Why You Shouldn’t Ignore Blood in Your Urine: A Urologist’s Perspective on Hematuria
You notice a pink tinge when you flush. Or your urine looks darker than usual, maybe tea-colored or outright red. Your first instinct might be to attribute it to something you ate, a tough workout, or dehydration. And sometimes those explanations are correct. But blood in the urine, a condition urologists call hematuria, can also be the first visible sign of something that needs medical attention, including conditions where early detection changes the outcome significantly. Dr. Jon Lazare at Lazare Urology in Brooklyn evaluates hematuria regularly, and the message he gives every patient is consistent: even if it only happened once, even if it went away on its own, get it checked.
The cause is often benign. But the diagnostic process exists because the causes that aren’t benign are the ones you don’t want to miss.
Visible vs. Microscopic Hematuria
Hematuria comes in two forms. Gross hematuria is blood you can see. The urine may be pink, red, brown, or contain visible clots. It doesn’t take much blood to change the color of urine. Even a small amount can make it look alarming.
Microscopic hematuria is blood that’s invisible to the naked eye but detected on a urinalysis. This is frequently discovered incidentally during a routine physical or a pre-employment screening when the patient had no idea anything was off. Microscopic hematuria is actually more common than gross hematuria, and it warrants the same diagnostic workup because the underlying causes overlap.
The American Urological Association defines clinically significant microscopic hematuria as three or more red blood cells per high-power field on a properly collected urine specimen. If your primary care doctor flagged this on your lab work and referred you to a urologist, that’s why.
What Causes Blood in the Urine
The list of potential causes is long, and they range from completely harmless to life-threatening. A urologist’s job is to work through the possibilities systematically and rule out the serious ones.
Urinary Tract Infections
UTIs are one of the most common causes of hematuria, particularly in women. The infection irritates the bladder lining, which can produce blood along with the more familiar symptoms of burning, urgency, and frequency. A UTI is easily diagnosed with a urinalysis and urine culture and treated with antibiotics. If hematuria resolves completely after the infection clears and there are no other risk factors, additional workup may not be necessary. But if the blood persists after treatment, further investigation is warranted.
Kidney Stones
Stones can cause hematuria as they move through the urinary tract, scraping the lining of the ureter or bladder. The blood may appear alongside the classic flank pain and cramping of a stone episode, or it may be the only symptom if the stone is sitting quietly in the kidney. CT imaging can identify stones as small as 1 to 2 millimeters and is the standard diagnostic tool when stones are suspected.
Enlarged Prostate (BPH)
In men over 50, benign prostatic hyperplasia can cause blood in the urine. The enlarged prostate has increased blood supply, and the vessels on its surface can rupture, particularly during straining. BPH-related hematuria is typically intermittent and self-limiting, but it still requires evaluation to confirm the source and exclude other causes.
Bladder and Kidney Cancer
This is the reason hematuria can’t be dismissed. Bladder cancer is the fourth most common cancer in men, and painless gross hematuria is its most frequent presenting symptom. Kidney cancer, renal cell carcinoma specifically, can also present with blood in the urine, though it’s often detected incidentally on imaging before hematuria develops.
The critical point about cancer-related hematuria is that it’s typically painless. There’s no burning, no cramping, no urgency. The urine is simply red or pink, and then it may clear up for weeks or months before reappearing. That intermittent pattern can create a false sense of reassurance. Men and women who see blood once, notice it resolves, and decide it must have been nothing are sometimes diagnosed with a more advanced cancer months later when the hematuria returns.
Other Causes
Vigorous exercise (especially running), certain medications like blood thinners, recent urological procedures, and kidney diseases like glomerulonephritis can all produce hematuria. Menstrual contamination in women is also a common cause of false-positive results on urinalysis.
The Diagnostic Workup at Lazare Urology
When a patient presents with hematuria, Dr. Lazare follows a structured evaluation designed to identify or exclude the most clinically significant causes.
Urinalysis and Urine Cytology
The first step is confirming the hematuria and looking for additional clues. A urinalysis checks for infection, protein, and other markers. Urine cytology examines the urine under a microscope for abnormal cells that could suggest bladder cancer. Cytology is more sensitive for high-grade tumors than low-grade ones, so a negative result doesn’t rule out cancer entirely, but a positive result is highly informative.
Imaging
A CT urogram is the standard imaging study for hematuria evaluation. It provides detailed views of the kidneys, ureters, and bladder in a single scan, identifying stones, masses, structural abnormalities, and signs of obstruction. For patients who can’t undergo CT (due to contrast allergy or kidney function concerns), an ultrasound of the kidneys combined with an MRI or retrograde pyelogram may be used as alternatives.
Cystoscopy
Cystoscopy is the direct visualization of the bladder interior using a thin, flexible scope passed through the urethra. It’s the most sensitive test for detecting bladder tumors, which can be flat, small, and invisible on imaging. At Lazare Urology, cystoscopy is performed in the office using a local numbing gel and takes only a few minutes. Most patients tolerate it well, describing the sensation as mild pressure rather than pain.
The combination of imaging and cystoscopy covers the entire urinary tract from the kidneys through the bladder, giving Dr. Lazare a complete picture of what might be causing the bleeding.
Why Timing Matters
The urgency around hematuria evaluation isn’t about panic. It’s about the practical reality that early-stage bladder and kidney cancers have significantly better outcomes than those caught later. Bladder cancer confined to the inner lining of the bladder (non-muscle-invasive) has a five-year survival rate above 95% and can often be managed with outpatient procedures. Once it invades the muscle wall or spreads beyond the bladder, treatment becomes far more complex and outcomes decline.
The same principle applies to kidney masses. A small renal tumor found incidentally on imaging for hematuria may be treatable with a partial nephrectomy that preserves most of the kidney. A larger tumor discovered later may require removal of the entire kidney or additional systemic therapy.
Early evaluation doesn’t always lead to a cancer diagnosis. In fact, most hematuria workups identify a benign cause or find nothing at all. But completing the workup is what allows you and your urologist to move forward with confidence rather than uncertainty.
Schedule a Hematuria Evaluation at Lazare Urology
Blood in the urine is your body telling you something. It might be something minor, or it might be something that benefits enormously from early detection. The only way to know is to have it properly evaluated. If your primary care doctor flagged microscopic hematuria on your labs, or if you’ve seen visible blood in your urine even once, don’t wait for it to happen again.
Contact Lazare Urology at (718) 568-7516 to schedule an evaluation. Dr. Lazare has the in-house lab, imaging capabilities, and cystoscopy equipment to conduct a thorough workup efficiently, often within a single visit. The peace of mind that comes from knowing the answer is worth the appointment.
