Blood in Urine in Men: Never Ignore These Warning Signs

Seeing red, pink, brown, or tea-colored urine can be alarming.

Sometimes blood in the urine comes from something relatively straightforward, such as a urinary infection, kidney stone, vigorous exercise, or an enlarged prostate.

But in other situations, it can be an early warning sign of disease involving the kidneys, bladder, prostate, or urinary tract.

The important message I want men to remember is this: blood in urine should not automatically be blamed on a urinary tract infection, dehydration, exercise, or “prostate weakness.”

Medically, blood in the urine is called hematuria.

It may be visible to your eyes, known as gross or visible hematuria, or detectable only on urine microscopy, known as microscopic hematuria.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, even a small amount of blood can noticeably change urine color. (NIDDKD)

As a physiotherapist, I often meet men who are surprised to learn that the urinary system and pelvic floor are closely connected.

However, when blood is actually present in the urine, pelvic floor exercises are not the first treatment.

The first responsibility is to identify where the bleeding is coming from.

That distinction can prevent both unnecessary fear and dangerous delay.

What Does Blood in Urine Mean in Men?

Blood in urine can result from a urinary tract infection, kidney or bladder stones, enlarged prostate, kidney disease, vigorous exercise, urinary tract injury, medications such as:

blood thinners, or cancers of the bladder, kidney, prostate, or urinary tract.

Visible blood deserves medical assessment even when it happens only once, causes no pain, or disappears by itself.

Current guidance emphasizes evaluating hematuria according to the person’s risk factors rather than simply assuming that it is harmless.

First, Understand What “Blood in Urine” Actually Means

Visible versus microscopic hematuria

There are two broad forms.

Visible hematuria means you can see a color change. Urine may look:

• Pink
• Bright red
• Rust-colored
• Dark brown
• Tea-colored
• Occasionally contain visible clots

Microscopic hematuria means the urine looks completely normal but red blood cells are detected on testing.

This difference matters because the absence of visible blood does not necessarily mean the urinary tract is completely healthy.

The 2025 AUA/SUFU guideline update revised the risk-based approach to microscopic hematuria using evidence published since the original guideline.

It emphasizes appropriate risk stratification and selective use of imaging, cystoscopy, and urine-based tests rather than treating every patient identically. (Wolters Kluwer)

Why the urine can look dramatically red from a small amount of blood

This is one of the lesser-known facts about hematuria.

You do not need to lose a large amount of blood for urine to look frighteningly red. A relatively small quantity can change the appearance of urine.

That is why judging the seriousness of hematuria purely by how red the urine looks is unreliable.

NIDDK specifically notes that only a small amount of blood may produce a visible color change.

In other words, very red urine does not necessarily mean massive bleeding, while invisible blood does not necessarily mean insignificant disease.

9 Possible Causes of Blood in Urine in Men

The cause can originate anywhere along the urinary tract, including the kidneys, ureters, bladder, prostate region, or urethra.

1. Urinary tract infection

Although urinary tract infections are often discussed more frequently in women, men can develop them too.

A UTI may cause:

• Burning while urinating
• Frequent urination
• Urinary urgency
• Lower abdominal discomfort
• Cloudy or foul-smelling urine
• Fever or chills in more significant infections
• Blood in the urine

The important mistake is to assume that every episode of hematuria is a UTI.

If infection is suspected, appropriate urine testing is important.

More importantly, if blood remains after the infection has been treated, it should not simply be ignored.

The AUA/SUFU guideline specifically recommends repeat urinalysis after treatment of a urinary tract infection when hematuria was attributed to the infection, to make sure the blood has resolved.

Physiotherapy perspective: urinary urgency, frequency and pelvic discomfort can sometimes coexist with pelvic floor dysfunction.

But pelvic floor dysfunction does not explain away confirmed blood in urine.

The bleeding still requires appropriate medical evaluation.

2. Kidney or bladder stones

Stones can scrape or irritate the urinary tract as they move.

A kidney stone may produce:

• Sharp flank pain
• Pain radiating toward the groin
• Blood in urine
• Nausea or vomiting
• Urinary urgency
• Pain while urinating

Interestingly, the amount of pain does not always tell you how important the stone is.

NIDDK identifies pink, red, or brown urine as one of the characteristic symptoms that can accompany kidney stones.

A man with severe flank pain and hematuria should not simply stretch his back or attempt to “release the stone” through exercises.

Hydration advice also needs nuance.

Drinking reasonable amounts of fluid is sensible, but aggressively forcing huge quantities of water is not a substitute for medical assessment, particularly if urinary flow is obstructed.

