What Causes Back pain & Bloody urine in females?

Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.

Key Points:

The most common cause of back pain and bloody urine in females is kidney stones.
Other causes include:
- Urinary tract infection.
- Glomerulonephritis.
- Trauma to the kidneys or the urinary tract.
- Excercise-induced hematuria.
- Cancers of the kidney or ureter.
- Hydronephrosis.
- Endometriosis of the urinary tract.
Rare causes include loin-pain hematuria syndrome, renal artery or renal vein thrombosis, malignant hypertension, etc.
Always see a doctor if you have unexplained blood in your urine and back pain.

Most cases are either due to a stone or other benign causes, but any unexplained hematuria mustn’t be ignored.

Keep reading this article, where I will break down the symptoms and features of the common causes of hematuria and back pain in women.

1. Kidney stones (commonest cause).

The kidneys lie in the abdominal cavity behind the intestines (just in front of the muscles forming the back). The kidneys are also the most common site of stone formation in the urinary tract.

The two most common symptoms of kidney stones are hematuria (blood in urine) and back pain or renal colic.

Kidney stones are very common. By the age of 70, It is estimated that (reference):

19 % of males will be diagnosed with a kindy stone.
9% of females will also be diagnosed with a stone.

Although stones are less common in females, it is still a very common cause of back pain and blood in the urine.

Risk factors:

Habitual low intake of fluid.
Lower intake of potassium and calcium.
Higher intake of oxalate, sodium, and fructose.

Over-consumption of vitamin C.
Excess intake of animal protein.
Lower intake of fruits.

Specialized diets such as Mediterranean and DASH diets.
Some medications, such as diuretics, laxatives, ceftriaxone, etc.
Males are more commonly affected than females (twice the risk).

Race: stones are more common in white, non-Hispanic races.
Stones are also more common in persons with functional disabilities.

Symptoms of kidney stones:

The pain is often sudden onset, severe, and colicky and may last minutes to hours.

Kidney stones cause loin pain (in the flanks and upper back on both sides).
Bladder stones often cause central pelvic pain (urinary bladder pain). The pain may radiate to the lower back.
Ureteric stones cause severe flank pain that radiates to the groin and the inner thigh.

Some cases are completely asymptomatic and may present with isolated blood or worm-like clots in the urine.
Blood or blood clots in urine.
Turbid urine may also occur due to superimposed infection.

The pain may be associated with nausea and/or vomiting.
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. So, always consult your doctor if you get sudden onset back pain and blood in your urine.

2. Urinary Tract infections (especially pyelonephritis).

Urinary tract infections (UTIs) occur mainly due to bacteria invading the urinary tract (either from the urethra or the bloodstream).

The most common form of urinary tract infection is uncomplicated cystitis (infection and inflammation of the urinary bladder). It predominantly affects females as they have shorter and wider urethra (easier infection).

However, bacteria may progress upward and infect the kidney (pyelonephritis), a more severe form of UTI.

UTIs may cause back pain (especially with pyelonephritis) and blood in the urine.

Symptoms of UTI in females:

A. Uncomplicated UTI (cystitis):

Dysuria (pain during urination).

Urinary frequency.
Frequent waking up to pee at night (nocturia).
Sudden urge to pee (urgency).

Bladder pain (suprapubic pain). Low back pain may also occur in females with UTI.
Blood in the urine (hematuria):
Cloudy (turbid urine).

Symptoms of complicated UTI include (reference):

All the classic symptoms of acute cystitis (dysuria, urgency, frequency, blood in urine, etc.).
Fever >37.7°C (>99.9°F).

Chills or rigors.
Significant fatigue, muscle aches, or any other feature of systemic illness.
Flank or back pain.

Pelvic or perineal pain in men.
Tenderness over the kidney area when your doctor examines it (A tender costovertebral angle at the upper back just below the ribs).

What to expect:

If your doctor suspects UTI based on characteristic symptoms (mentioned above), he will do a urine culture. I

f the back pain is significant, he will often require an imaging study of the kidneys and urinary tract to search for stones and pyelonephritis and to exclude other causes of blood in urine and back pain.

Once UTI is confirmed, your doctor will often prescribe antibiotics for a week or so. However, complicated UTIs (kidney infections) may need hospitalization and other interventions, such as more aggressive intravenous antibiotics.

