Blood Chunks In Urine: 7 Causes & When to Worry
Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.
- A variety of conditions, including urinary stones, UTIs, bladder cancer, BPH, endometriosis, trauma, and vaginal bleeding, can cause blood chunks in urine (hematuria).
- Common symptoms of urinary stones, UTIs, and BPH include painful urination, urgency, and frequency.
- Bladder cancer often presents with painless blood in the urine, while endometriosis typically presents with bloody urine or blood clots during the menstrual period.
- Trauma or instrumentation of the urinary tract, as well as vaginal bleeding, can also cause blood chunks in urine.
- It is important to see a doctor if you experience any of the following symptoms along with hematuria: fever, persistent or recurrent blood chunks in urine, severe pain, inability to pass urine, rapid onset of symptoms, or weight loss.
 Urinary tract stones (Typically cause Severe pain).
Kidney stones are one of the most common causes of blood in the pee (which can look like red chunks of meat or blood).
When they move around in the urinary tract, they can cause injury, which leads to blood in the urine with pieces of clots.
The blood chunks may differ in size. Tiny fragments of blood or big chunks can be seen in your pee.
The bigger the blood clot and the darker red your urine, the more serious the bleeding is.
Common locations of the urinary tract stones:
- Kidney stones (may be asymptomatic in some cases).
- Urinary bladder stones.
- Ureteric stones.
- Urethra (rare).
Symptoms of stones in the urinary system:
- Kidney stones cause loin pain (in the flanks and upper back on both sides).
- Bladder stones often cause central pelvic pain (urinary bladder pain).
- Ureteric stones cause severe flank pain that radiates to the groin and the inner thigh.
- Some cases are completely asymptomatic and may present with bloody urine with or without chunks of blood clots.
- The pain is often sudden onset, severe, and colicky and may last minutes to hours.
- Turbid urine.
- The pain may be associated with nausea and/or vomiting.
- Heavy bleeding with blood clots in urine may also occur if the stone causes injury to any part of the urinary tract.
- Obstruction of the urine outflow can also occur in severe cases.
Urinary stones are often diagnosed by an imaging study such as an X-ray, ultrasound, or CT scan of the urinary tract.
You can learn more about urinary stones.
 UTI (Urinary Tract Infection).
Urinary tract infections (UTIs) are very common in females. Almost 50-60% of women will get UTI at some point in their lifetime (reference.
UTI commonly affects the urinary bladder (cystitis). When cystitis is severe, the lining of the urinary bladder may bleed due to severe inflammation.
Typically, Mild to moderate UTI causes blood in urine, but not chunks of blood clots in your pee.
However, Severe cases of UTI may present with fragments of blood (typically small or stringy) and is accompanied by Severe UTI symptoms.
It is not typical chunks of blood in your pee without significant UTI symptoms (such as bladder pain, burning urine, severe urgency, etc.).
- Bacteria are the most common cause of UTIs (such as E. Coli).
- Bacteria reach the urinary bladder from outside through the urethra. It reaches the urethra by contamination from the stool.
- The most common risk factors include frequent sexual intercourse, spermicide-coated diaphragms, condoms, and diabetes mellitus.
- Recurrent simple cystitis (frequent UTIs) is very common in young and healthy women.
Symptoms & diagnosis:
- Dysuria: burning or pain in the urethra when you pee.
- Urgency: sudden, severe urgency to pee.
- Frequency: Frequent urge to pee, but only a small amount of urine comes out.
- Suprapubic (lower abdominal) pain.
- Turbid (cloudy) urine may also be present.
- Bloody urine or tiny blood fragments in urine.
- The symptoms may be very mild, with a strange feeling in the bladder and urethra.
- Also, UTI may become complicated (reaching the kidneys), causing high fever, flank pain, chills, etc.
- The diagnosis is often established by urine analysis and culture.
What to do:
UTI is a very common cause of abnormal urinary symptoms in females. Consult your doctor to confirm the diagnosis if you have symptoms consistent with UTI.
UTIs are treated mainly by antibiotics (such as Nitrofurantoin and Trimethoprim-sulfamethoxazole).
The blood clots in urine often resolve with antibiotic treatment. However, if it doesn’t go away after UTI treatment, you should tell your doctor, as it may be due to other causes.
An over-the-counter urinary analgesic such as Oral phenazopyridine may help relieve the dysuria and uncomfortable urethral sensations.
 Urinary Tract Endometriosis (Women Only).
Endometriosis is the presence the endometrial tissue (the lining of the uterus that sheds during menses) in abnormal locations.
Nearly 20% of patients with Endometriosis have urinary tract involvements (reference).
Endometrial tissues are implanted in the urinary bladder, ureter, or kidney tissues. And it gives women bloody pee or blood chunks in pee DURING the menstrual period.
It typically goes disappears when the period ends.
Symptoms of urinary Endometriosis:
- Dysuria (burning sensation when urinating).
- Bloody urine may appear during menses.
- Chunks of blood clots may be seen in urine during the menstrual period.
- Urine frequency changes.
- Flank pain.
- Abdominal pain.
- Dyspareunia (pain during intercourse).