3. Enlarged prostate

As men age, benign prostatic hyperplasia, or BPH, becomes increasingly common.

An enlarged prostate can contribute to:

• Weak urine stream
• Difficulty starting urination
• Dribbling
• Increased nighttime urination
• Urinary urgency
• Incomplete emptying
• Occasionally hematuria

NIDDK lists BPH among conditions associated with hematuria.

But here is an important distinction: blood in urine should not automatically be labelled “because of the prostate.”

A prostate problem may be present while another urinary condition is responsible for the bleeding.

4. Prostate inflammation

Prostatitis can cause urinary and pelvic symptoms, sometimes accompanied by:

• Burning urination
• Pelvic discomfort
• Pain around the perineum
• Pain with ejaculation
• Increased urinary frequency
• Difficulty urinating

Some men with chronic pelvic pain also develop excessive pelvic floor muscle activity.

This is where physiotherapy can have a meaningful role, but only after appropriate medical assessment.

For men whose symptoms are predominantly related to pelvic floor overactivity, treatment may include breathing retraining, pelvic floor down-training, relaxation strategies, mobility work, and carefully selected manual therapy.

What I would not recommend is automatically prescribing repeated Kegel exercises to every man with urinary symptoms.

If the pelvic floor is already overactive, repeatedly squeezing it can potentially make relaxation and voiding more difficult.

The European Association of Urology notes that successful voiding requires relaxation of the pelvic floor and urinary sphincter and discusses pelvic floor relaxation with biofeedback in voiding dysfunction. (Springer)

5. Vigorous exercise

This is particularly relevant to runners, athletes, military personnel, cyclists, and men performing high-intensity training.

Exercise-related hematuria has been documented in the medical literature.

A review in European Urology Focus reported that microscopic hematuria can occur frequently after intense exercise, while visible hematuria is less common and is more concerning when associated with trauma. (Science Direct)

Possible mechanisms include changes in kidney blood flow, increased glomerular permeability, repeated bladder impact, foot-strike hemolysis, dehydration, and urinary tract trauma.

One fascinating finding from the literature is that exercise-related hematuria does not necessarily require contact sports.

Running and other non-contact activities can also produce microscopic blood in urine.

However, there is a crucial rule:

Do not assume that blood after exercise is automatically “runner’s hematuria.”

Especially if the blood is visible, recurrent, accompanied by pain, follows a blow to the abdomen or flank, or does not disappear after rest, medical evaluation is appropriate.

6. Urinary tract injury

A direct blow to the abdomen, pelvis, flank, or genital region can injure the urinary tract.

This may occur during:

• Contact sports
• Falls
• Road accidents
• Heavy-impact activities
• Certain procedures
• Catheterization

An important lesser-known fact is that the absence of hematuria does not completely exclude urinary tract trauma.

A review of sports-related hematuria reported that hematuria may be absent in some cases of urological injury. (Elsevier)

Therefore, after significant trauma, symptoms and injury mechanism matter more than simply checking whether urine looks clear.

7. Kidney disease

Not all hematuria comes from the bladder or prostate.

The tiny filtering structures inside the kidneys, called glomeruli, can also be responsible.

Some kidney disorders can produce microscopic hematuria and may occur alongside:

• Protein in urine
• High blood pressure
• Swelling
• Changes in kidney function
• Abnormal kidney blood tests

This is one reason a proper evaluation may involve more than a simple urine dipstick.

8. Medications and blood thinners

Men taking medications such as anticoagulants or antiplatelet drugs may notice bleeding more readily.

But there is a common misconception I want to correct:

“I take a blood thinner, so the blood in my urine is obviously from the medicine.”

That assumption can delay diagnosis.

The AUA/SUFU guideline states that patients taking anticoagulants should undergo hematuria evaluation in the same manner as patients who are not anticoagulated because the risk of significant underlying disease is still present.

Do not stop prescribed blood-thinning medication on your own.

9. Cancer of the urinary tract

This is the possibility men understandably fear most.

Blood in urine can occur with cancers involving the:

• Bladder
• Kidney
• Upper urinary tract
• Prostate

It does not mean that you have cancer.

But visible hematuria can be an early warning sign, sometimes occurring without pain or other obvious symptoms.

The European Association of Urology identifies hematuria as the most common finding in non-muscle-invasive bladder cancer and emphasizes appropriate investigation. (EAU)

A systematic review and meta-analysis involving 18,752 men evaluated for hematuria found a pooled prostate cancer prevalence of 3.0%, rising to 5.9% among men presenting with macroscopic hematuria. (Wiley)

These figures do not mean that a man with blood in urine has a 5.9% personal chance of prostate cancer.

