What causes blood in the urine in women

Blood in the urine: causes, symptom & treatment

What is blood like in the urine?

Blood in the urine or hematuria is when there are more red blood cells (erythrocytes) in the urine. However, the urine of healthy people can also have a certain number of red blood cells. However, if the blood in the urine can be clearly seen with the naked eye, this represents a macrohematuria. If blood in the urine cannot be seen with the naked eye and can only be detected under the microscope, this is referred to as microhematuria.

Red urine doesn't always have to be an indication of high red blood cell counts. Sometimes there is also too much red blood pigment (hemoglobin from the red blood cells) behind it. This hemoglobinuria is caused by hereditary forms of anemia, intolerance reactions or autoimmune diseases. Another possible cause is what is known as march hemoglobinuria. Due to physical stress, red blood pigment escapes from the red blood cells and passes into the urine. This then looks reddish-brown.

This change in the urine does not require treatment and does not lead to discomfort.

Red urine also sometimes shows up after muscle injuries. If muscle protein gets into the bloodstream and urine, it turns red (myoglobinuria).

A red coloration of the urine can, however, also result from the consumption of certain foods such as beetroot. The coloration then usually disappears after the next toilet visits.

Causes of blood in the urine

If blood is found in the urine, this indicates either a disease or an injury to the genitourinary system (system of the urinary and genital organs).

The most common causes of hematuria (blood in the urine) are:

  • Urinary tract or kidney disease
  • Special infections
  • Tumors
  • Injuries
  • Medication
  • Systemic and autoimmune diseases

In addition, there are special diseases that cause blood in the urine, which either only men or women get sick (see following chapter).

Urinary tract or kidney disease

Cystitis, Urethritis: If pathogens such as bacteria enter the urinary bladder via the urethra, this can irritate the bladder wall and cause inflammation. In addition to the typical symptoms, sometimes bloody urine occurs.

Urinary stones: If larger bladder, urethral and ureteral stones irritate and injure the mucous membrane in the urinary tract, hematuria can be triggered. In addition to pain, the blood in the urine is a key symptom.

Renal pelvic inflammation: In the case of a bladder infection, bacteria or other pathogens can get into the kidney pelvis via the ureter, sometimes also via the blood. There they trigger the kidney inflammation. Typical symptoms include an increased urge to urinate with only a little leakage of urine, which can also be bloody.

Kidney inflammation: Bacterial infections or autoimmune processes can cause kidney inflammation. Affected are the blood vessels in the kidney cortex (glomeruli, components of the kidney corpuscles) on which the blood is filtered and the first stage of urine is formed. The symptoms usually only appear when the disease has progressed. Among other things, bloody-brownish or cloudy, foamy urine occurs.

Kidney cysts: Cysts can occur sporadically in the kidney and then usually do not cause any symptoms. However, if a large number of cysts form in a kidney, blood can be seen in the urine. This so-called cyst kidney is a genetic disease.

Kidney infarction: If a blood clot clogs a kidney artery, the surrounding tissue becomes undersupplied and dies. The kidneys can then only function to a limited extent. With a small kidney infarction, symptoms can be minimal. In addition to pain, possible fever and nausea, there are blood and protein in the urine.

Renal vein thrombosis: As with a kidney infarction, a clot of blood blocks a kidney vessel, here a vein in particular. Affected people suffer from acute flank pain and have blood in their urine.

Diverticula in the urethra and bladder: The bag-like bulges on the bladder wall can be congenital or develop as the bladder becomes increasingly pressurized and has difficulty emptying. For example, due to a narrowed urethra or an enlarged prostate. Operations or injuries can also be responsible. In addition to painful urination, there is often an increased urge to urinate. If there is also blood in the urine, then there is also an infection of the bladder.

Polyps in the urethra and bladder: The growths in the urethra and bladder are usually benign. However, in addition to causing discomfort when urinating, they can also cause blood in the urine.

Other causes of hematuria can be constrictions at the exit of the bladder or in the urethra, as well as kidney damage due to high blood pressure or diabetes (diabetic nephropathy).

Special infections

Hematuria can also be caused by other parasitic and bacterial infections. Among other things through:

Urogenital tuberculosis: This tuberculosis disease is caused by tubercle bacteria and manifests itself in the areas of the urinary tract and genital organs.

