4 Main Causes of Blood Drops After Urination in Females.

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Terminal hematuria is a term that describes the presence of blood drops at the end of urination. Today, you will learn about the most likely causes of such a condition & what to do.

Terminal hematuria often occurs due to lesions or inflammations in the neck, urinary bladder, or the first part of the urethra.

Possible causes of drops of blood after urination in females include:

  • Urinary tract infection.
  • Menses & other causes of gynecological bleeding.
  • Urinary stones.
  • Urinary tract endometriosis.
  • Urethral diverticulum.
  • UB cancer.
  • Others include bladder radiation, urethra trauma, urethritis, kidney or ureteric bleeding, drugs, etc.

1. UTI (cystitis).

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 cysitis is severe, the lining of the urinary bladder may bleed due to severe inflammation leading to drops of blood at the end of urination in women.

Causes:

  • 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 blood drops at the end of 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.
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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 in urine often resolves 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.

2. Menses & other causes of gynecological bleeding.

Another common cause of blood drops after urination or on tissues is simply menses. Vaginal blood may be shredded with a urine stream at the end of peeing.

So, always consider vaginal bleeding as a cause of blood seen after urination.

Not only menses cause such phenomenon but also other conditions such as (reference):

  • Fluctuating hormone levels with menstrual irregularities.
  • Pregnancy.
  • Ectopic pregnancy.
  • Use of IUDs.
  • Ovarian dysfunction.
  • Perimenopausal periods.
  • Vaginal atrophy.
  • Miscarriage.
  • Sexual intercourse or violent sexual activities.
  • Contraceptive pills and post-menopausal hormonal pills.
  • Skin diseases involving the vulval area such as Crohn’s disease, Behcet syndrome, Erosive lichen planners, herpes, etc.

How to differentiate vaginal bleeding from hematuria?

With vaginal bleeding, you may see blood without urination (on tissues or underwear). You also have to carefully check the source of blood after urination to help the differentiation.

Also, blood from vaginal sources is often not associated with urinary symptoms (no dysuria, no frequency, no bladder pain, etc.).

3. Stone in the urinary bladder.

Stones or gravel inside the urinary bladder may cause blood in urine after peeing. It also causes significant bladder irritation and UTI-like symptoms.

The stones inside the urinary bladder may lead to minor trauma (injury to the inner wall of the urethra.

These minor abrasions secondary to the passage of the stone may cause urethral pain or a burning sensation that lasts for days after the stone passage.

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Symptoms:

  • History of passing a stone with urine.
  • Severe burning pain in the urethra, especially with urination (dysuria).
  • Bloody urine may occur due to the injury to the urethra.
  • Prior history of flank or bladder pain during the passage of the stone in the ureter.
  • Other urinary symptoms, such as urgency and frequency, may also exist.

4. Bladder cancer.

Painless blood in the stool in females after 50 years old would raise suspicion about urinary bladder cancer.

Here are some Key statistics about urinary bladder cancer in females (reference):

  • Urinary bladder cancer is the ninth most common cancer globally, with only 743,00 new cases in 2016.
  • It typically affects older individuals; 73% of cases of bladder cancers are above the age of 65.
  • Urinary bladder cancer is 3 to 4 times greater in MEN than in WOMEN (about 25% of the cases of bladder cancer are women).

Risk factors of bladder cancer in females (reference).

  • Cigarette smoking.
  • 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.
  • Typically, bladder cancer causes painless bleeding in the urine (intermittent attack).
  • Blood is often present throughout the urination. However, it may rarely be in the form of blood drops after urination.
  • Bladder pain in the lower abdomen.
  • 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.

Any blood in the urine (through or after urination) in females older than 50 should be thoroughly investigated to exclude bladder cancer.

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The diagnosis of urinary bladder cancer depends mainly on:

  • First, visualize the bladder mass with an imaging technique such as CT, MRI, or ultrasound.
  • Cystoscopy and biopsy from the bladder mass.

5. Urethral diverticulum.

The urethral diverticulum is a localized dilatation or pouch in the female urethra (common in the middle portion of the urethra).

Urethral diverticulum is a common condition affecting up to 5% of women (reference).

The diverticulum can cause pain or discomfort in the female urethra without UTI. Also, it can cause blood drops after urination in females.

Symptoms (reference):

  • Urethral pain.
  • Dripping of urine after peeing.
  • Tender vaginal mass (felt in its anterior wall).
  • Painful intercourse.
  • Dysuria (pain during urination).
  • Chronic or recurrent UTIs.
  • Increased frequency of urination with urinary urgency.
  • Bloody urethral discharge (during or after urination).
  • Urinary incontinency.
  • Urine retention.

6. Others

The below are common causes of hematuria but rarely cause terminal hematuria (blood after urination):

  • Endometriosis of the urinary system.
  • Interstitial cystitis.
  • Trauma to the urethra, the bladder, or the kidneys.
  • TB of the urinary bladder.
  • Recent catheterization or cystoscopy.
  • Recent stone lithotripsy (destructing the stone with an ultrasound device).
  • Strenuous exercise.
  • Bleeding disorders or anticoagulant medications.
  • Severe urethritis.
  • Urethral stricture.
  • Pyelonephritis.
  • Renal vein thrombosis.
  • Severe hypertension (malignant hypertension).
  • Kidney tumors (benign or malignant).
  • Polycystic kidney.
  • Hydronephrosis.
  • Hypercalciuria.
  • Drugs such as phenytoin, Pyridium, rifampin, and nitrofurantoin.