One of the most common early symptoms of bladder cancer is blood in your urine that you’ll likely notice in the toilet after you pee. It doesn’t happen in all cases, however.

Bladder cancer happens when cancerous tissues grow in or around your bladder. The bladder stores urine from your kidneys and drains it through your urethra.

The American Cancer Society estimates there were 81,180 new cases of bladder cancer in the United States in 2022. One of the most common early symptoms of bladder cancer is blood in your urine — also known as hematuria — that you’ll likely notice in the toilet after you pee.

Even though it’s a common symptom, it can resemble the symptoms of other conditions. And it may not happen at all in some cases.

Read on to learn how to recognize hematuria from bladder cancer, other bladder cancer symptoms to watch for, and when to contact a doctor for medical help.

When you have bladder cancer, blood gets in the urine from a cancerous tumor that starts hemorrhaging. This means a blood vessel in the tumor or near the tumor has burst and is leaking blood into the bladder.

Small cancerous tumors that have just started growing have small, delicate blood vessels that are prone to burst easily. This is why hematuria is a common early symptom of bladder cancer.

At this stage, blood may not be visible in the urine (known as microscopic hematuria). It may only be detected in a urinalysis test.

As the tumor grows, it can also cause blood vessels to burst in nearby tissues. As more blood leaks into the urine, the color of your urine may change to a more noticeable pink, red, or dark tint. This is known as gross hematuria.

Microscopic hematuria may not always cause any visible changes to your urine besides a very slight, almost invisible change in color.

Most of the obvious symptoms happen when you have gross hematuria. This means your urine will darken significantly enough to be visible to the naked eye.

Gross hematuria might cause your urine to turn various shades of the following colors:

  • pink
  • red
  • brown

In some cases, you may also notice dark red or brown chunks in your urine when you have gross hematuria. This can result from blood clots that form in the bladder that exit your body when you pee. Blood clots also often occur with pain in your bladder or lower back.

Eating certain foods, such as beets, can change the color of your urine temporarily. Changes in your urine color that only last for a few days shouldn’t be considered a cause for concern. But changes to your urine color that last for several weeks or longer may indicate bladder cancer.

Hematuria is not known to cause pain on its own. You may notice changes to the color of your urine when you have gross hematuria but not experience any pain at all in many cases.

Hematuria can hurt if you’re passing blood clots when you pee. You may also experience hematuria alongside other common symptoms of bladder cancer:

In many cases, you may have bladder cancer without having any symptoms. Microscopic hematuria can happen in the earliest stages of bladder cancer but doesn’t result in any visible symptoms.

But once the cancer starts growing and spreading inside and outside the bladder, hemorrhaging of tumors and bladder tissues often result in hematuria before you notice any of the other common symptoms.

Hematuria is one of the most common symptoms of bladder cancer — and one of the earliest symptoms. A 2018 study of over 134,000 adults in Denmark suggests hematuria is one of the most significant predictors of bladder cancer within 5 years of the symptom first appearing.

Hematuria is just one symptom that can mean you have bladder cancer.

Other symptoms to watch for when you notice blood in your urine include:

Contact a doctor right away if you notice any of the following symptoms:

  • you see blood in your urine, especially with blood clots (which may appear like small chunks) or blood in dark- or amber-colored urine
  • extreme pain when you urinate
  • not being able to urinate at all
  • having frequent urine leakage
  • losing a significant amount of weight for no obvious reason
  • extreme pain in your lower back or abdomen
  • feeling extremely weak or fatigued

Bladder cancer doesn’t always cause hematuria. Sometimes, only a tiny amount of blood may not cause any visible changes. However, it’s often one of the first symptoms of bladder cancer you may notice before any pain, changes in urinary behavior, or other symptoms of bladder cancer.

Contact a doctor as soon as you notice any changes in your urine color. They can get you tested for bladder cancer or other underlying conditions that can cause hematuria.