If you have blood in your urine accompanied by pain, the appropriate level of care depends on the severity of your symptoms and whether you have signs of a spreading infection or blockage. While many cases of painful haematuria are caused by common conditions like urinary tract infections (UTIs) or kidney stones, certain ‘red flag’ symptoms require immediate assessment to prevent complications like kidney damage or sepsis.
What We’ll Discuss in This Article
- Differentiating between routine, urgent, and emergency symptoms
- When NHS 111 is the correct first step for painful haematuria
- Red flag signs that require a visit to A&E
- The significance of ‘loin pain’ and high fever
- What to expect during an urgent medical evaluation
- Guidance on managing symptoms while waiting for care
When to Call NHS 111
NHS 111 is the best point of contact if your symptoms are distressing but not life-threatening. This service can provide clinical advice and, if necessary, book you into an out-of-hours GP appointment or an Urgent Treatment Centre (UTC).
You should contact 111 if:
- You have blood in your urine and a burning or stinging sensation when peeing.
- You have a dull ache in your lower tummy or pelvic area.
- You feel generally unwell but do not have a high fever or vomiting.
- You are concerned about a change in urine colour and cannot get a GP appointment quickly.
111 clinicians can assess whether your symptoms suggest a standard bladder infection (cystitis) or if you need to be seen more urgently by a doctor.
When to Go to A&E (or Call 999)
In some cases, blood in the urine combined with pain indicates a more serious issue, such as a severe kidney infection (pyelonephritis) or an obstructing kidney stone. These situations require the diagnostic facilities of a hospital, such as blood tests and urgent scans.
Red Flag Symptoms for A&E:
- Severe, Unbearable Pain: Often felt in the ‘loin’ (the side of your back) or radiating to the groin. This is often ‘colicky’ pain that comes in waves.
- Signs of Sepsis: High fever, shivering, chills, or a very low body temperature.
- Vomiting: Being unable to keep fluids or pain relief down.
- Urinary Retention: Feeling a desperate need to pee but being completely unable to pass any urine.
- Large Clots: Passing significant blood clots that make it difficult to urinate.
If you experience severe, sudden, or worsening symptoms, call 999 immediately.
Identifying the Source of Pain
The location and type of pain provide vital clues to medical staff about where the problem lies within your urinary tract.
| Type of Pain | Possible Source | Associated Symptoms |
| Stinging/Burning | Bladder or Urethra | Frequent need to pee, cloudy urine |
| Sharp, Waving Pain | Ureter (Kidney Stone) | Restlessness, nausea, visible blood |
| Deep Ache in Back | Kidney (Infection) | Fever, chills, feeling very tired |
| Lower Tummy Pressure | Bladder (Cystitis) | Pelvic heaviness, urgency |
What Happens During an Urgent Check?
Whether you are seen at a UTC or A&E, the medical team will perform several rapid tests to ensure your safety.
- Urine Dipstick: To check for blood, protein, and signs of infection (nitrites/leucocytes).
- Observations: Checking your blood pressure, heart rate, and temperature to look for signs of systemic illness.
- Physical Exam: Pressing on your tummy and back to check for ‘costovertebral angle tenderness’ (kidney pain).
- Blood Tests: To check your kidney function and look for markers of inflammation in the blood.
- Imaging: If a stone or blockage is suspected, you may receive an urgent ultrasound or a CT scan.
To Summarise
Blood in the urine with pain is a symptom that should be addressed promptly. For most cases involving stinging or mild aching, NHS 111 or an urgent GP appointment is the appropriate route. However, if the pain is severe, if you have a high fever, or if you cannot pass urine, you must go to A&E. Identifying the cause early whether it is a UTI or a kidney stone is the most effective way to manage pain and protect your long-term kidney health.
Can a UTI cause enough pain to need A&E?
Usually, a UTI can be managed by a GP or 111, but if you develop a high fever and severe back pain, it may have reached the kidneys and requires hospital assessment.
What if I have blood and pain but it stops?
You should still see a GP. Symptoms that come and go can be a sign of kidney stones or other issues that need to be ruled out.
Is blood in the urine always pink?
No, it can be bright red, or even a dark brown ‘tea’ colour, depending on how much blood is present and where it is coming from.
Will I be given antibiotics at A&E?
If the doctors find evidence of a bacterial infection, they will likely start you on a course of antibiotics.
Can a kidney stone cause a fever?
A stone itself usually doesn’t cause a fever, but if a stone causes a blockage that leads to an infection, a fever can develop; this is a medical emergency.
What is ‘renal colic’?
This is the medical term for the intense, waving pain caused by a kidney stone moving through the urinary tract.
How much water should I drink if I’m in pain?
If you suspect a stone and aren’t vomiting, staying hydrated can help, but if you have a blockage or severe pain, wait until you have been assessed by a clinician.
Authority Snapshot
This article was reviewed by Dr. Stefan Petrov, a UK-trained physician with experience in emergency care and general medicine. The guidance follows the NHS and NICE protocols for the triage and management of haematuria and renal colic. Our goal is to help patients make safe, informed decisions about where to seek care based on the severity and nature of their symptoms.
