Blood in Urine (Hematuria) in Males

15 Common and Uncommon Causes of Hematuria

Blood in urine (hematuria) in males has many causes, including an enlarged prostate, urinary tract infection, kidney stones, and injury.

Hematuria may be visible to the naked eye or only be detected with urine tests. While the cause is often benign (not harmful), blood in the urine should never be ignored as it may be a sign of a serious medical condition, cancer included.

This article explores some of the common and uncommon causes of hematuria in males. It offers an overview of how the conditions are diagnosed and treated, as well as when to see a healthcare provider.

A man consulting with his doctor
Shannon Fagan / Taxi / Getty Images

A Note on Gender and Sex Terminology

Verywell Health acknowledges that sex and gender are related concepts, but they are not the same.

  • Sex refers to biology: chromosomal makeup, hormones, and anatomy. People are most often assigned male or female at birth based on their external anatomy; some people do not fit into that sex binary and are intersex.
  • Gender describes a person's internal sense of self as a woman, man, nonbinary person, or another gender, and the associated social and cultural ideas about roles, behaviors, expressions, and characteristics.

Research studies sometimes don't use the terminology in this way. For example, terms that describe gender (“woman,” “man”) may be used when terms for sex (“female,” “male”) are more appropriate. 

To reflect our sources accurately, this article uses terms like "female," "male," "woman," and "man" as the sources use them.

Urinary Tract Infection

Urinary tract infection (UTI) is the most common cause of hematuria, particularly infections of the bladder.

A urinary tract infection happens when bacteria from the gut enter the urinary tract through the urethra and infect the bladder. More than 80% of urinary tract infections are caused by the bacteria Escherichia coli (E. coli).

Symptoms of a bladder infection include:

  • Blood in urine
  • Pain or burning while urinating
  • Frequent urination
  • Having an empty bladder but still feeling like you need to urinate
  • Pressure or cramping in the groin or lower abdomen

Injury

Hematuria occurs in at least 88% of cases of urogenital trauma. In males, the urogenital system includes the kidneys, ureters, bladder, urethra, penis, and testes.

Top causes of blunt injuries to these parts include deceleration (when a vehicle stops suddenly), gunshot and stab wounds, falls, and sport-related impacts.

In addition to hematuria, a male with urogenital trauma may also have other symptoms of trauma, such as:

  • Flank (side and back of the abdomen) pain
  • Abdominal pain
  • Flank or abdominal bruising
  • Rib fractures

Symptoms of a kidney injury may include hematuria as well as:

  • Right or left abdominal pain
  • Low back pain
  • Abdominal bruising and swelling
  • Signs of internal bleeding, including reduced alertness, dizziness, fatigue, blurred vision, low blood pressure, nausea, and vomiting
  • Decreased urine output or inability to urinate
  • Fever
  • Increased heart rate and pale, cool skin (symptoms of shock)

While having a large amount of blood in the urine is more frequently associated with major injuries, it is possible to have a major injury with only a small amount of blood in the urine. Thus, any amount of blood in the urine following an injury should be treated as a medical emergency.

Enlarged Prostate

Benign prostatic hyperplasia (BPH)—the medical term for an enlarged prostate—is a condition in which the prostate gland grows bigger.

Symptoms of an enlarged prostate include:

  • Hematuria
  • Dribbling at the end of urinating
  • Inability to urinate
  • Inability to completely empty the bladder
  • Loss of bladder control (urinary incontinence)
  • Frequent urination at night
  • Painful urination
  • Weak urine stream
  • Straining to urinate

BPH is not cancer, nor does having BPH increase your risk of cancer. BPH becomes more common with age. In fact, more than 90% of men over the age of 80 have an enlarged prostate.

Kidney Infection

Kidney infection, or pyelonephritis, is usually caused by a bacteria that infects the kidneys. It can either be an acute (short duration) infection, or chronic (lasting three months or longer).

Most kidney infections are caused by the bacteria Escherichia coli (E. coli), which normally lives in your bowel. The infection usually starts when the bacteria enters the opening of the urethra then moves through the urinary tract, infecting the bladder then the kidneys.

Kidney infection may present with the following symptoms:

  • Pus or blood in urine
  • Foul-smelling urine
  • Frequent urination
  • Painful urination
  • Pain in your back, side, or groin
  • High fever (101.3°F or higher)
  • Chills
  • Nausea and vomiting

Kidney or Bladder Stones

Kidney stones, known medically as renal calculi, are hard deposits made of calcium and urate crystals that form inside the kidneys. In males, calculi can also develop within the ureters and bladder.

The main symptoms of kidney or bladder stones include:

  • Blood in urine
  • Flank pain
  • Nausea and vomiting
  • Fever and chills
  • Weak urine stream
  • Painful urination
  • Inability to urinate

Kidney and bladder stones can be brought on by a variety of things, including infections, trauma, medication poisoning, enlarged esophageal veins (varices), and drinking too little water. However, it's not always clear why calculi form.

High-Intensity Exercise

Hematuria can sometimes occur following a high-intensity workout. In most cases, hematuria lasts between a few hours to three days after the intense workout ends. If it lasts longer, another underlying cause is likely at play.

