Blood in the urine in men: causes and when to see a urologist

Causes of blood in the urine in men, tests to investigate it and warning signs.

The essentials

Seeing blood in your urine (haematuria) is always a reason to seek advice in an adult man, even if it doesn’t hurt and even if it has only happened once. The cause is often benign — an infection, a stone or an enlarged prostate — but a bladder or kidney tumour must be ruled out.

The examination is straightforward: a urine test, an ultrasound scan and, usually, a flexible cystoscopy.

Pink, red or tea-coloured urine is alarming – and rightly so. The important thing is not to panic or wait for it to happen again: even if it goes away on its own, the underlying cause may still be present. We explain what might be causing it, how it is investigated and when you should go to A&E.

Visible haematuria and microhaematuria

There are two ways. In the visible haematuria the colour of the urine changes. In the microhaematuria The urine looks normal and blood is only detected in the test, for example in a urine sediment. Both warrant further study, although the more obvious one is more urgent.

Not everything red is blood. Beetroot, blackberries or certain medicines can discolour your urine. A simple test will confirm whether there is actually any blood present.

Most common causes in men

Reason	Common clues
Urinary tract infection or prostatitis	A burning sensation when passing urine, a strong urge to urinate, and sometimes a fever.
Kidney stones	Severe pain in the side that may radiate down towards the groin.
Benign prostatic hyperplasia	Weak urine stream, frequent urination and night-time urination; the blood vessels in an enlarged prostate may bleed.
Bladder or kidney tumour	Often painless bleeding. Smokers and those over 40 are at greater risk.
Intense exercise or a blow	Bleeding following a long run or an injury; you should check that it stops.

The tobacco It is the main risk factor for bladder cancer. If you smoke or have smoked and have noticed blood in your urine, don’t ignore it.

How to study

Urine analysis and culture to check the blood and rule out an infection.
Urological ultrasound of the kidneys, bladder and prostate.
Flexible cystoscopy: a thin, flexible tube with a camera allows the inside of the urethra and the bladder to be viewed in the doctor’s surgery, under local anaesthetic. It is the key test for ruling out a bladder tumour.
CT scan of the urinary tract when the kidneys and ureters need to be examined in greater detail.

What to do in the meantime

Drink water as normal, without forcing yourself.
Do not take antibiotics on your own: they can mask an infection and delay diagnosis.
If you are taking anticoagulants, do not stop taking them without consulting your doctor, but do tell your urologist.
Make a note of when it appeared, whether there were any clots, and whether you had any pain or a fever.

Go to A&E if you pass clots in your urine and are unable to urinate, if you have a high fever or severe pain, or if there is a heavy flow of blood or you feel dizzy.

Frequently asked questions

Is it serious if you pass blood in your urine but it doesn’t hurt?

That may well be the case. Painless blood in the urine is actually the most common symptom of bladder tumours, which is why it should always be investigated by a urologist, even if it has only happened once.

If it’s only happened once, do I need to see a doctor?

Yes. Even if it resolves on its own, an episode of visible blood in the urine in an adult man should be investigated, as the underlying cause may still be present even if the urine returns to normal.

Could anticoagulants explain the presence of blood in the urine?

They may contribute to a lesion bleeding, but they are not, on their own, a sufficient explanation. Even if you are taking anticoagulants, haematuria should still be investigated.

What tests will I have to undergo?

Usually a urine analysis and culture, an ultrasound scan of the urinary tract and a cystoscopy to examine the inside of the bladder. Depending on the case, a CT scan may also be carried out.

When should I go to A&E?

If you are passing clots in your urine and are unable to urinate, if you have a high fever, severe pain in your side or feel dizzy, or if there is a very heavy flow of blood.

Have you noticed any blood in your urine?

We provide a prompt service and, if necessary, carry out flexible cystoscopies and ultrasound scans at our clinics in Alicante and Elda.

Alicante: 5 Av. de la Estación, Unit 29 (Maternum Clinic) · 965 98 15 58
Elda: La Feria Clinic, 43 Pablo Iglesias Street · 966 98 01 53
Also because of WhatsApp o video consultation.

Sources: Guidelines from the European Association of Urology (EAU) · MedlinePlus: blood in the urine · Spanish Association of Urology. This article is for information purposes only and is not a substitute for a specialist’s assessment.