Bladder Bilharzia: This infectious disease, which is particularly widespread in the tropics, is now also found in southern Corsica, is also known as schistosomiasis. Pathogens are flukes that deposit their larvae in water. These get through the skin into the blood vessels of the intestine or the urinary bladder, where they grow into worms. If the bladder is infected, in addition to the known symptoms of the disease, there is also a bladder infection with bloody urine.


Blood in the urine can be the first sign of a malignant tumor. In the urinary tract this is, for example, bladder cancer, urethral cancer, ureteral cancer or kidney cancer (e.g. renal cell carcinoma).


If the bladder or kidney is injured, this can also lead to bloody urine. For example after accidents, external impacts or during an operation.


As a side effect of some medications, blood may appear in the urine. For example, when taking certain antibiotics (penicillins), cancer drugs (cytostatics) and blood thinners (e.g. acetylsalicylic acid, phenprocoumon).

Systemic and autoimmune diseases

Rare systemic diseases and autoimmune diseases also show blood in the urine as a symptom. This is especially the case when the kidneys are also affected.

Lupus nephritis (systemic lupus erythematosus): In this autoimmune disease, the body's own defense cells primarily attack the skin and many internal organs, including the kidneys. If the kidneys are diseased, there are also classic symptoms, often blood in the urine, changes in the amount of urine and flank pain.

Wegener's granulomatosis (Wegener's disease): The disease leads to chronic inflammation of the blood vessels. In the area of ​​the inflammatory processes, small skin nodules (granulomas) also form. If the kidneys are affected, traces of blood can be seen in the urine.

Blood in the urine in men

Some conditions that can lead to hematuria occur only in men. Common causes of blood in the urine in men include:

Prostatitis (inflammation of the prostate): The prostate gland can become inflamed chronically or acutely. It is often triggered by bacteria (especially in acute illness) that usually penetrate the urinary tract to the prostate. If there is blood in the urine in addition to the classic symptoms, this suggests a simultaneous urethritis.

Seminal vesicle inflammation: In the course of prostate inflammation, the seminal vesicle can also become inflamed. In addition to pain during sex and urination, symptoms can also include pain in the abdomen and blood in the urine and semen.

Prostate variceal bleeding: Here, the prostate veins expand, similar to varicose veins. Those affected do not suffer from pain or urinary tract problems. However, the bleeding from the “varicose veins” shows up in the urine.

Prostate cancer: The malignant tumor remains unnoticed for a long time - without an early detection examination. Those affected suffer from symptoms late, such as problems urinating, blood in the urine and / or in the sperm, pain in the pelvic area and erectile dysfunction.

Blood in the urine in women

Some conditions that can lead to hematuria occur only in women. Some of the causes of blood in the urine in women include:

Endometriosis: If uterine lining tissue has settled in the wrong place, for example in the bladder or intestine, this can - depending on the cycle - lead to blood in the urine or stool. Endometriosis is a common, benign, and pain-related chronic disease for many. It affects women before the onset of menopause.

Flank pain hematuria syndrome (Loin Pain Hematuria Syndrome): The very rare disease mainly affects young women, especially between 20 and 30 years of age. Symptoms are pain in one or both flanks that occurs several times a year. Then there is also blood in the urine, either visible to the naked eye or only detectable in the laboratory.

Blood in the urine - when to see a doctor?

Blood in the urine should always be taken seriously and checked immediately by a doctor. This also applies if the bleeding goes away on its own. The event can turn out to be harmless, but it can also be a sign of a malignant disease.

Blood in the urine - diagnosis

After a thorough anamnesis (recording of the medical history) and physical examination, the family doctor will decide whether a further examination by a specialist is necessary. Depending on the suspected diagnosis, the patient is referred to a urologist (specialist in diseases of the urinary organs and male genital organs), a gynecologist (specialist in gynecology and obstetrics) or a nephrologist (specialist in kidney and hypertension). If there is a suspicion of a systemic disease, a specialist internist (specialist in internal medicine) is responsible for the further examination.

Physical examination

Blood pressure and body temperature are measured. The doctor also palpates the abdomen and flanks.

Laboratory examination: A urine sample is checked for red blood cells. A quick test can also provide initial clues. The blood analysis in the laboratory provides more information about the blood in the urine. There may be a urinary tract or kidney disease, or an infection.

