Never Ignore It, Even Once
Hematuria (Blood in Urine)
Blood in the urine is one of the most important warning signs in urology, and one of the most commonly dismissed — because it is often painless and frequently goes away on its own. At Texas Regional Urology, we evaluate hematuria thoroughly at our offices in The Woodlands, Tomball, and Kingwood.
What is Hematuria?
Understanding Hematuria
Hematuria means blood in the urine, and it comes in two forms. Gross hematuria is visible, turning urine pink, red, or cola-colored. Microscopic hematuria is invisible and detected only on a urine test, often during a routine physical. Both warrant evaluation. Causes range from the benign and easily treated — urinary tract infection, kidney stones, an enlarged prostate, vigorous exercise — to the serious, including bladder cancer, kidney cancer, and cancers of the ureter. Most hematuria turns out not to be cancer, but hematuria is frequently the first and only sign of bladder cancer, and it is often painless. That combination is exactly why it should never be watched and waited out.
How Would I Know if I Had Hematuria?
Symptoms and Warning Signs
Visible hematuria is unmistakable: urine that appears pink, red, brown, or the color of tea or cola, sometimes with clots. It may occur once and never return, which does not make it less significant. It is often painless, though when accompanied by burning, urgency, or frequency it may indicate infection, and when accompanied by severe flank pain it often indicates a stone. Microscopic hematuria produces no symptoms at all. Certain foods such as beets and rhubarb, and some medications, can discolor urine without any blood being present — a urinalysis distinguishes between them.
How is Hematuria Evaluated?
How We Evaluate Hematuria
A complete hematuria workup has three parts, and skipping any of them risks missing something. Urinalysis and urine culture confirm the blood is real and check for infection, and urine cytology can detect abnormal cells shed by a tumor. CT urography images the kidneys, ureters, and bladder to look for stones, masses, and structural abnormalities. Cystoscopy allows the urologist to look directly inside the bladder and urethra with a small scope — the only reliable way to identify early bladder tumors, which imaging can miss. We also assess kidney function and, when findings suggest a kidney rather than urologic source, coordinate with nephrology.
Why Choose Texas Regional Urology for Hematuria Evaluation?
Why Patients Choose TRU
Here is What We Can Do
Treatment Depends on the Cause
Hematuria is a symptom, so treatment addresses whatever is producing it. Many patients complete the workup, learn the cause is benign, and need little or no treatment beyond reassurance and a follow-up test. Others need a stone treated, an infection cleared, or an enlarged prostate managed. When the cause is a tumor, finding it while the bleeding is the only symptom is the best possible circumstance, because early bladder and kidney cancers are highly treatable.
Infection and Stones
Bacterial infections are treated with targeted antibiotics based on culture results, and hematuria typically resolves as the infection clears. Stones are managed with observation, lithotripsy, or ureteroscopy depending on size and location.
Enlarged Prostate
BPH is a common and benign cause of bleeding in men, treatable with medication or minimally invasive procedures such as Urolift or Rezum. Addressing the prostate typically resolves the hematuria.
Bladder Cancer
If cystoscopy identifies a bladder tumor, endoscopic resection removes it and provides tissue for staging, often followed by intravesical therapy and ongoing surveillance. Early-stage bladder cancer detected through hematuria evaluation has an excellent prognosis.
Kidney Cancer
Kidney masses are staged with imaging and treated surgically, frequently with da Vinci robotic partial nephrectomy that removes the tumor while preserving the rest of the kidney. Our surgeons perform these procedures at Houston Methodist The Woodlands, Memorial Hermann, and HCA Houston Healthcare.
Answers to Your Hematuria Questions
Frequently Asked Questions
Yes, absolutely.
Hematuria from a bladder tumor characteristically comes and goes, so resolution provides no reassurance at all. A single episode of visible blood warrants a complete evaluation.
Usually not, but it must be excluded.
Infection, stones, and enlarged prostate account for most cases, and the majority of patients do not have cancer. Because hematuria is often the only early sign of bladder cancer, a full workup is still necessary.
Uncomfortable briefly, but not painful.
The procedure is performed in the office using numbing gel and takes only a few minutes, with most patients describing pressure rather than pain. Mild burning with urination for a day afterward is normal.
Possibly, but that's a diagnosis of exclusion.
Strenuous exercise, particularly distance running, can cause transient hematuria that resolves with rest. We confirm it clears on repeat testing rather than assuming exercise is the explanation.
It still warrants evaluation.
Microscopic hematuria carries a lower but real risk of significant findings, and guidelines recommend a workup based on your age and risk factors. Smoking history is a particularly important consideration.
Noticed blood in your urine?
