Possible Causes of Blood in Urine (Hematuria) in Females

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Having blood in your urine (hematuria) does not always mean you have an underlying abnormality. It may simply be the result of heavy exercise or a side effect of a drug that needs to be changed. However, other causes in females may indicate a serious medical condition, such as kidney disease, kidney or urinary stones, endometriosis, or cancer.

Although finding blood in your urine can be frightening, many causes are relatively benign and easily treated. Others may be indicative of a serious medical condition warranting further investigation.

Beets sitting on a wooden table

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As such, you should never discount blood in urine as being "minor," particularly if it is persistent and accompanied by other symptoms. This article covers 12 causes of blood in urine for females.

Types of Hematuria

There are two types of hematuria: gross hematuria and microscopic hematuria.

Gross hematuria is blood in the urine that is visible to the naked eye. Microscopic hematuria refers to blood in the urine that is not visible and typically requires a microscope or urine test to identify it.

Both types of blood in the urine can occur with or without pain.

Although many women are accustomed to seeing a little blood in urine during their period, hematuria that occurs outside of menses should be evaluated.

Causes of Blood in the Urine

If you notice what looks like blood in your urine, it may be caused by one of the following factors or medical conditions:

Strenuous Exercise

Vigorous workouts or intense physical activity, such as long-distance running or high-intensity interval training, may cause blood to be visible in your urine. It is reported to occur in 5% to 25% of people and usually lasts for a few hours up to three days. If you're seeing blood in your urine for longer than three days or have other symptoms, see your healthcare provider.

Medications

Certain drugs, including blood thinners such as warfarin, can lead to blood in the urine. Healthcare providers often prescribe blood thinners if you have a heart or blood vessel disease, or if you have poor blood flow to your brain.

Blood thinners reduce the risk of heart attack and stroke by reducing the formation of blood clots in your arteries and veins. You may also take a blood thinner if you have an abnormal heart rhythm, have undergone heart valve surgery, or have a congenital heart defect.

Finding blood in your urine if you are on blood thinners requires a full hematuria workup.

These medications can also change the color of your urine:

  • Phenazopyridine (Pyridium), a drug that numbs urinary tract discomfort, and laxatives containing senna can turn your urine reddish orange
  • The anti-inflammatory drug sulfasalazine (Azulfidine) and certain chemotherapy drugs might cause your urine color to be orange

Certain Foods

Some foods, such as beets, can cause your urine to turn red or pink. Foods and juices containing extracts or pigments of beetroot can also cause dark red or pink urine. This pink or red color is the result of unmetabolized pigments in your food that is passed from the kidneys into your urine.

As such, the redness in urine is not hematuria but simply a benign discoloration that will go away.

Bladder and Kidney Stones

Kidney stones and bladder stones are small, hard deposits that develop when minerals in your urine start to crystallize. As the stones are passed from the body in urine, they may tear or scratch the lining of the urinary tract causing extreme pain and bleeding.

The blood can mix with the urine, resulting in visibly pink or reddish urine, or the blood may only be visible with a urine dipstick testing or microscopic examination of the urine.

Recent Urinary Tract Procedures

There are a number of procedures that are done to check the functioning of the kidneys, the bladder, and your urethra (the tube through which urine leaves the body), or to eradicate other health conditions.

These include cystoscopy, pyelograms, voiding cystourethrogram, and ureteroscopy. One side effect of these procedures can be blood in the urine.

Urinary Tract Infections

A urinary tract infection (UTI) is a bacterial infection that occurs when bacteria invade the urinary tract system and then multiply.Blood in the urine is one of several common symptoms associated with UTIs.

UTIs are more common in women and principally affect the bladder and urethra. Bladder infections (cystitis) are usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal tract.

Trauma

The kidneys and the rest of the urinary tract can become injured due to blunt force (such as a motor vehicle accident, a fall, or a sports injury), a penetrating force (such as a gunshot or stab wound), or surgery.

Injuries to the urinary tract often occur together with injuries to other organs, especially the abdominal organs.

Renal Blood Clots

Also known as renal vein thrombosis (RVT), this is a blockage of the renal vein, which carries blood away from the kidney and ureter blood to the inferior vena cava (a large vein that carries blood to the heart from the lower part of the body). 

RVT is not common and is usually a result of an underlying kidney disease. It can cause severe damage to the kidneys and other life-threatening complications.

Bleeding Disorders

Hemophilia: This is a disorder in which your blood fails to clot normally. If an injury or infection occurs somewhere in the urinary tract, it may cause bleeding that people without hemophilia may be able to control. By contrast, the same infection or injury may result in sustained bleeding and the development of hematuria in people with hemophilia.