They describe populations evaluated for hematuria and demonstrate why medical investigation should not be skipped.

What Makes Blood in Urine More Concerning?

I encourage men to pay attention not only to the blood but also to the context.

Medical assessment becomes particularly important when hematuria is:

• Visible
• Recurrent
• Painless
• Persistent
• Associated with clots
• Associated with unexplained weight loss
• Accompanied by urinary obstruction
• Associated with smoking history
• Occurring in an older adult
• Associated with significant occupational chemical exposure
• Accompanied by flank or abdominal pain
• Associated with fever or systemic illness

The NHS recommends medical assessment even when visible blood occurs for the first time, is painless, or appears to be only a small amount.

Why Painless Blood in Urine Can Be More Important Than Painful Blood

This sounds counterintuitive.

Pain often makes people seek help quickly.

If a kidney stone causes intense flank pain, most men are unlikely to ignore it.

Painless visible hematuria can be different.

A man may feel perfectly healthy, notice pink urine once, see normal urine the next morning, and decide the problem has disappeared.

That is exactly the situation in which I would advise against complacency.

Certain urinary tract conditions can produce bleeding without significant pain.

The European Association of Urology specifically identifies visible hematuria as a major presentation of bladder cancer.

So, “It didn’t hurt” is not the same as “it wasn’t important.”

How Doctors Investigate Blood in Urine in Men

The evaluation depends on age, symptoms, risk factors and whether the blood is visible or microscopic.

Step 1: Urinalysis

A urine test can determine whether blood is actually present.

Microscopic examination can identify red blood cells and may provide additional clues.

Urine testing can also help investigate infection and other urinary abnormalities.

Step 2: Medical history

Your clinician may ask about:

• Smoking
• Recent infections
• Exercise
• Kidney stones
• Previous urinary procedures
• Medication use
• Blood thinners
• Family history
• Urinary symptoms
• Previous cancer
• Occupational exposures
• Recent trauma

Do not leave out details because you think they are unrelated.

Step 3: Blood tests

Blood testing may help evaluate kidney function, anemia, infection or other systemic issues depending on the presentation.

Step 4: Imaging

Ultrasound, CT, MRI or CT urography may be considered depending on the suspected cause and risk category.

The 2025 AUA/SUFU guideline emphasizes risk-based evaluation rather than indiscriminate testing.

Step 5: Cystoscopy

Cystoscopy allows a urologist to inspect the urethra and bladder using a small camera.

This is particularly important because imaging and urine testing cannot simply substitute for direct bladder inspection in every situation.

The EAU bladder cancer guideline states that cystoscopy is necessary for diagnosing bladder cancer and cannot be replaced by cytology or another non-invasive test.

Where Does Physiotherapy Fit Into Hematuria?

This is an important question because pelvic health physiotherapy has become increasingly recognized in men’s health.

But let me make the boundary very clear:

Physiotherapy does not diagnose the cause of blood in urine.

If a man reports hematuria, medical evaluation comes first.

Physiotherapy may become useful when the underlying medical assessment identifies a condition in which musculoskeletal or pelvic floor dysfunction contributes to symptoms.

For example, some men experience:

• Pelvic pain
• Urinary urgency
• Difficulty relaxing during urination
• Post-void discomfort
• Perineal tension
• Chronic pelvic pain
• Symptoms aggravated by prolonged sitting

In these cases, assessment of breathing mechanics, pelvic floor coordination, hip mobility, abdominal wall tension, posture, and pelvic muscle tone may be useful.

The surprising pelvic floor mistake: more Kegels are not always better

This is one of the most important points I would teach a male patient.

The pelvic floor has two jobs that can appear contradictory:

It needs to contract when continence is required.

It needs to relax when urination is occurring.

A man with poor pelvic floor coordination may therefore have difficulty relaxing rather than simply lacking strength.

The EAU specifically describes pelvic floor relaxation as part of successful voiding.

So if you have blood in urine plus urinary difficulty, do not begin an aggressive Kegel program without knowing what is actually happening.

Can Exercise Prevent Hematuria?

Exercise is extremely important for cardiovascular, metabolic and musculoskeletal health, but exercise should not be presented as a treatment for unexplained hematuria.

If a particular workout repeatedly produces visible blood in your urine, change the question from:

“How can I exercise through it?”

to:

“Why is this happening?”

