Blood in Urine on a Dipstick Test: What Does It Mean?

A dipstick positive for blood means the test strip reacted to something that looks like blood in the sample. When the urine looks normal, this is called microscopic or non-visible haematuria (hematuria in US spelling). It does not by itself show where the blood came from or whether it will still be there on a repeat test.

Many causes are temporary or not serious, but some need investigation, so a positive result should be followed up rather than ignored. This guide is for adults with a dipstick result and urine that looks normal. It explains what the result can and cannot show; it cannot identify a cause.

Do not wait for a routine repeat test if the urine becomes pink, red or brown, or you see clots. The NHS advises asking for an urgent GP appointment or contacting NHS 111 if you have, or think you have, blood in your urine. Use the equivalent service where you live.

Healthdirect Australia advises calling emergency services for a lot of blood or blood clots in the urine, and getting urgent care if blood in urine comes with these symptoms:

• Pain in the abdomen, back or side (flank).
• Fever or feeling hot and shivery.
• Nausea or vomiting.
• Severe on-and-off pain in the side, back or groin, which the NHS links to kidney stones.

A dipstick is a quick chemical strip test. A review in American Family Physician reported that it is sensitive, so it rarely misses blood, but that it can give positive results that are not confirmed when the urine is looked at under a microscope. Other substances, such as haemoglobin or muscle protein (myoglobin) released without intact red cells, or semen in the sample, can trigger the strip.

For that reason, the same review describes confirming a positive dipstick with microscopic examination, which counts red blood cells in a properly collected sample. Ask whether your result was a strip reading alone or was confirmed in a laboratory. The report wording, units and reference range vary between labs.

Yes. Some common causes put real blood in the sample for a short time, without pointing to an ongoing problem. NIDDK notes that menstrual blood can contaminate a urine sample and give a misleading result, and that people who test positive during a period may be asked to repeat the test once it has ended.

Vigorous exercise, such as long-distance running, is another recognised cause. Healthdirect says exercise-related blood in urine usually settles on its own but should still be checked by a doctor. MedlinePlus also lists sexual activity and certain medicines. Bleeding haemorrhoids can contaminate a sample too.

Tell the person taking the sample about a period, recent hard exercise, recent sex or a urinary infection. Some foods, such as beetroot, can turn urine red without any blood being present; that is a colour change, not a dipstick finding.

Infection is one cause of blood in urine, but a sample with no sign of infection still has other possible explanations. NIDDK lists kidney stones, an enlarged prostate, inflammation of the kidney filters (glomerulonephritis), injury, blood-clotting disorders, and less often cancers of the bladder, kidney or prostate.

If infection was found and treated, the American Family Physician review describes repeating the urine test afterwards to check whether the blood has cleared. If your main question is about urinary symptoms with a negative culture, the separate SameCase guide on that topic covers it in more detail.

Whether further tests are needed depends on whether blood is confirmed and persists, your age, symptoms, medical history, other urine findings such as protein, and kidney blood tests. These decisions belong to your clinician.

A single positive result is a snapshot. A repeat test, taken when temporary causes such as a period, recent hard exercise or infection are no longer present, helps show whether the finding persists. The American Family Physician review describes retesting after a temporary cause has passed and states that persistent blood warrants a full assessment.

Ask how the repeat sample should be collected. A clean-catch midstream sample, taken away from a period, reduces contamination. Follow the instructions your service gives rather than guessing.

If blood is confirmed and persists, NIDDK and Healthdirect describe possible next steps. Not everyone needs all of them, and the choice depends on individual risk.

• Blood tests, including kidney function, to check how the kidneys are working.
• Further urine tests, for example for protein. A raised kidney result is covered in the separate guide on one low eGFR result.
• Imaging such as ultrasound or CT scans of the kidneys and bladder.
• Cystoscopy, where a specialist looks inside the bladder with a thin camera.
• Referral to a urologist or kidney specialist, depending on what the first results show.

Bring a copy of the urine report and any earlier results. These questions can help you understand the plan.

• Was the blood found on a dipstick only, or was it confirmed under a microscope?
• Could my period, recent exercise, sex or an infection explain this sample?
• When and how should I give a repeat sample, and who will check the result?
• Did the test also show protein or signs of infection, and what were my kidney blood tests?
• If blood persists, which further tests do you suggest for my situation, and why?
• Which new symptoms should make me seek help before the next appointment?

On SameCase, patients and verified doctors share de-identified cases. Reading how others with a positive dipstick were followed up, such as when they repeated the test or what their clinician asked about, can help you think of questions for your own appointment.

Other people's cases cannot tell you what your result means or which tests you need. Use them only to prepare questions, and rely on your own clinician for decisions.