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Blood clots can obstruct bladder outflow, causing painful retention, post-renal kidney injury and continued haemorrhage.
Ask about visible blood, poor catheter drainage, suprapubic pain, anticoagulation, instrumentation and suspected urinary infection; assess for shock.
Call urology early, assess haemodynamics, review anticoagulants with appropriate senior advice and arrange bladder assessment. Appropriate large-bore/three-way catheterisation and washout require trained staff and a local pathway.
Check haemoglobin, renal function, coagulation profile and blood group if clinically significant bleeding; quantify urine output and monitor catheter patency.
Do not repeatedly force irrigation against resistance or miss ongoing haemorrhage in an older patient with apparently stable observations. Catheter manipulation can cause further injury.
UK reference: NHS haematuria information. Focused editorial source check, 7 November 2026; this is not independent clinical or pharmacy sign-off. Verify current local policy, BNF/BNFC and specialist advice before treatment. Not a prescribing protocol.
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