Blood in urine (haematuria) investigation
A set of tests to find the cause of blood in the urine, including ruling out serious causes such as cancer.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It finds the cause of blood in the urine and, importantly, rules out or detects serious causes such as cancer.
- Visible blood in the urine should always be investigated, and is usually fast-tracked on an urgent cancer pathway.
- Most tests are quick and outpatient; a normal result is reassuring but does not always rule out every cause forever.
- Never assume blood in the urine is 'just a UTI' — it needs proper assessment in its own right.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Finds the cause of blood in the urine.
Reassurance without investigation is never appropriate for unexplained visible blood in the urine.
Urine and blood tests are quick. A scan is usually not painful. A bladder camera takes a few minutes with local anaesthetic gel and you are awake.
A clear explanation of what was found and an explicit plan if symptoms continue.
Urine and blood tests are quick. A scan is usually not painful. A bladder camera takes a few minutes with local...
Mild stinging when passing urine and pink-tinged urine are common. Drinking plenty of fluid helps. Most people...
Many results, including the scan and camera findings, are available quickly. Urine cell tests take a little longer.
The team explains what was found, whether the cause is serious, and what happens next.
What is a blood in urine (haematuria) investigation?
A blood in urine (haematuria) investigation is a set of tests to find out why there is blood in your urine. Blood can be visible (you can see it) or non-visible (only found on a urine test). Either type can be harmless, but it can also be the first sign of something serious, including cancer of the bladder or kidney, so it should always be checked.
The investigation usually combines urine tests, blood tests, a scan of the kidneys and urinary tract, and often a bladder camera test (cystoscopy). The combination is chosen according to your age, whether the blood is visible, and your risk factors.
The aim is a clear answer: what is causing the blood, and in particular whether a serious cause needs to be ruled out or treated. Many people turn out to have a harmless cause, but the investigation exists to make sure nothing important is missed.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Visible vs non-visible blood in the urine
| Visible haematuria | Non-visible haematuria | |
|---|---|---|
| You can see it | Yes | No (found on testing) |
| Chance of urinary cancer | Higher | Lower |
| Typical referral | Urgent suspected-cancer pathway | Routine, criteria-based |
| Bladder camera | Usually advised | Often advised, depending on age and features |
Both types need assessment; visible blood carries a higher chance of a serious cause and is prioritised.
Preparing for your test
- Note when you first saw or were told about the blood, whether it is visible or found on testing, and any pattern.
- List any pain, burning, fever, weight loss or other symptoms.
- Bring a list of your medicines, especially blood thinners, which can be relevant.
- Mention smoking history and any work with dyes, chemicals or rubber, which raise bladder cancer risk.
- Bring a fresh urine sample if asked, and mention if you are having a period (which can affect the result).
- Tell the team if you are pregnant or might be, as this affects which scans are safe.
- Bring previous urine results, scans or letters if you have them.
What happens
A urologist usually leads the investigation. They take a history, examine you, and confirm the blood with a urine test, also checking for infection. Blood tests check your kidney function and blood count.
A scan of the kidneys, ureters and bladder is arranged — an ultrasound or, often for visible blood, a CT scan. A bladder camera test (cystoscopy) is commonly done, usually with local anaesthetic gel, to look directly at the bladder lining. This takes a few minutes and you are awake.
If the blood comes with protein in the urine or reduced kidney function, a kidney specialist (nephrologist) may assess you for a medical kidney cause, sometimes arranging a kidney biopsy. Once the tests are complete, the team explains what they found and what happens next.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Reassurance without investigation is never appropriate for unexplained visible blood in the urine.
- A urine dipstick alone is not a screening test for blood in people without symptoms and should not replace proper assessment when blood is found.
- Investigation does not treat the cause; if cancer or a stone is found, separate treatment is needed.
- If blood clearly comes with heavy protein and falling kidney function, a urology-only work-up is the wrong pathway — a nephrologist should be involved.
Delay or rearrange if…
- You currently have a heavy bleed, clots or cannot pass urine — this needs urgent, not routine, care.
- You have an active urine infection, which can cause blood and should be treated and the urine re-checked.
- You are having a period, which can contaminate a urine sample.
- You are pregnant or might be, which affects which scans and contrast are safe.
Alternatives to discuss
- Treating and re-testing first if a urine infection is the likely cause of non-visible blood.
- The standard NHS urgent haematuria pathway via your GP.
