The most important and most common symptom of bladder cancer is blood in the urine; the urine may look rusty to bright red, and the blood may be seen only once and then not come back for a while [1]. Passing urine often, pain or burning when passing urine, feeling an urgent need to pass urine even when the bladder is not full, and waking often at night to pass urine are other symptoms [1]. These symptoms may have another cause, such as a urinary tract infection or a stone, and most of the time they are not cancer [1, 6]; but always show a doctor visible blood in your urine, even without pain and even once, especially if you smoke or used to smoke [4, 7].
Key points
- Blood in the urine is the most common symptom of bladder cancer [1] and its strongest sign in people who see their GP [5].
- Smoking is the main risk factor: in a large study, about half of bladder cancers in both men and women were linked to smoking, and the risk in current smokers was about 4 times that of people who had never smoked [4].
- The risk in people who had stopped smoking was clearly lower than in current smokers [4].
- Using opium also raises the risk; in the Golestan study in Iran, almost 3 times [9].
- The diagnosis is made with cystoscopy: looking inside the bladder with a thin tube that has a camera [3].
Symptoms of bladder cancer
| Symptom | Explanation | What to do |
|---|---|---|
| Visible blood in the urine (rusty to bright red) | The most common symptom; it may come and go and not be seen for a while [1] | See a doctor even if it happened only once and there is no pain; the bleeding stopping does not mean the problem has gone [1, 7] |
| Microscopic blood (found only on a urine test) | A small amount of blood that cannot be seen with the eye [1]; the chance of cancer is lower than with visible blood [6] | The doctor decides which tests are needed based on your age, smoking history and the amount of blood [8] |
| Passing urine often, or waking often at night to pass urine | A common symptom [1] | If it does not improve with treatment, have it checked |
| Burning or pain when passing urine | May be due to a urinary tract infection [1] | If it continues after the infection is treated, or infections keep coming back, see a doctor [7] |
| Feeling an urgent need to pass urine even when the bladder is not full | A listed symptom [1] | If it continues, have it checked |
| Being unable to pass urine | When the tumour has grown or spread [1] | Seek urgent care at an emergency department |
| Pain on one side of the lower back, abdominal pain or bone pain | When the tumour has grown or spread [1] | See a doctor as soon as possible |
| Weight loss and loss of appetite, tiredness and swollen feet | In advanced disease [1] | See a doctor as soon as possible |
This table does not replace an examination by a doctor; in most people these symptoms have another cause.
When should I call my doctor?
Blood in the urine is not always cancer; a urinary tract infection, kidney or bladder stones and other kidney problems can also cause it, and most people with blood in their urine do not have cancer [1, 6]. But show these to a doctor as soon as possible, and do not wait for them to go away on their own:
- visible blood in the urine, even without pain and even if it happened only once; especially if you are 45 or older or you smoke or used to smoke [4, 7]
- blood that remained or came back after treatment for a urinary tract infection [7]
- a urinary tract infection or burning when passing urine that keeps coming back or does not get better, especially after the age of 60 [7]
- if you take a blood thinner (such as warfarin or aspirin), blood in the urine still needs the same checks and should not be put down to the medicine alone [8]
Urine full of blood or clots, being unable to pass urine, or fever and shivering with flank pain needs urgent care at an emergency department.
Who is at higher risk?
Bladder cancer is more common in men than in women, and it becomes more common with age [2]. Risk factors [2]:
- smoking: the main risk factor. Cancer-causing chemicals from smoke pass through the kidneys into the urine and collect in the bladder
- opium, whether smoked or eaten [9]
- exposure at work to paints, dyes, metals or petroleum products
- past radiotherapy to the pelvis or certain chemotherapy drugs, such as cyclophosphamide and ifosfamide
- a family history of bladder cancer
- well water with high levels of arsenic
- infection with the parasite Schistosoma (bilharzia), found in Africa and the Middle East
- a long-term urinary catheter
The best ways to lower the risk are stopping smoking and avoiding opium [4, 9]. Read more: Does opium cause cancer?
If the doctor suspects bladder cancer, which tests are needed?
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Cystoscopy
Using a thin tube with a camera, the doctor looks inside the bladder through the urethra. If a suspicious area is seen, a sample is taken there and then, and sometimes a small tumour is removed completely at the same time [3]. For a day or two afterwards you may have a little blood in your urine or a burning feeling when passing urine [3].
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Urine tests for tumour cells or markers
They sometimes help, but they do not replace cystoscopy [8].
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If cancer is confirmed
The tumour is removed through the urethra and examined to see whether it has grown into the muscle of the bladder wall; this decides the type of treatment [10]. Read more: Bladder cancer
Frequently asked questions
Painless blood in the urine: is it dangerous?
