Blood in Your Urine That Went Away: Should It Still Be Checked?

Blood in the urine shows up in two ways: visibly, when the urine turns pink, red or dark; or only on a urine test. Visible blood needs to be assessed even if you have seen it only once.

Many people put off seeing a doctor because the bleeding stopped by the next day. But with some of the conditions that cause it, bleeding comes and goes; a clear spell in between does not show that the problem has gone.

This is not meant to alarm you. A large share of the causes are benign. But telling which one applies takes an assessment.

A urinary tract infection, a kidney or bladder stone and an enlarged prostate can all cause bleeding. Some foods, such as beetroot, and some medicines can colour the urine red without any blood being present; a urine test tells the two apart.

Less often, the source is a tumour in the bladder, the kidney or the urinary tract. Painless blood in the urine is the most common first sign of a bladder tumour.

Blood thinners can make bleeding easier, but they do not explain it. In people taking them, the underlying cause is still looked for.

Smoking is the most important risk factor for bladder tumours. Substances in tobacco smoke are filtered by the kidneys and stay in contact with the bladder lining. Long-term exposure in the dye, rubber and some chemical industries also carries a risk.

The older you are, and the more clearly the bleeding is painless and visible, the more important the assessment becomes. Being young or a non-smoker does not make it unnecessary, though.

The first step is a urine test and culture. If there is an infection, it is treated first and the urine is checked again, because infection can cause bleeding too.

The kidneys and upper urinary tract are assessed with imaging, most often a CT urogram. Urine cytology, which looks at cells shed into the urine, may be added.

The inside of the bladder is seen with cystoscopy: a thin camera passed through the urethra. Ultrasound alone is not enough; it can miss small tumours and flat lesions spreading over the bladder surface.

Diagnostic cystoscopy is usually done with a thin, flexible instrument and numbing gel, and takes only a short time. Mild burning and pink urine for a few days afterwards are common.

If a tumour is seen, it is removed through the urethra in a procedure called TURBT. This is both treatment and diagnosis: examining the removed tissue shows whether the tumour has reached the bladder muscle, and the treatment plan is built on that.

When the tumour has not reached the muscle, the bladder is kept and treatment is given from inside it. These tumours tend to come back, so regular cystoscopy follow-up is part of the treatment.

Send your urine test and culture results, any imaging reports together with the images themselves, and a list of your medicines, including any blood thinners. With these, it can be decided before you travel which tests are still needed.

If a tumour is found and treated, follow-up cystoscopies can be done in your own country. What matters is that follow-up happens, not where. Ask for your pathology report and follow-up schedule in writing, in a language your own doctor can read.

Bleeding with clots and an inability to pass urine, fever and shivering with the bleeding, or severe pain in the side need prompt medical care where you are. Do not wait for an appointment or for a reply to a message.

Blood in the urine is often due to a benign cause, but saying so requires an assessment. Bleeding that stops on its own is not a reason to put that assessment off.

This article is general information and does not replace medical advice.