgery or vascular inflammation are considered risk factors.

Cystic kidneys

A simple cyst in the kidney usually means no problem. In the presence of a so-called cystic kidney, which, in contrast to a simple cyst, is inherited, these encapsulated tumors, filled with fluid, can considerably restrict the function of the kidneys. The cysts are numerous and reach a diameter of several centimeters. They are common foci of inflammation and increasingly displace healthy kidney tissue. This can lead to complete kidney failure. Cystic kidneys cause symptoms such as:

  • unilateral or bilateral flank pain,
  • Hematuria,
  • High blood pressure,
  • chronic fatigue,
  • progressive kidney failure.

Injuries to the kidney

Blood must not be present in the urine if blunt force is applied. However, kidney trauma is sometimes associated with massive pain, defense tension and possible shock symptoms.

Kidneys and bladder are closely linked, so that kidney diseases are often noticeable through changes in the urine. (Image: Adiano /

Renal papillary necrosis

In the kidneys, the kidney marrow is formed by ducts. This is where the urine is filtered. The ducts converge in papillae, which then end in the kidney pelvis. Inflammation can cause the papilla to die or necrotize. Diabetes mellitus, anemia in the form of a sickle cell disease or pain medication abuse can lead to inflammatory processes. In this disease, those affected suffer from pain in the flanks, fever and blood in the urine.

Bladder and urinary tract as the cause

The urinary tract or bladder is often the source of bleeding. Various diseases in this area can be responsible for the blood in the urine. These include, for example:

  • Cystitis,
  • Bladder stones,
  • Ureteral stones,
  • Diverticula,
  • Bladder schistosomiasis,
  • Bladder tumors.


A quite common cause is the bladder infection (cystitis) or the so-called urinary tract infection. Pathogens can reach the bladder from the intestine via the urethra. Women are affected much more often because the intestine and urethral opening are not far apart and the female urethra is quite short. The development of a bladder infection is supported by drainage disorders, in women by frequent intercourse and also by inserting a catheter. Other triggers are wetness, cold, menstruation and the hormonal change in menopause.

Symptoms of a urinary tract infection

Symptoms of a urinary tract infection include frequent urge to urinate (pollakiuria), discomfort when urinating (dysuria) and constant painful urination (tenesmen). Blood in the urine can also be added. If fever and a poor general condition can be observed, the upper urinary tract is usually also affected.

Bladder and ureter stones

Bladder stones and ureter stones can also lead to blood residues in the urine. The stones are created by the fact that mineral salts, which normally occur dissolved in the urine, are precipitated and crystallize. The reasons for this are drainage obstructions, such as an enlarged prostate or a too narrow urethra. Inflammation also promotes the formation of bladder or urinary stones. Residual urine formation and protuberances in the bladder wall and the presence of diabetes mellitus and gout can also lead to the formation of urinary and bladder stones. Those affected show hematuria, frequent urge to urinate and so-called urine stuttering (urination occurs with interruptions).

Bladder and ureter stones can also cause blood in the urine. (Image: bilderzwerg /


Bladder diverticula are sac-like bulges on the bladder wall or the inner wall of the urethra. These are partly hereditary, but can also result from a bladder emptying disorder, narrowed urethra or enlarged prostate. The diverticula often cause pain when urinating, increased urination, and sometimes bloody urine.

Bladder schistosomiasis

Bladder schistosomiasis (schistosomiasis) is an infectious disease caused by suction worms. The suction worm larvae are found in water, mainly in tropical areas. But also here in Germany they are occasionally found in swimming lakes. If they get into the human organism, they settle in the bladder wall. Symptoms such as itchy rash, diarrhea, fever, cough, painful urination, and blood in the urine may occur. In addition, growths of the bladder mucosa are possible, from which a so-called precancerosis can develop.

Bladder tumors

Regardless of whether benign or malignant, painless hematuria is the main symptom in both bladder tumors. The bladder papilloma is a benign tumor with a low risk of degeneration. Bladder cancer, on the other hand, is one of the most common cancers of the urinary tract. Men are more affected than women. In the case of bladder papillomas (benign tumors of the bladder mucosa), those affected may suffer from recurrent cystitis in addition to hematuria. Blood in the urine and symptoms similar to those of cystitis accompany bladder cancer. Later there are flank pains and lymphatic congestion of the lower extremities (see fat legs ).

Causes only in men

The following diseases, which can be responsible for bloody urine, affect the male genital organs and can therefore only occur in men. These include, for example:

  • Prostate cancer,
  • Prostatitis,
  • Cystitis,
  • Prostate variceal bleeding.

Prostate cancer often goes undetected for a long time. Blood in the urine is often the only indication of this malignant tumor. (Image: PATTARAWIT /

Prostate cancer

This malignant tumor is difficult to detect because it develops over a long period of time and those affected are initially symptom-free. Because early detection is very important for successful treatment, men should take early warning of prostate cancer seriously. Blood in the urine is considered an early warning sign of prostate cancer. There may also be changes in urination, such as frequent use of the toilet, a sudden urge to empty your bladder, or difficulty starting to urinate. Later symptoms include blood in the sperm, pain in the pelvic area and erectile dysfunction.

Inflammation of the prostate and seminal vesicles

So-called prostatitis is a chronic or acute inflammation of the prostate. This happens, for example, when pathogens spread through the urinary tract and thus enter the prostate. Younger men with frequent sexual contacts are considered a risk group. Fever, urinary discomfort, discharge from the penis and possibly blood in the urine are signs of prostate inflammation. As a result of such inflammation, it can also lead to inflammation of the seminal vesicles, which can also lead to symptoms such as pain after sex, abdominal pain and blood in the sperm .