According to a study in the journal Renal Failure, out of 491 people who went on a five-kilometer run, 12% developed hematuria, most of whom were under the age of 30. Also, 81% of people with hematuria were hematuria-free within three days.

Although endurance exercise (such as long-distance running) is a risk factor for hematuria, researchers in this study concluded that hematuria is more often related to the intensity of a workout rather than its duration.

Apart from blood in the urine, exercise-induced hematuria is not known to cause other symptoms.

Cancer

Cancer of the bladder, kidney, or prostate can cause blood in urine in males. Hematuria happens when a tumor grows on the affected organ, weakening nearby blood vessels until they rupture and bleed.

Bladder cancer is the most likely form of cancer to cause hematuria. However, prostate cancer is the most common cancer in males. Hematuria is often seen in people with advanced prostate cancer (stage 4), nearly half of whom require medical treatment to control the bleeding.

In addition to hematuria, other common symptoms of cancer in the urogenital tract include:

  • Frequent urination
  • Painful urination
  • Feeling the need to urinate despite having an empty bladder
  • Frequent urination during the night
  • Inability to urinate
  • Lower back pain on one side of the body
  • Abdominal pain
  • Bone pain or tenderness
  • Unintended weight loss and loss of appetite
  • Swelling in the feet
  • Severe fatigue
  • Blood in semen
  • Painful ejaculation

It's important to note that many men with prostate cancer do not have any symptoms at all. For this reason, males between the ages of 55 and 69 should consider routine screening for prostate cancer under the guidance of their healthcare provider.

Additional Causes of Blood in Urine in Males

Other possible causes of blood in urine in males include:

  • Medications: This includes penicillin, blood thinners like warfarin, as well as some diuretics, analgesics (pain relievers), oral contraceptives, and anticonvulsants.
  • Epididymitis: This is the inflammation of the epididymis (the coiled tube that receives and stores sperm from the testicles), often caused by a bacterial infection. In addition to blood in the urine, there may also be blood in semen.
  • Orchitis: This is the inflammation of one or both testicles which often occurs alongside epididymitis (known as epididymal-orchitis). In addition to hematuria, orchitis can also cause testicular pain, pain and burning while urinating, swelling, and fever.

Uncommon and Rare Causes

There are several rare diseases and genetic disorders that can cause blood in the urine: 

  • Glomerulonephritis: A type of chronic kidney disease that affect filtering units of the kidneys, called glomeruli
  • Lupus nephritis: A complication of the autoimmune disease lupus involving the kidneys
  • Sickle cell disease: An inherited blood disorder that causes anemia, jaundice, yellowing of the eyes, stroke, and other severe complications
  • Von Hippel-Landau disease: An inherited disorder that causes abnormal blood vessel growth and tumors on the kidneys, testicles, and spine

How Is Blood in Urine Diagnosed?

There are a number of tests that, when combined with a physical exam and medical history, can help your healthcare provider identify the cause of hematuria.

Urine- and blood-based tests used to diagnose hematuria include:

  • Urine dipstick test: Used to detect the presence of blood in urine
  • Urine culture: Used to identify the bacterial cause of a UTI
  • Urinalysis: Used to check for excessive protein in urine suggestive of chronic kidney disease
  • Urine STI tests: Used to diagnose STIs like gonorrhea or chlamydia
  • Complete blood count (CBC): A blood test used to detect signs of infection or blood abnormalities like anemia
  • Renal function tests: A panel of blood and urine tests used to evaluate how well your kidneys are functioning

Depending on the suspected cause, other tests may be ordered, including:

  • Intravenous pyelogram: A type of X-ray that uses injectable dye to better highlight structures in the genitourinary tract
  • Cystoscopy: A flexible fiber-optic scope that is inserted into the urethra to examine the bladder
  • Ultrasound: A non-invasive imaging tool that uses sound waves to check for abnormalities in the genitourinary tract such as kidney stones or an enlarged prostate
  • Computed tomography (CT): An imaging technology that composites multiple X-ray images to create three-dimensional "slices" of internal organs

How Is Blood in Urine Treated?

The treatment of hematuria is directed by the underlying cause. Treatment of some of the more common causes include:

  • Antibiotics: Given by mouth or injection to treat epididymitis, orchitis, UTIs, cystitis, pyelonephritis, and bacterial STIs
  • BPH medications: Like Flomax (tamsulosin) or Proscar (finasteride) to help ease prostate inflammation and improve urine flow
  • Shockwave therapy: Used to break up bladder or kidney stones along with diuretics ("water pills") and drugs like Flomax that promote urination
  • Changes in diet: Such as a reduction in protein, salt, and potassium in people with advanced chronic kidney disease
  • Immunosuppressants: Such as Imuran (azathioprine), Sandimmune (cyclosporine), and methotrexate used to manage autoimmune diseases like lupus
  • Surgery: Which may be needed for traumatic injuries, kidney stones, or the treatment of Von Hippel-Landau disease
  • Cancer treatment: Which may involve surgery, chemotherapy, radiation, hormone therapy, immunotherapy, and other treatments
  • Oxbryta (voxelotor): An oral drug used for the treatment of sickle cell disease
  • Bone marrow transplant: The only current cure for sickle cell disease

Medications that cause hematuria may also need to be substituted or have their dose adjusted.