It needs to be checked. Visible blood in the urine is the most common symptom of bladder cancer [1], and guidelines recommend checking it whether or not there is pain [7]. But most of these people do not have cancer: in a study of more than 3500 people checked for blood in the urine, about 1 in 7 of those with visible blood had a urinary tract cancer [6].
I saw blood in my urine only once and it has not come back; do I still need to see a doctor?
Yes. In bladder cancer, blood may appear once and then not be seen for a while [1]; the bleeding stopping does not mean the problem has gone.
Can burning when passing urine and repeated urinary tract infections be a sign of bladder cancer?
Usually not; burning when passing urine and urinary tract infections have been linked with bladder cancer in studies, but on their own they are weak signs [5]. If you are 60 or older and your urinary tract infections keep coming back or do not clear, guidelines suggest checking for bladder cancer [7]. If there is still blood in your urine after the infection has been treated, make sure you are checked [7, 8].
I have stopped smoking; am I still at risk?
The risk in people who have stopped smoking is lower than in current smokers, but still higher than in people who have never smoked [4]. So take blood in your urine seriously and tell your doctor that you used to smoke.
Is a urine test or an ultrasound enough to rule out bladder cancer?
Is bladder cancer diagnosed later in women?
Does opium raise the risk of bladder cancer?
Yes. In the Golestan study of more than 50,000 people in Iran, opium users developed bladder cancer almost 3 times as often, and the more they used, the higher the risk [9]. Read more: Does opium cause cancer?
Referral criteria and diagnostic points (for doctors)
For physicians
NICE NG12 (updated 2026). Refer people using a suspected cancer pathway referral for bladder cancer (diagnosis or exclusion of cancer within 28 days) if they are aged 45 and over with unexplained visible haematuria without urinary tract infection, or visible haematuria that persists or recurs after successful treatment of urinary tract infection; or aged 60 and over with unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test (recommendation 1.6.4). Consider non-urgent referral in people aged 60 and over with recurrent or persistent unexplained urinary tract infection (recommendation 1.6.5) [7].
Diagnostic yield. DETECT I (3556 patients referred from 40 UK hospitals): urinary tract cancer 10.0% (bladder 8.0%, renal parenchyma 1.0%, upper tract urothelial 0.7%, prostate 0.3%); 13.8% with visible versus 3.1% with non-visible haematuria. Older age, male sex and smoking history were independently associated with cancer. Cancer was found in 3.5% of patients with visible haematuria younger than 45 and in 1.0% of those with non-visible haematuria younger than 60; of the bladder cancers found after non-visible haematuria, 59.4% were high risk and 31.3% muscle invasive [6]. In a primary care case-control study (4915 cases aged 40 and over), visible haematuria had an OR of 34 and a PPV of 2.6% in those aged 60 and over; dysuria (OR 4.1), urinary tract infection (2.2) and a raised white cell count (2.1) were also associated, but with low predictive values [5].
Microhaematuria (AUA/SUFU 2025). Definition: 3 or more red blood cells per high-power field on a single, properly collected specimen; a positive dipstick must be confirmed by microscopy. Risk groups are based on age (men: under 40, 40 to 59, 60 and over; women: under 60 low risk and 60 and over intermediate risk, and women are not classed as high risk on age alone), smoking history (under 10, 10 to 30, over 30 pack-years), degree of haematuria (3 to 10, 11 to 25, over 25 RBC/HPF) and a history of gross haematuria (a high-risk criterion). High risk: cystoscopy and multiphasic CT urography; intermediate risk: cystoscopy and renal ultrasound; low risk: repeat urinalysis within 6 months. Cytology and urinary markers should not be used routinely to decide on cystoscopy in low- or high-risk patients. Antiplatelet or anticoagulant therapy does not change the evaluation. Delayed evaluation in women (haematuria attributed to infection or a gynaecological source) is common [8].
Risk factors. In the NIH-AARP cohort (467,528 people), the HR was 4.06 (95% CI 3.66 to 4.50) for current smokers and 2.22 (2.03 to 2.44) for former smokers compared with never smokers; the PAR for smoking was 0.50 in men and 0.52 in women [4]. Opium use in the Golestan cohort: HR for bladder cancer 2.86 (1.47 to 5.55), with a dose-response relationship [9].
Scientific evidence
Scientific evidence
2 itemsAssociation Between Smoking and Risk of Bladder Cancer Among Men and Women
Opium use and subsequent incidence of cancer: results from the Golestan Cohort Study
Related cancer types
References
10 referencesShow all references, 3 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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- 10Bladder Cancer: A Review
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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