Is blood in your urine a sign of bladder cancer?
Seeing blood in your urine is not always a sign of cancer. In most cases, it’s caused by something less serious, like a UTI.
However, if you do spot blood in your urine, schedule an appointment with your GP as soon as possible. Bloody urine (hematuria) is the most common symptom of bladder cancer, and early diagnosis increases the odds of successful treatment.
When should I see a doctor?
Immediately.
According to Cancer Research UK, 80% of bladder cancer patients report seeing blood in their urine. It’s the most common symptom, and always warrants a visit to the doctor.
When caught at stage 1, bladder cancer has a substantially better prognosis than at stage 3 or 4, so acting fast is always the right call (Cancer Research UK). Do not wait to see if symptoms clear up on their own.
What if it’s painless?
Seeking immediate medical advice is particularly important if you’re experiencing bloody urine without any accompanying pain or discomfort. Painless hematuria is a key sign of bladder cancer. Consult your GP, even if it only happens once or clears up on its own.
What’s the difference between visible and non-visible hematuria?
Visible hematuria is blood in your urine that you can see with your naked eye. Your urine might appear pink, brown, or red in colour.
Non-visible (microscopic) hematuria is blood in your urine that can only be found through medical tests. Your urine looks normal to the naked eye, but tiny blood particles are visible under a microscope.
According to NICE guidelines, the referral pathways for visible and non-visible hematuria differ:
Visible hematuria carries a higher risk of serious conditions, including bladder cancer, and should prompt a visit to the GP.
Non-visible hematuria is less likely to signify bladder cancer, but follow-up tests are usually required to rule out underlying conditions.
What else causes blood in urine?
Blood in your urine (hematuria) can be a sign of bladder cancer and should always prompt a visit to the doctor. However, other, less serious conditions could be responsible for your symptoms.
Bloody urine can be caused by:
Urinary tract infection (UTI)
Kidney stones
Enlargened prostate
Strenuous exercise
Medications (including anticoagulants and some chemotherapy drugs)
Benign kidney conditions
Urinary tract infections are the most common cause of hematuria in women (particularly younger women). Blood in your urine can sometimes be confused with menstruation, so it’s important not to dismiss your symptoms.
For more information on the possible causes of hematuria, see the British Association of Urological Surgeons’ dedicated page.
Do I still have to see a doctor if it’s caused by something else?
Yes.
Lesser conditions such as kidney stones and UTIs still require medical treatment, and a GP appointment is the only surefire way to rule out the possibility of bladder cancer.
Microscopic hematuria is usually found incidentally by medical professionals during other tests. It follows a different diagnostic pathway and carries a lower degree of risk, but still warrants a suspected cancer referral in adults over 60 (NICE Guideline NG12, Suspected cancer: recognition and referral).
Who is most at risk of bladder cancer?
The statistical likelihood of developing bladder cancer varies by age, gender, and lifestyle habits.
Smoking tobacco is the number one risk factor for developing bladder cancer. According to Cancer Research UK, around 45% of all bladder cancers are directly caused by smoking.
Risk also increases with age. Most incidents of bladder cancer (around 58%) are diagnosed in adults over the age of 75 (Cancer Research UK)
Men are at higher risk than women. Cancer Research UK estimates that 1 in 55 men versus 1 in 130 women will be diagnosed with the condition in their lifetime.
Occupational exposure to certain chemicals is associated with a higher risk of bladder cancer. Contact with aromatic amines, polycyclic aromatic hydrocarbons, and mineral oils accounts for around 5-6% of bladder cancers in the UK. There's a latency period of up to 40 years before symptoms develop. This may be relevant if you work with dyes, rubber, and textiles.
For more information on the risks and causes of bladder cancer, see Cancer Research UK’s dedicated page.
Risk factors increase the probability of developing bladder cancer. But incidence can still occur in groups with a statistically lower risk. You should always consult a medical professional if you’re experiencing symptoms consistent with cancer.
What happens when you see a GP about blood in your urine?
When you see a GP about blood in your urine, they’ll most likely perform a physical examination and request a urine sample for testing. If the culprit is infection, you’ll be prescribed antibiotics.
If your GP suspects something more serious, like bladder cancer, they may refer you to a specialist for further tests. For men and women over the age of 45, this process is fast-tracked and will usually result in an appointment within two weeks (NHS England).
What are the tests for bladder cancer?
The primary test for bladder cancer is called a cystoscopy. Your doctor will insert a thin, flexible camera into your urethra (the tube that urine passes through) to see inside your bladder. This is typically performed under local anesthetic and shouldn’t be painful.
You may need upper urinary tract imaging as well. This is a non-invasive procedure and involves a doctor taking photos of your kidneys and ureters using an ultrasound or CT scan.
Most people seeking medical advice after spotting bloody urine will not be diagnosed with cancer; however, clinical investigation is the only way to rule it out.
For more information on testing and referrals, see Action Bladder Cancer UK’s patient guide to diagnosis.
When should you seek emergency help rather than a GP appointment?
Some instances of blood in your urine are more urgent than others and require emergency medical attention.
You should call 111 or head to A&E if you experience any of the following symptoms:
Heavy, continuous bleeding. This typically presents as dark red urine, with or without blood clots.
Bleeding accompanied by inability to urinate.
Bloody urine alongside a fever, severe pain, or sepsis symptoms.
NHS guidance can help you decide whether to call 111 or visit A&E.
For everyone else, a visit to the GP is the correct response to spotting blood in your urine. The only differences should be the urgency with which you seek medical help and the specific pathway you take.
Do not wait to see if your symptoms improve on their own. It’s better to get tested than to let a potentially serious condition go undiagnosed.
Whatever the cause, the action is always the same: seek medical advice.