Prostate variceal bleeding

Varices are varicose veins that can also form from prostate veins if they expand pathologically. Such varices can cause hematuria without further pain or urinary problems.

Prostate diseases can be responsible for blood in the urine. (Image: Henrie /

Cause only in women (endometriosis)

Blood residues can pass into the urine of women during a normal menstrual period. When urinating, the period blood is partially captured by the flow of urine and washed away, which can cause the urine to change color. But there is also a disease that can be responsible for blood in the urine, especially in women. With endometriosis, the endometrium overgrows in places in the body where it shouldn’t be, for example in the bladder. As a result, there can be complaints like

  • heavy and painful menstrual bleeding,
  • Blood in urine,
  • Blood on the anus,
  • Abdominal pain,
  • and bleeding occurs.

Systemic and autoimmune diseases

With systemic diseases, several organs or regions of the body are involved in a disease process. With autoimmune diseases, the body is attacked by its own defense mechanisms. Many of these processes are still considered to be insufficiently understood. Hematuria can occur as a result of some system and autoimmune diseases. For example:

  • Panarteritis nodosa,
  • Lupus nephritis,
  • Purpura-Schoenlein-Henoch,
  • Granulomatosis with polyangiitis,
  • Goodpasture syndrome.

Panarteritis nodosa

In this rare vascular disease, arteries of various organs and the surrounding tissue are inflamed. If the kidneys are affected, blood in the urine, high blood pressure and swollen legs can occur.

Lupus nephritis

With this autoimmune disease, the body’s own defenses attack the skin and several internal organs. The striking rashes on the face are characteristic of the disease. If the kidneys are affected by this autoimmune disease, blood in the urine, swelling, flank pain and changes in urination can also occur.

Many autoimmune and systemic diseases such as panarteritis nodosa, lupus nephritis, purpura-schoenlein-henoch, granulomatosis with polyangiitis or goodpasture syndrome can be the cause of the bloody urine. (Image: Zerbor /


This vascular disease is characterized by symptoms in many small vessels in different parts of the body. The kidneys can also be affected in the course of the disease. This can be expressed by blood in the stool, blood in the urine, high blood pressure and abdominal pain.

Granulomatosis with polyangiitis

Granulomatosis with polyangiitis was formerly known as Wegener’s granulomatosis and is one of the inflammatory rheumatic diseases. Initially, the disease is characterized by repeated runny nose, sinus infections, ear pain, hearing loss and headache. If tissue changes in the kidney occur in the course of the disease, edema, hematuria and flank pain are often also shown.

Goodpasture syndrome

Chronic blood infections are characteristic of this autoimmune disease, which mainly affects the lungs and kidneys. Blood in the urine, cough with bloody expectoration and shortness of breath are signs of such a syndrome.

Medications as a cause of bleeding

In addition to the diseases described, medications can also be considered as triggers for blood residues in the urine, especially if they are taken in high doses and / or over a long period of time. These include, for example

  • Anticoagulants,
  • Antibiotics such as penicillins, cefalosporins, aminoglycosides or gyrase inhibitors,
  • Pain relievers like paracetamol,
  • other nonsteroidal anti-inflammatory drugs.

Sickle cell anemia

Sickle cell anemia leads to hemolytic anemia due to the destruction of the erythrocytes. Due to the occlusion of small arteries, those affected suffer from circulatory disorders with severe pain in multiple organ areas. Macro hematuria is also possible.

The urologist will usually perform a urine test after the patient interview and a physical exam. (Image: Lothar Drechsel /

A visit to the doctor is essential

Much of the underlying causes of bloody urine are easy to treat. Affected people should therefore remain calm and consult a doctor if they notice any discolouration. A urologist may be consulted. After a detailed medical history, in which the patient reports how strongly the urine is colored and what additional symptoms are present, further examinations will follow.


After a detailed patient consultation, the doctor has a number of diagnostic options available. In most cases, a physical examination and a urine and possibly a blood test are carried out first. Other diagnostic options are x-ray, bladder examination, CT and MRI. Urologists often use ultrasound techniques to examine the kidneys and bladder. The prostate is also often examined in men.


The respective cause of the bloody urine largely determines which therapies are used. The treatments depend on the existing disease. For example, an antibiotic is often used to treat cystitis. Patients are advised to drink enough so that any pathogens can be flushed out. Special bladder-kidney tea mixtures are suitable here. Certain diets and diets may sometimes be necessary during or after therapy.


Kidney diseases can be the cause. Diabetics tend to develop kidney diseases. A healthy lifestyle is important for preventive purposes. This includes physical exercise, relaxation exercises and a healthy diet. Smoking and alcohol are absolutely counterproductive, and both should be avoided. Existing overweight or obesity should also be reduced.

These preventive measures can help prevent hematuria from occurring. Naturopathic support can also help prevent and cure many underlying diseases. (Image: prockopenko / /

Drink plenty and regularly

In general, the fluid intake is important, so that any germs do not settle in the first place, but are immediately transported outside. Coldness in the abdomen and cold feet should be avoided. Both can promote inflammation in the urogenital tract. If there is a heart disease, the amount to drink should be discussed with the doctor.

Naturopathy for blood in the urine

A patient with blood in the urine must, as already mentioned, be in a doctor’s office. However, in the case of uncritical, harmless inflammations in the urinary tract – accompanying medical treatment – naturopathy can promote recovery. The defense can be strengthened, for example, with the help of naturopathic therapies, especially if those affected tend to have recurring infections. This is done using autologous blood therapy , special diversion procedures, classic homeopathy and approaches to phytotherapy that strengthen the immune system . In order to strengthen the bladder and kidney, therapies such as acupuncture and the foot reflex zone massage are also used in naturopathyfor use. Appropriate herbs, administered correctly, round off the holistic treatment. (sw, vb)


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