Imaging procedures: Ultrasound can be used to examine the bladder, kidneys and prostate more closely. The condition of the ureter and renal pelvis can be shown with an X-ray. CT (computer tomography) and MRI (magnetic resonance imaging) are useful if a tumor above the bladder is suspected. For a comprehensive picture of the bladder and urethra, the urologist can also perform a cystoscopy.

Therapy for blood in the urine

Because bloody urine can have many different causes, it is important to make a safe diagnosis. Then the specific treatment can take place. For example, if the blood in the urine was caused by a urinary tract infection, antibiotics may be useful. If certain medications trigger the bloody urine, they should be discontinued in consultation with the attending physician and replaced by another agent that is kind to the kidneys.

Depending on the specific cause of the bloody urine, the patient will be treated by a specialist in urology, gynecology, nephrology or an internist.

Acupuncture for blood in the urine

Traditional Chinese Medicine assumes that certain energy flows in the body are blocked in the event of illness. With the help of acupuncture, these congestion can be resolved. The acupuncturist works with very fine needles that are supposed to compensate for the disturbed flow of energy. For example, a study on patients with endometriosis found that acupuncture could reduce their pain.

Homeopathy for blood in the urine

Blood in the urine can indicate a wide variety of diseases. The use of homeopathic remedies can help with some diagnoses. For example with cystitis:

  • Apis: For burning and stabbing pains, a painful need to urinate and only little urine. Exacerbated by heat.
  • Cantharis: For cutting, burning and spasmodic pain. Urination burns like fire. Urine can get bloody.
  • Pulsatilla: For bladder pain that gets worse quickly. If you cannot urinate immediately when you urge to urinate and urine passes involuntarily when you cough or laugh.

Treatment should take place after detailed advice from an experienced homeopath.

Blood in the urine (hematuria): ICD code

In medicine, every illness is assigned its own ICD code. The abbreviation ICD stands for International Statistical Classification of Diseases and Related Health Problems. The classification system is recognized worldwide and one of the most important for medical diagnoses. For example, hematuria is recorded under the ICD code "R31". Entering these codes often helps with research on the Internet.

Blood in the Urine - How Do I Find the Right Hospital?

When looking for a suitable hospital that is well versed in the treatment of hematuria, you can find a number of helpful links on the website www.aerzteblatt.de. Among other things to www.weisse-liste.de, www.kliniken.de and www.krankenhaus.de. The website www.kliniken.de offers a particularly comprehensive overview. There are currently 3,846 hospitals from Germany, Austria and Switzerland listed here. In addition, there is detailed information on the specialist departments of the clinics and quality reports.

Go to the homepage of www.kliniken.de: Under the menu item “Top-10” you can search specifically for diseases and diagnoses. For blood in the urine (hematuria), enter the ICD code: "R31". Then click on the field below with the text "XVIII Symptoms and abnormal clinical and laboratory findings that are not classified elsewhere". Then click again on the field below "R30-R39 Symptoms that affect the urinary system" and finally on the field "R31 Unspecified hematuria, blood excretion in the urine not specified by the doctor". The hospitals you are looking for then appear to the right of this, sorted according to the ranking of their case numbers. The Zeisigwaldkliniken Bethanien in Chemnitz is in first place, the Ernst von Bergmann clinic in Potsdam takes second place and the AMEOS clinic in Aschersleben takes third place, etc.

Blood in the urine - What does the health insurance company pay for and what do you have to pay for yourself?

Members of a statutory health insurance basically have the right to inpatient and outpatient care, to drugs and other services. As a rule, however, certain personal contributions (additional payments) are stipulated by law. These additional payments amount to 10 percent of the costs, but a maximum of 10 euros per additional payment. If the service costs less than 5 euros, the insured person must pay the actual price.

These limits also apply to pharmaceuticals. If the person concerned receives a particularly inexpensive preparation, there is no additional payment. The health insurances can determine fixed amounts that they reimburse if several preparations with the same active ingredient are available. Medicines, the price of which is 30 percent below this fixed amount, are reimbursed by health insurance companies without additional payment.

In addition, there is a regulation that the statutory health insurance no longer has to reimburse the individual price of the respective drug for certain preparations, but only the fixed amount that has been set for a group of comparable preparations. If the prescribed medication is more expensive, the patient has to pay the additional price himself plus the statutory additional payment for the reimbursed portion of the costs.