- A staged approach (scan and urine tests before a camera) in lower-risk non-visible cases, as advised by your specialist.
- Nephrology assessment rather than urology when features point to a medical kidney cause.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Finds the cause of blood in the urine.
- Detects or rules out serious causes, especially bladder and kidney cancer, when treatment is most effective early.
- Identifies treatable causes such as stones or infection.
- Separates urinary-tract causes from medical kidney causes that need a nephrologist.
- Gives reassurance when no serious cause is found.
- Guides whether any follow-up testing is needed.
Risks & complications
- Discomfort or stinging during and just after a bladder camera test, and pink urine for a day or so.
- Inconvenience and anxiety while waiting for results.
- A normal result does not always identify a cause, which can be unsettling.
- A short-lived urine infection after a bladder camera test.
- Reaction to the contrast dye used in some CT scans.
- Incidental findings on a scan that lead to further tests.
- Bleeding or difficulty passing urine after a bladder camera, occasionally needing help.
- Complications of a kidney biopsy, such as bleeding, if one is performed.
The most important point is not to dismiss blood in the urine. Visible blood in particular carries a real chance of a serious cause and is fast-tracked for that reason. A normal investigation is reassuring, but if visible blood comes back, you should be re-checked rather than reassured by the earlier result. Ask which tests you are having and why, and what the plan is if everything is normal but bleeding continues.
Published figures to discuss
How often a serious cause is found depends heavily on whether the blood is visible, your age and risk factors. Figures below come from a large UK study of people referred for investigation, and apply to that referred group rather than everyone with blood in the urine. They explain why visible blood is prioritised, without implying cancer is likely in any one person.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Urinary tract cancer found, visible blood | About 16% in referred patients | From the UK IDENTIFY study; most cancers found are bladder cancer. Higher with older age and smoking. | IDENTIFY study — urological cancer detection in haematuria (PMC)pmc.ncbi.nlm.nih.govPublished figure |
| Urinary tract cancer found, non-visible blood | About 3 to 5% in referred patients | Lower than for visible blood, but still enough to warrant investigation in the right people. | IDENTIFY study — urological cancer detection in haematuria (PMC)pmc.ncbi.nlm.nih.govPublished figure |
| Kidney disease rather than urological cancer | Important when protein, casts, high blood pressure or reduced eGFR are present | Visible or non-visible blood can come from glomerulonephritis as well as stones, infection or bladder causes. | IDENTIFY study — urological cancer detection in haematuria (PMC)pmc.ncbi.nlm.nih.govSource-linked context |
| False reassurance after one negative urine dip | Recognised | Intermittent bleeding, exercise, menstruation and sampling issues can affect results; persistent findings need follow-up. | IDENTIFY study — urological cancer detection in haematuria (PMC)pmc.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Most of the tests need no physical recovery. After a bladder camera test you may have mild stinging and pink urine for a day; the main 'afterwards' is getting your results and a clear plan.
- Mild stinging and pink urine for up to a day after a bladder camera test.
- Needing to pass urine a little more often for a short time after the camera.
- Waiting and some anxiety until results are confirmed.
- No physical after-effects from urine tests, blood tests or scans.
Aftercare
- Drink plenty of fluid after a bladder camera test to ease stinging and flush the bladder.
- Expect pink urine for up to a day after the camera; it should clear quickly.
- Take simple pain relief if needed and as advised after the camera.
- Watch for signs of infection (fever, worsening burning) and report them.
- Keep all follow-up appointments, especially if results are pending.
- If you see visible blood again after a normal result, report it — do not assume it is the same harmless cause.
- Follow any specific advice if a biopsy was taken, including rest and what to watch for.
- Note of when blood was seen and whether it is visible or found on testing
- List of medicines, especially blood thinners
- Smoking and occupational history noted
- Fresh urine sample if requested
- Previous results, scans and letters gathered
- Someone available if you feel unwell after a bladder camera
- Questions about next steps if results are normal written down
⚠ Get urgent help if…
- Heavy visible blood in the urine, or passing clots.
- Being unable to pass urine.
- Fever, shivering or feeling very unwell after a bladder camera test (possible infection).
- Severe pain in the side or lower tummy.
- Worsening burning and frequency suggesting infection.
- Feeling faint, breathless or very unwell, especially after a biopsy.
- Any new visible blood after a previously normal investigation — get re-checked.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result is a clear explanation of why there is blood in your urine and confirmation of whether a serious cause has been found or ruled out. Many people have a harmless or treatable cause such as infection or a stone, and a normal bladder camera and scan are very reassuring.
