Hematuria refers to the presence of blood in the urine. Some causes are specific to, or more likely to affect, females.
Blood in the urine is often due to infections, kidney problems, or injuries.
In this article, we discuss the possible causes of blood in the urine in females. We also discuss when to visit a doctor, diagnosis, treatment options, and what blood in the urine can mean for children.
Hematuria can occur when part of the urinary tract, which includes the kidneys, bladder, and ureters, sustains damage or becomes irritated.
However, blood that appears in the urine does not always come from the urinary tract. In females, blood from the vagina, cervix, or uterus may appear in the urine, giving the false appearance of hematuria.
Types of hematuria include:
- Gross hematuria, where a person can see blood in their urine. The urine can appear pink, red, or brown.
- Microscopic hematuria, in which the urine contains trace amounts of blood that are invisible to the naked eye. Microscopic hematuria accounts for 13% to 20% of urology referrals.
Causes of blood in the urine in females can include:
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Urinary tract infections
Females have a higher risk of developing urinary tract infections (UTIs) due to the location of their urethras.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), at least 40–60% of women experience a UTI in their lifetime.
UTIs occur when bacteria from the bowels enter the urethra, the tube that carries urine out of the body. A UTI can travel up the urethra and infect the ureters, kidneys, or bladder.
A UTI can cause people to feel a frequent and urgent need to urinate.
Other symptoms of a UTI can include:
- painful urination
- cloudy or foul-smelling urine
- blood in the urine
- pressure or pain in the lower back, abdomen, or pelvic area
Excess minerals can form hard deposits or stones in the bladder and kidneys.
Stones may tear or scratch the lining of the urinary tract and its associated organs. Blood from these tears can mix with the urine, resulting in either gross or microscopic hematuria.
Stones in the urinary tract can cause the following symptoms, according to the NIDDK:
- pink, red, or brown urine
- frequent urination
- incontinence, or involuntary urination
- painful urination
- cloudy or foul-smelling urine
The following factors may increase a person’s risk of developing stones, according to the Urology Care Foundation:
- consuming large quantities of salt
- gastrointestinal conditions, such as Crohn’s disease or ulcerative colitis
- thyroid problems
- being overweight or having obesity
Blood in the urine that accompanies severe lower back pain may indicate endometriosis, a common health condition that occurs in more than 11% of adolescent and adult females in the United States.
Endometriosis occurs when tissue similar to the endometrium — the lining of the uterus — grows in areas of the body outside of the uterus.
Although endometriosis can affect any part of the body, the Office on Women’s Health state that it commonly involves the following areas:
- outer lining of the uterus
- fallopian tubes
Without treatment, endometriosis can affect fertility.
Although it does so less commonly than infections and stones, cancer of the kidney or bladder can also cause hematuria.
The urine may contain blood one day and appear clear the next. A person should not wait for the blood to reappear before contacting a doctor.
Bladder cancer can cause a person to urinate more or less frequently. Kidney cancer does not typically affect a person’s urination habits, but it can cause lower back pain.
Treating blood in the urine requires an accurate diagnosis of the underlying cause. A doctor may start the diagnosis process by reviewing a person’s medical and family history for any contributing risk factors.
They are likely to ask females when their last menstrual period occurred. The presence of menstrual blood in the urine can result in a false positive hematuria diagnosis.
Doctors use the following tools to diagnose blood in the urine:
During a pelvic exam, a doctor will assess the condition of the female reproductive organs, including the:
Depending on the reason for the evaluation, the doctor may examine the bladder and rectum as well.
A urinalysis tests for protein, blood cells, and waste products in the urine. It can identify a range of medical conditions that affect the urinary tract, such as kidney disease and UTIs.
Imaging tests can detect stones, endometriosis growths, and cysts in the urinary tract and pelvis.
Imaging tests can include:
- ultrasound tests
- MRI scans
- CT scans
When to see a doctor
People should not wait to see a doctor if they notice blood in their urine. They should speak with a doctor even if the blood clears on its own.
Females should speak with their doctor if they see blood in their urine outside of their regular menstrual period, especially if it occurs alongside the following symptoms:
- severe pain in the lower back, intestines, or pelvis
- gastrointestinal problems, such as constipation, diarrhea, or nausea
- painful urination
- cloudy or abnormally colored urine
- foul-smelling urine
Blood in urine in children
UTIs, stones, injuries, and some inherited diseases, such as polycystic kidney disease, can cause hematuria in children. In general, hematuria will not cause further complications in children. It may resolve on its own without treatment.
However, parents or caregivers should still take the child to see a doctor.
In most cases, a doctor will use a physical exam and urinalysis results to diagnose the underlying cause of hematuria in a child.
The presence of blood and protein in the urine may indicate an issue relating to the kidneys. In this case, it may be best to take the child to see a nephrologist, a healthcare professional who specializes in treating kidney conditions.
Treatments for hematuria will address the underlying cause.
A doctor may prescribe a course of antibiotics to treat hematuria that is due to a bacterial UTI.
People who have kidney stones can expect an improvement in their symptoms after they pass the stone. Large stones may require either medication, a special procedure to break the stone into smaller pieces, or surgical removal to relieve the symptoms.
If a doctor finds that a person has kidney or bladder cancer, they will usually refer the individual to an oncologist, a healthcare professional who specializes in treating people who have cancer.
Treatment options for kidney and bladder cancer include surgery, chemotherapy, and radiation. Treatment programs will vary from person to person, depending on the stage of cancer and whether it involves other organs.
A doctor can help diagnose the cause of blood in the urine. Some causes, such as endometriosis, are specific to females, and females are more likely than males to experience UTIs.
The treatment for blood in the urine will depend on the cause.
Treating UTIs usually involves antibiotic therapy. Stones in the urinary tract can pass on their own without treatment. Large stones may require medication to break them up or surgical removal.
People should contact their doctor if they experience severe symptoms that interfere with their daily lives.