Co-payments also apply to hospital stays. They amount to 10 euros per calendar day, whereby the additional payment only has to be made for a maximum of 28 days per year. Several hospital stays can be combined in one year, so that the maximum additional payment for inpatient treatment is 280 euros per calendar year.

In the case of home nursing, a one-time fee of ten euros is due for the prescription. In addition, a personal contribution of 10 percent per day is to be paid. The co-payment is limited to 28 calendar days per calendar year and is only charged for adults over 18 years of age. The upper limit of EUR 280 per calendar year also applies to home care. Co-payments for hospital stays count towards the cap on co-payment for home nursing.

If the costs for household help are covered by the health insurance, the insured must make an additional payment of 10 percent of the costs incurred. The limits are at least 5 and a maximum of 10 euros per calendar day.This co-payment obligation applies to the entire period in which domestic help is used.

In the case of aids, the insured must make an additional payment of 10 percent of the selling price, with an upper and lower limit of 10 and 5 euros per prescription.

The amount of co-payments for rehabilitation measures depends on the measure and the respective cost bearer.

The costs for pain therapy in a pain clinic are usually covered by any statutory health insurance company, as it is a contracted medical service. However, additional costs (such as additional payments for prescriptions) may arise privately.

The costs of a classic body acupuncture are covered by all statutory health insurances for chronic pain in the lumbar spine or knee osteoarthritis. It is assumed that the pain has existed for at least six months. In such cases, legally insured persons are entitled to up to ten acupuncture sessions per case of illness within a maximum of six weeks. A new treatment can take place no earlier than twelve months after completion of the last acupuncture treatment. The health insurance will only reimburse the costs if the treatment is carried out by a qualified doctor. Acupuncture from a naturopath is not accepted. The costs are then to be paid privately.

Blood in the urine - what does the DFV do?

The outpatient supplementary health insurance DFV-AmbulantSchutz reimburses you for additional payments provided for by law for medicines, bandages, remedies and aids and travel costs as part of outpatient treatment. The DFV-AmbulantSchutz also offers you extended pension benefits and is also there to support you financially if a serious illness is diagnosed.

In the event of illness, with the additional hospital insurance DFV-KlinikSchutz Exklusiv, you do not wait longer than 5 days for an appointment with a specialist doctor.

You also benefit from head physician treatment, a single room, free choice of hospital and daily hospital allowance for an inpatient clinic stay. DFV-KlinikSchutz makes you a private patient in the hospital including international health insurance.

FAQs about blood in the urine

Which doctor if there is blood in the urine?

The first point of contact if there is blood in the urine is your family doctor. Based on the anamnesis and initial examinations, he can assess whether a referral to a specialist is necessary or whether there is only a harmless cause behind the red discolored urine. Depending on the suspected illness, the family doctor can issue a referral to the urologist, gynecologist, nephrologist or internist. The further diagnosis and treatment is then taken over by the responsible specialist.

How do you recognize blood in the urine?

Red colored urine does not always have to be an indication of blood. Sometimes there is also too much red blood pigment (hemoglobin from the red blood cells) behind it. The causes are hereditary forms of anemia, intolerance reactions or autoimmune diseases. But even after extreme physical exertion, red urine due to hemoglobin can occur (so-called marsh hemoglobinuria). Red-brown urine can also be caused by an increased excretion of the protein myoglobin. (so-called myoglobinuria). Certain foods, such as beetroot, can also stain the urine red. Only a doctor can determine with certainty whether the discolored urine is blood.

What does blood in urine mean in men?

There can be various explanations for this, as blood in the urine causes a variety of diseases. However, some of them can only be obtained by men. These are, for example: prostate inflammation (prostatitis), seminal vesicle inflammation, prostate variceal bleeding and prostate cancer.

What does blood in urine in a woman mean?

Blood in the urine can be a symptom of many diseases. However, endometriosis only affects women. Depending on the cycle, blood can also appear in the urine here.

What to do if there is blood in the urine

If blood can be seen in the urine with the naked eye (macrohematuria), the cause should be clarified by a doctor immediately. In this way, a serious illness can either be ruled out or treated as quickly as possible. However, blood is not always visible in the urine (microhematuria). Only a laboratory test then provides evidence.

All statements without guarantee!