Haematuria (Blood in the Urine): The Most Important Symptom Patients Ignore

Blood in the urine — even once, even if painless — is never normal.
Haematuria is one of the most important early warning signs in urology, yet many patients delay seeking help because the bleeding stops, comes and goes, or doesn’t cause pain. Unfortunately, ignoring haematuria can delay the diagnosis of serious conditions, including cancers of the kidney, bladder, or prostate.

This blog explains what haematuria means, why it happens, and when you must seek urgent specialist evaluation.

What Exactly Is Haematuria?

Haematuria refers to the presence of red blood cells in the urine. It can appear in two ways:

Visible haematuria (gross haematuria)

You can clearly see the blood — the urine looks pink, red, brown, or tea-coloured.

Microscopic haematuria

Blood is only seen on a urine test, even though the urine looks normal.

Both forms require medical investigation.
Visible haematuria is especially concerning because it is more strongly linked to urological cancers.

Common Causes of Haematuria

Not all causes are serious, but distinguishing harmless from dangerous requires a specialist assessment. Some of the most common causes include:

1. Kidney or Ureteric Stones

Stones scratch the delicate lining of the urinary tract, causing bleeding.
This may be accompanied by flank pain, nausea, or urinary discomfort — but bleeding can also occur without pain.

2. Urinary Tract Infections (UTIs)

UTIs can irritate the bladder and cause blood in the urine, but blood alone should never be assumed to be “just an infection”.

3. Enlarged Prostate (Benign Prostatic Hyperplasia)

The enlarged prostate has increased blood supply and can bleed, especially in men over 50.

4. Kidney Disease

Inflammation of the kidneys (glomerulonephritis) can cause microscopic haematuria.

5. Trauma or Recent Exercise

A hard fall, accident, or intense exercise can cause transient bleeding.

6. Cancers of the Kidney, Bladder, or Prostate

Blood in the urine is one of the earliest — and sometimes the only — warning signs of urological cancer.

Haematuria and Cancer: The Warning You Must Never Overlook

Bladder and kidney cancers commonly present with painless visible haematuria.
Because the bleeding often resolves spontaneously, patients assume the issue is gone — but the underlying cause remains.

Red flags that increase cancer risk include:

• Age over 40
• Smoking history
• Chronic chemical or dye exposure
• Recurrent haematuria
• Family history of urological cancers

Delaying evaluation can allow a treatable early-stage cancer to progress to an advanced one. Early detection dramatically improves outcomes.

When Is Haematuria an Emergency?

Seek urgent medical help if haematuria occurs with:

• Severe pain in the flank or abdomen
• Fever or chills (may indicate an infection behind a blockage)
• Inability to pass urine
• Large blood clots

These symptoms could indicate a blocked ureter or bladder, or a dangerous infection that requires immediate care.

How Haematuria Is Investigated

Dr Conradie follows international urological guidelines when assessing patients with haematuria, ensuring a complete and accurate diagnosis. A typical investigation may include:

1. Urine analysis and culture

To check for infection or other abnormalities.

2. Blood tests

To evaluate kidney function.

3. Ultrasound or CT scan

To identify stones, tumours, or structural abnormalities.

4. Cystoscopy

A small camera is used to examine the bladder lining directly.
This is the gold-standard test for bladder cancer detection.

5. Further specialised testing

If needed — including CT urography or urine cytology.

Why Specialist Urological Care Matters

Haematuria must be interpreted in the context of your full health picture.
A specialist urologist ensures:

• The cause of bleeding is correctly identified and not overlooked
• Early cancers are detected while they are still highly treatable
• Serious conditions such as stones, infections, or obstructions are managed appropriately
• You receive minimally invasive treatment whenever intervention is needed

Dr MC Conradie specialises in advanced minimally invasive and robotic urological surgery.
Her extensive clinical experience in diagnosing haematuria-related conditions — combined with her contributions to peer-reviewed research and international surgical education — supports her ability to provide:

• Accurate early detection
• Safe and effective treatment
• Reduced recovery times
• Long-term preservation of kidney and urinary tract health

Takeaway: Never Ignore Blood in the Urine

Even a single episode of haematuria deserves attention.
Early evaluation can be life-saving. If you have noticed blood in your urine — visible or microscopic — make an appointment with a specialist as soon as possible.