When to See a Healthcare Provider

It is important to note that the amount of blood in the urine has no correlation with the severity (or lack thereof) of the underlying condition.

For this reason, if you notice even a small amount of blood in your urine, you should contact your healthcare provider right away for a diagnosis.

Depending on your other symptoms, your provider may refer you to a specialist in the male genitourinary tract, known as a urologist.

You should also see your provider right away if you have any new or unusual symptoms, including:

  • Signs of infection, such as fever and chills or swollen lymph nodes
  • Problems while urinating, such as pain or burning and frequent urination
  • Pain in your sides, abdomen, lower back, or pelvic area
  • Severe fatigue
  • Faintness, dizziness, or lightheadedness
  • Nausea or vomiting
  • Reduced alertness
  • Blurred vision

Summary

Blood in the urine (hematuria) is common in males. It is frequently caused by conditions like an enlarged prostate, urinary tract infections, epididymitis, orchitis, bladder or kidney stones, bladder or kidney infections, and certain medications.

Less common causes include glomerulonephritis, lupus, genetic disorders like sickle cell anemia, and cancers like bladder cancer, kidney cancer, and prostate cancer.

Hematuria is diagnosed with a physical exam, a review of your medical history, and urine- and blood-based tests. Based on the suspected cause, imaging tests or an intravenous pyelogram may be ordered. The treatment of hematuria is directed by the underlying cause.

21 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Bolenz C, Schröppel B, Eisenhardt A, Schmitz-Dräger B, Grimm MO. The investigation of hematuria. Dtsch Arztebl Int. 2018 Nov;115(48):801-807. doi:10.3238/arztebl.2018.0801

  2. Jin Choi H, Hoon Jeong S, Seob Shin K, et al. Characteristics of Escherichia coli urine isolates and risk factors for secondary bloodstream infections in patients with urinary tract infections. Microbiol Spect. 2022 Jul;10(4). doi:10.1128/spectrum.01660-22

  3. Centers for Disease Control and Prevention. Urinary tract infection.

  4. Coccolini F, Moore E, Kluger Y, et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg. 2019 Dec;14(1):1-25. doi:10.1186/s13017-019-0274-x

  5. University of Connecticut. Kidney injury.

  6. Mount Sinai. Enlarged prostate.

  7. Venkatesh L, Karadakere Hanumegowda R. Acute pyelonephritis - Correlation of clinical parameter with radiological imaging abnormalities. J Clin Diagn Res. 2017 Jun;11(6):15-18. doi:10.7860/JCDR/2017/27247.10033

  8. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of kidney infection (pyelonephritis).

  9. Nagendra V, Dhande R, Mishra G, Reddy N, Gowda H. Hematuria as a sign of kidney stone disease evaluated using computed tomography: A review. Cureus. 2023 Apr;15(4):e38064. doi:10.7759/cureus.38064

  10. Varma PP, Sengupta P, Nair RK. Post exertional hematuria. Ren Fail. 2014 Jun;36(5):701-703. doi:10.3109/0886022X.2014.890011

  11. Urakami S, Ogawa K, Oka S, et al. Macroscopic hematuria caused by running-induced traumatic bladder mucosal contusions. IJU Case Rep. 2019 Jan;2(1):27-29. doi:10.1002/iju5.12030

  12. Memorial Sloan Kettering Cancer Center. UTI or cancer: What to know about blood in the urine.

  13. Ogita M, Kawamori J, Yamashita H, Nakagawa K. Palliative radiotherapy for gross hematuria in patients with advanced cancer. Sci Rep. 2021 May;11(1):9533. doi:10.1038/s41598-021-88952-8

  14. National Cancer Institute. Bladder cancer symptoms.

  15. U.S. Preventive Services Task Force. Prostate cancer: screening.

  16. Yale Medicine. Blood in the urine (hematuria).

  17. McConaghy J, Panchal B. Epididymitis: An overview. Am Fam Phys. 2016;94(9):723-726.

  18. Ansari M, Mangal R, Stead T, Carman M, Ganti L. Epididymo-orchitis and pelvic abscess in a patient with inflatable penile prosthesis. Cureus. 2022 Sep;14(9):e29715. doi:10.7759/cureus.29715

  19. Patel JV, Chambers CV, Gomella LG. Hematuria: etiology and evaluation for the primary care physician. Can J Urol. 2008;15 Suppl 1:54-61.

  20. Johns Hopkins Medicine. Sickle cell disease.

  21. Avellino GJ, Bose S, Wang DS. Diagnosis and Management of Hematuria. Surg Clin North Am. 2016;96(3):503-15. doi:10.1016/j.suc.2016.02.007

By Jerry Kennard
 Jerry Kennard, PhD, is a psychologist and associate fellow of the British Psychological Society.