No single test rules out every possible cause forever. That is why ongoing or recurrent visible blood should always be re-assessed, even after a previously normal investigation. Your team should tell you clearly what was checked and what the plan is if symptoms continue.
A normal investigation reflects the situation at the time of testing. Risk factors such as smoking and age mean blood can appear later from a new cause, so any fresh episode of visible blood should be investigated again rather than assumed to match an earlier normal result. For persistent non-visible blood, your team will advise whether periodic kidney-function and blood-pressure checks are needed.
Related tests, treatments or support
Investigation is often combined with treatment of the cause found — for example managing a stone (urology), treating an infection, or a kidney specialist managing a medical kidney cause such as glomerulonephritis. Where blood comes with protein, the proteinuria is investigated alongside it.
Follow-up & long-term care
After the tests, the team explains the findings and arranges any treatment or further tests. If a cause such as cancer is found, you are referred into the relevant treatment pathway. If everything is normal, you should be told what to do if visible blood returns, and whether persistent non-visible blood needs ongoing kidney-function and blood-pressure monitoring.
- Report any new episode of visible blood in the urine, even after a normal investigation.
- Attend any agreed follow-up for persistent non-visible blood.
- Have blood pressure and kidney function checked periodically if advised.
- Stop smoking, which lowers bladder cancer risk.
- Keep copies of your results to share with future clinicians.
Repeat, follow-on and what comes next
- A normal investigation does not rule out a future cause; new visible blood should always be re-investigated.
- Persistent non-visible blood may need repeat urine tests and ongoing kidney-function and blood-pressure checks.
- If a first set of tests is inconclusive, a further or different test (such as a CT or repeat camera) may be advised.
- A medical kidney cause may need a biopsy to clarify, separate from the urology tests.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear explanation of what was found and an explicit plan if symptoms continue.
- Written advice on what to do if visible blood returns, including re-referral.
- A monitoring plan for persistent non-visible blood, including blood pressure and kidney function.
- A named contact and clear warning signs after a bladder camera or kidney biopsy.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Number and length of specialist consultations.
- Which tests are done — urine tests, blood tests, ultrasound or CT.
- Whether a bladder camera test (cystoscopy) is needed and who performs it.
- Whether a kidney specialist assessment or kidney biopsy is required.
- Reporting fees for scans and any urine cell tests.
- Follow-up appointments and any treatment of the cause found.
- The specialist (urologist and, if needed, nephrologist) consultation fees.
- Laboratory fees for urine and blood tests.
- Imaging fees (ultrasound or CT) and who reports them.
- Cost of a cystoscopy, including the facility and local anaesthetic.
- Cost of any kidney biopsy and its analysis.
- What happens, and what it costs, if results are inconclusive or further tests or treatment are needed.
On the NHS? Investigation of blood in the urine is available on the NHS, with urgent suspected-cancer pathways for visible blood; private access is sometimes used for speed, but visible blood should be acted on quickly either way.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being reassured that visible blood is 'just a UTI' without proper investigation.
- Not being told that a normal result does not cover future episodes of visible blood.
- No clear plan for who manages the result if a medical kidney cause (protein, falling function) is found.
- Not understanding the small risks of a bladder camera or kidney biopsy before consenting.
Marketing red flags
- Offers to 'reassure' or clear you without the appropriate scan and camera for visible blood.
- Promising results faster than is safe by skipping necessary tests.
- Selling urine 'cancer screening' products in place of a proper pathway.
- Downplaying visible blood to avoid an urgent referral.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Is my blood visible or non-visible, and what does that mean for my risk?
- Which tests do I need — scan, bladder camera, urine cell test — and why?
- Is my blood coming from the bladder/drainage system or from the kidneys themselves?
- What happens if the tests are normal but I see blood again?
- Do I need a kidney specialist as well, for example if I have protein in my urine?
- What follow-up will I have, and who do I contact if I become unwell after a bladder camera?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is blood in my urine serious?
Why have I been referred urgently?
Does a bladder camera test hurt?
Could it just be a urine infection?
What if all my tests are normal?
Can I have this on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Blood in urine NICE NG12 — Suspected cancer: recognition and referral BAUS — Haematuria (blood in the urine) IDENTIFY study — urological cancer detection in haematuria (PMC) NHS England — cancer waiting times guidance (Faster Diagnosis Standard)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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