- Unexplained infertility.
Diagnosis & Treatment:
The diagnosis is made mainly by imaging studies (ultrasound, MRI) and the presence of endometrial tissue in the bladder or urethra biopsies.
The treatment includes hormonal therapy and/or surgical removal of the endometrial implants.
 Benign Prostatic Hypertrophy (Typically in Elderly Men).
Benign prostatic hypertrophy (BPH) is very common in elderly males, ranging from 8% in men aged 50-59 to 90% in men aged 80 and above (reference).
The enlarged prostate can cause bloody urine or small blood chunks in urine (particularly if it is inflamed).
Common symptoms of BPH include:
- Difficulty starting urination.
- Weak urine stream.
- A feeling of incomplete bladder emptying.
- Urinary urgency.
- Intermittent or hesitating urine stream.
- Frequent urination.
- Nocturia (excessive urination at night).
- Straining to urinate.
- Urine leakage (incontinence).
- Bloody urine or small blood chunks in urine.
 Bladder cancer.
Cancer of the urinary bladder is one of the common malignancies. It represents about 4.5% of all diagnosed cancers in the united states (reference).
The cancer mass inside the bladder often bleeds and may present with blood clots in urine.
You should suspect bladder cancer if you have the following:
- Risk factors for bladder cancer.
- Painless blood in the urine (Any form of hematuria, including blood clots).
Risk factors of bladder cancer (reference).
- Cigarette smoking.
- Being older (more than 50).
- Being male.
- Opium use.
- Occupation exposure to carcinogens as with metal workers, painters, rubber industry workers, leather workers, textile and electrical workers, miners, cement workers, transport operators, excavating-machine operators, and jobs that involve the manufacture of carpets, paints, plastics, and industrial chemicals.
- Genetics also plays a role.
- Schistosomiasis infection (common in north Africa and Japan).
Symptoms & diagnosis:
- Early bladder cancer may present with irritative symptoms such as painful urination (dysuria), the urgency to urinate, or frequent urination.
- Bladder cancer typically causes painless urine bleeding (intermittent attacks).
- Blood is often present throughout the urination (it may be heavy hematuria or blood clots in different shapes (small masses, strings, or worm-like red clots).
- Bladder pain or pressure in the lower abdomen.
- Dysuria or pain after the end of urination.
- Signs of metastasis may also exist, such as bone pain, abdominal pain, liver pain, headache, or blurring of vision.
- Weight loss, anorexia, and other systemic symptoms may also present.
Other types of urinary tract cancer that may cause blood clots in urine are:
- Kidney cancer.
- Prostate cancer (in men only).
- Ureteric cancer.
- Urethral cancer.
 Trauma or recent instrumentation of the urinary tract.
Recent trauma, procedures, or catheter insertion are common causes of blood clots in urine.
Recalling any recent trauma or instrumentation of the urinary tract in the past few days before the appearance of worm-like clots in urine helps determine the cause.
Report any of the below incidents to your doctor or health care provider:
- Recent insertion of a urinary catheter.
- Trauma to the urethra during sexual activities or intercourse.
- Recent cystoscopy (a tool to visualize the bladder introduced through the urethra.
- Recent insertion of a ureteric stent (double-J stents).
- Recent operations (bladder, kidney, urethral, or prostatic).
- Taking a biopsy from the urinary bladder, kidney, or prostate.
- Blunt trauma to the perineum.
In most cases, the onset of blood clots (chunks) in urine is shortly (minutes to hours) after the initial trauma). Seek immediate medical assistance in you experience blood clots after an identifiable trauma to the urinary tract.
 Vaginal bleeding (false hematuria).
In females, Vaginal bleeding is often confused with hematuria. Many females may confuse menstrual blood chunks with hematuria.
Blood chunks in the toilet can be either true hematuria (from the urinary tract) or false (from the uterus or vagina).
So, always pay attention to the source of the worm-like blood clots during urination.
Common causes include:
- Spotting (due to hormonal fluctuations).
- Use of OCPs.
- Ectopic pregnancy.
- Intrauterine device (IUD).
- Sexual intercourse.
- During the times before and just after menopause.
- Miscarriage (before the 20th week of pregnancy.
- Vaginal atrophy (post-menopausal).
 Other possible (less common) causes
- Urethral diverticulum.
- TB of the urinary tract.
- Urethral stricture.
- Polycystic kidney disease.
- Arteriovenous malformations inside the urinary tract.
- Renal vein thrombosis.
- Renal artery thrombosis.
- Benign kidney tumors.
When to Worry about Blood chunks in urine?
It is important to get medical help if you experience any of the following symptoms. If you experience any of the following symptoms along with hematuria, you should see your doctor as soon as possible:
- Persistent or recurrent blood chunks in urine.
- Severe pain in the lower abdomen or flank.
- Painful urination.
- Urine frequency changes.
- Severe hematuria (very heavy blood in urine).
- Inability to pass urine.
- Rapid onset of symptoms.
- Weight loss.
- Written by a doctor.
MD, Internal Medicine and Nephrology specialist.
Dr. Esraa A. MagidAuthor