Exercise-related microscopic hematuria can be transient, but research emphasizes that hematuria following trauma requires appropriate investigation.

A sensible approach is to temporarily reduce strenuous activity until you have been appropriately assessed, particularly after visible bleeding.

Things Men Should Do

Do get visible blood checked

Even one episode deserves attention.

Do record what the urine looked like

If safe and practical, noting whether the urine was pink, red, brown or contained clots can help your clinician.

Do mention recent intense exercise

A long run, marathon, contact sport session or unusually intense workout may be clinically relevant.

Do tell your doctor about medications

Especially anticoagulants, antiplatelet medications and regular painkiller use.

Do mention urinary symptoms

Weak stream, urgency, frequency, nighttime urination, burning, incomplete emptying and difficulty starting can help narrow the possibilities.

Do seek urgent care for severe symptoms

Especially if you cannot urinate, have large clots, severe flank pain, fever with significant illness, major trauma, dizziness or substantial bleeding.

Things Men Should Avoid

Don’t self-prescribe antibiotics

Blood in urine does not automatically equal infection.

Don’t stop blood thinners yourself

The medication may need review, but abruptly stopping prescribed anticoagulation can be dangerous.

Don’t assume it is just your prostate

An enlarged prostate is common, but hematuria deserves appropriate assessment.

Don’t perform repeated Kegels simply because you have urinary symptoms

If pelvic floor overactivity is present, strengthening may not be the appropriate first strategy.

Don’t “flush it out” with extreme amounts of water

Hydration is important, but excessive water consumption does not diagnose or treat the cause of hematuria.

Don’t ignore recurrence

If blood disappears and then returns, that pattern is useful clinical information rather than proof that the original episode was harmless.

A Lesser-Known Clue: Urine Color Isn’t Always Blood

Not every red or brown urine sample contains red blood cells.

Certain foods, medications, pigments and muscle breakdown products can alter urine color.

For example, strenuous exercise can cause myoglobin to appear in urine following muscle injury, potentially producing dark urine.

Exercise-related literature discusses both hematuria and non-blood causes of urine discoloration.

That is another reason laboratory urinalysis is more reliable than trying to diagnose yourself by looking at the toilet bowl.

When Blood in Urine Is an Emergency

Seek urgent medical attention if blood in urine occurs with:

• Inability to pass urine
• Large blood clots
• Severe or rapidly worsening pain
• Fever and chills with urinary symptoms
• Significant abdominal or flank trauma
• Fainting, severe weakness or symptoms of substantial blood loss
• Severe vomiting or dehydration
• Sudden severe flank pain with urinary obstruction

Kidney stone symptoms such as severe pain, blood in urine, inability to urinate, fever or vomiting warrant prompt medical attention.

The Bottom Line for Men

Blood in urine is a symptom, not a diagnosis.

Sometimes the explanation is benign or easily treatable.

Sometimes it is related to exercise, infection, stones, prostate enlargement or medication.

And sometimes it is the first clue to kidney disease or urinary tract cancer.

The safest approach is neither panic nor dismissal.

If you see blood in your urine, especially visible blood, arrange an appropriate medical assessment rather than waiting to see whether it returns.

From a physiotherapy perspective, my role begins after the medical red flags have been appropriately addressed.

If pelvic floor dysfunction, poor relaxation, chronic pelvic pain, movement-related symptoms or muscular contributors are identified, physiotherapy can become part of a broader treatment plan.

But the first question is never simply, “Which pelvic floor exercise should I do?”

The first question is:

“Why is there blood in my urine?”

That answer needs to come from proper medical evaluation.

Final Clinical Takeaway

One episode of visible blood in urine is worth investigating, even if you feel completely well afterward.

Don’t panic. Don’t self-diagnose.

Don’t automatically blame the prostate, exercise or infection.

Get the source identified first.

Then treat the actual cause.

That is the safest and most sensible approach to men’s urinary health.

Medical note: This article is educational and does not replace examination, urinalysis, imaging or assessment by a qualified physician/urologist. The physiotherapy sections address potential rehabilitation considerations and should not be interpreted as treatment for unexplained hematuria.

Medical Disclaimer!

This article has been reviewed and written under the guidance of our Head Physiotherapist, Dr. Kruti Raj (PT, MUHS,CPT,CMPT). The information shared is intended for educational purposes only and should not be considered a substitute for personalized medical advice, diagnosis, or treatment.

Please consult us or any other qualified healthcare professional before beginning any exercise program, especially if you are experiencing pain, recovering from injury, or managing a medical condition.