3. Trauma.

Trauma to the kidneys, ureter, or urinary bladder may also cause blood in urine and back pain in females. Trauma can come in many forms, such as:

Blunt trauma to the kidneys or the perineum (fall from height, road traffic accidents, vigorous contact sports, etc.).
Taking a biopsy from the urinary bladder, kidney, or prostate.
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).

4. Endometriosis of the Urinary tract.

Endometriosis describes the presence of endometrium (the cells lining the uterus) in abnormal sites outside the uterus.

One of the sites of endometriosis is the urinary tract (mainly the urinary bladder and the ureter).

Contrary to popular belief, Endometriosis of the urinary tract is a COMMON cause of hematuria in females. It may also lead to pelvic (bladder), flank, or back pain.

Symptoms of urinary tract endometriosis:

Cyclic pain (every month) in the bladder (lower abdominal or lower back pain), flank, or back pain.

Hematuria (blood in urine) comes and goes (often correlated to the time of menstruation).
Frequent urge to pee.
Recurrent urinary tract infection.

Urine incontinence (rare).
Asymptomatic in many cases (reference).

The diagnosis of urinary tract endometriosis depends on either visualizing the migrating uterine mucosa by a cystoscope or cystourethroscopy as red implants in the bladder’s walls or the ureter.

Also, imaging such as transabdominal ultrasound, a transvaginal ultrasound, or MRI.

5. Exercise-induced hematuria.

Blood in the urine may appear after stressful exercises or sports. The exact cause is still unclear. However, exercise-induced hematuria is a benign condition that is not known to cause serious or long-term kidney diseases.

Exercise-induced hematuria can occur with (reference):

Vigorous contact sports such as boxing and football.
Non-contact sports such as marathon running, rowing, and swimming.
It can also occur with long-distance cycling (but rare).

Possible mechanisms (reference):

Traumatic: trauma to the kidneys or the urinary bladder with vigorous contact sports or long-distance running.
Blood shifting from the kidneys to the muscle leads to ischemic inflammation of the kidneys.
Lactic acidosis from excessive muscle work makes your kidneys more permeable to red blood cells (hence the blood appears in urine).

Symptoms and features:

Bloody urine often starts after stressful or prolonged sports such as boxing, football, marathon running, etc.
It may be associated with bladder or kidney pain in the back.
The condition improves with rest (after a few days to one week).

Often, it doesn’t lead to significant kidney disease or kidney failure.
Imaging studies (such as Ultrasound or CT scans) are often normal.
Your doctor should thoroughly investigate hematuria that continues for more than a week from the last exercise.

6. Glomerulonephritis.

Glomerulonephritis is inflammation and damage to the tiny urine filters inside your kidneys (the glomeruli).

Glomeruli nephritis is a relatively common disease and may cause significant kidney damage if undiagnosed or untreated.

Causes of glomerulonephritis:

Infections (bacterial, viral, etc.).
Medications (such as some antibiotics and nonsteroidal anti-inflammatory drugs).
Some chemicals are harmful to the kidney.

Autoimmune diseases such as systemic lupus erythematosus.
Severe Hypertension.
Long-lasting or uncontrolled diabetes mellitus.

Many cases occur due to unknown causes.

Symptoms and signs:

The symptoms may include one or more of the following:

Bloody urine (often pink, light brown, or tea-colored).

Bilateral back pain or flank pain.
Foamy urine (foams form on the toilet water’s surface after peeing).
Headache.

Sometimes, Fever, sore throat, and other signs of infection.
The amount of urine may remain normal or decrease. Some patients may completely stop urination.
Swelling of the face and eyelids (more noticeable in the morning).

Swelling of the lower limbs.
Some patients may present with acute kidney failure symptoms (severe shortness of breath, hiccups, headaches, dizziness, confusion, or loss of consciousness).

7. Others.

Other possible causes of back pain and bloody urine in females include:

Hydronephrosis (obstruction of the ureters or urethra leading to distension of the kidney with urine).
Kidney cancer.

Bladder or ureteric cancer.
Loin-pain hematuria syndrome.
False hematuria due to uterine or vaginal bleeding.

Adult polycystic kidney disease.
Medullary sponge kidney.
Severe (malignant) hypertension.

Renal artery thrombosis.
Renal vein thrombosis.
Arteriovenous malformation inside the kidney.

Ureteric stricture.
Acute papillary necrosis (mainly due to sickle cell disease).
Ureteric strictures.

Urinary bladder or kidney irradiation.
Tuberculosis of the kidney or ureters.
Recent interventions include lithotripsy (stone destruction with an ultrasound device without surgery).