Blood in urine during monsoon is not always a UTI: Doctor reveals when you should worry

Seeing red or pink urine can be unsettling, especially when it appears suddenly. During the monsoon, people may quickly blame an infection or UTI and wait for the symptom to settle. But blood in urine, medically called haematuria, deserves more attention than that.

“Blood in the urine can have several causes. UTIs are one of them and may also cause burning while passing urine, frequent urination, lower abdominal discomfort or fever,” said Dr Sanket Sathe, Consultant Uro oncology and Robotic Surgery, HCG Hospital, Mumbai. “However, blood in urine can also occur due to kidney or bladder stones, prostate problems, kidney disease and, in some cases, cancers of the urinary system.”

A UTI happens when infection affects parts of the urinary tract. When the bladder becomes infected or inflamed, its lining can become irritated enough to cause bleeding. That blood may make urine appear pink, red or darker than usual.

A person with a bladder infection may also notice burning while urinating, an urgent or frequent need to pass urine, lower abdominal discomfort, cloudy urine or a strong smell. Bloody urine is a recognised symptom of bladder infection.

The monsoon can make urinary symptoms more noticeable because people may pay greater attention to infections during the season. However, blood in urine should not automatically be labelled a “monsoon UTI.” There is no reliable basis to assume that visible blood during the rainy season is caused by infection alone.

The important clue is what comes with the blood. If blood appears along with burning, urgency, frequency and other typical infection symptoms, a UTI is one possible explanation. But bleeding without these symptoms, bleeding that keeps returning, or blood that remains after an infection has been treated needs further evaluation.

Dr Sathe said, “One important warning sign is blood in the urine without the typical symptoms of a UTI. Repeated episodes of blood in urine, particularly without a clear explanation, should also be evaluated by a doctor.”

Blood may sometimes be visible only once and then disappear. That does not necessarily mean the problem has gone away. The US National Cancer Institute notes that blood in urine is the most common symptom of bladder cancer and can appear intermittently.

A urinary stone can scrape or irritate the urinary tract and cause bleeding, often with severe pain in the side, back or groin. Kidney disease, prostate enlargement and inflammation can also cause haematuria.

Cancer is less common than infections or stones, but it is the reason unexplained bleeding should not be brushed aside.

Smoking is a major risk factor for bladder cancer. Certain workplace exposures, previous pelvic radiation, some cancer treatments and a family history can also raise risk.

Dr Sathe said, “Other symptoms that may need attention include unexplained weight loss, persistent pain in the side or lower back, changes in urination, difficulty passing urine, increased frequency of urination or unexplained fatigue. These symptoms do not necessarily mean cancer, but they should not be ignored.”

The first step is usually not a complicated scan. A doctor may ask about the colour and timing of the bleeding, urinary symptoms, medicines and medical history.

Urinalysis can look for blood and signs of infection, while a urine culture can help identify bacteria when infection is suspected.

Depending on age, symptoms and risk factors, doctors may then recommend blood tests, ultrasound or other imaging. If a bladder problem needs investigation, cystoscopy may be advised. It allows a doctor to examine the bladder using a thin camera.

The key point is simple: do not keep treating unexplained blood in urine as a UTI without finding out why it is happening.

A rainy season can make infection the first explanation that comes to mind. But the urinary system does not follow the calendar.

Dr Sathe said, “If blood is seen in the urine, particularly if it occurs repeatedly, a person should consult a doctor rather than repeatedly taking antibiotics or waiting for the symptom to disappear. Early evaluation can identify the actual cause and, if cancer is present, may help in detecting it at an earlier and more treatable stage.”

Blood in urine does not mean cancer. In many people, the cause is an infection, stone or another non-cancerous condition. The important part is identifying the cause instead of guessing.

This article includes expert inputs shared with TOI Health by:

Dr Sanket Sathe, Consultant Uro oncology and Robotic Surgery, HCG Hospital, Mumbai.

Inputs were used to explain when blood in urine may point to a UTI and why persistent or unexplained bleeding needs medical evaluation.