Low platelets: Platelets are tiny, disc-shaped pieces of cells that are found in the blood and spleen. They help form blood clots to slow or stop bleeding and to help wounds heal.  If you have low platelets in your blood, called thrombocytopenia, your ability to form clots and stop bleeding may be impaired.

The causes of thrombocytopenia are many and include aplastic anemia, alcohol abuse, viral infections (like chickenpox and Epstein-Barr), liver cirrhosis, leukemia, and iron, folate, or vitamin B-12 deficiency.

Polycystic Kidney Disease

Polycystic kidney disease (PKD) is an inherited disorder that causes many fluid-filled sacs, called cysts, to form in both kidneys. In addition to blood in urine, symptoms of PKD include high blood pressure, back or side pain, and a swollen abdomen.

Should you notice blood in your urine that is not caused by menstrual bleeding, see your healthcare provider as soon as possible for evaluation and diagnosis.

Endometriosis

Endometriosis occurs when tissue similar to the lining of the uterus (womb) grows outside of the uterus. It may affect more than 11% of American women between 15 and 44 years old. Pain is the most common symptom and although blood in the urine isn't a common symptom, it can occur.

Cancer

Painless blood in urine is the most common sign of bladder cancer. There are often other symptoms including:

  • Blood clots in the urine
  • Pain or burning when urinating
  • Frequent urination, including many times at night
  • Feeling the need to urinate, but not being able to pass urine
  • Lower back pain on one side of the body

Hematuria also occurs as a result of renal cell cancer—a type of kidney cancer. Just like with bladder cancer, there are usually other symptoms such as:

  • Unexplained fever for a few weeks
  • Unintentional weight loss
  • Dull ache or pain in the side, abdomen or lower back
  • Fatigue

How Is Hematuria Diagnosed?

An accurate diagnosis of what's causing blood in the urine will be important for determining the best treatment. Your healthcare provider will likely:

  • Review your medical and family history
  • Do a physical exam and pelvic exam
  • Rule out whether menstrual blood could be a false cause of hematuria
  • Possibly examine the bladder and rectum

Other common tests include:

Urine Test

A urine test, also called urinalysis, tests for protein, blood cells, and other components in the urine. It can identify a variety of medical conditions, such as UTIs, diabetes, and kidney disease.

Imaging Tests

Sometimes your healthcare provider will get imaging tests, such as:

  • Ultrasound 
  • Magnetic Resonance Imaging (MRI) scan
  • Computed Tomography (CT) scan
  • Cystoscopy (examines the lining of the bladder and urethra)

Treating Blood in the Urine

Treatment will depend on the diagnosis and underlying cause of hematuria. It may include rest if strenuous exercise, trauma, or a procedure is the cause. Antibiotics are typically prescribed for UTIs. Specific treatments will be recommended for conditions, such as cancer, endometriosis, kidney disease, and bleeding disorders.

When to See Your Healthcare Provider

You should not wait to see a healthcare provider if you see blood in the urine. Get checked by your provider, especially if you also have:

  • Discomfort with urination
  • Frequent or urgent urination
  • Inability to urinate
  • Blood clots passed in your urine
  • Fever or shaking chills
  • Nausea or vomiting
  • Pain in your abdomen, side, or back
  • Pain with sexual intercourse
  • Heavy menstrual bleeding
  • Unexplained weight loss

Summary

If you discover blood in your urine, it could be due to any number of issues varying from something minor, such as exercise, to something much more serious like cancer or a bleeding disorder. 

You shouldn't discount blood in urine as being "minor." If you can visibly see blood in your urine, especially if it is persistent or accompanied by other symptoms, see your healthcare provider right away.

Frequently Asked Questions

  • Does blood in my urine mean I should drink more water?

    Probably not. But if you don't drink enough water, your urine is likely to be dark in color. Persistent dehydration can cause kidney stones and other problems associated with hematuria. Although individual needs vary, a general rule is males need around 13 cups (3 liters) of fluid each day and females need 9 cups (2.2 liters).

  • Is blood in urine an emergency?

    It can be, especially if it's accompanied by pain during urination or back or abdominal pain, which can be a sign the blood is due to infection or kidney stones. Err on the side of caution: See your healthcare provider about any blood in your urine you can't identify and head to the ER if you have other symptoms.

  • What does blood in urine look like?

    Hematuria that's visible (gross hematuria) can be seen in the toilet bowl and/or on toilet paper. It can range in color from shades of pink or red to tea-colored to dark brown. Clots of blood in urine likely come from the urethra in females, or the urethra or prostate in males.

17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • Medline Plus. Urine - Bloody.

By Tracee Cornforth
Tracee Cornforth is a freelance writer who covers menstruation, menstrual disorders, and other women's health issues.