Table of ContentsView AllTable of ContentsWhat They Look LikeCauses Without PainCauses With PainDiagnosisComplicationsTreatment
Table of ContentsView All
View All
Table of Contents
What They Look Like
Causes Without Pain
Causes With Pain
Diagnosis
Complications
Treatment
Thoughblood clotsin urine can be distressing, it’s not uncommon for blood to occur there.Blood in urine, also known ashematuria, can affect as many as 30% of adults at some point in their lives due to trauma, vigorous exercise, urinary tract infections (UTIs), medications, enlarged prostate, endometriosis, kidney disease, and, in rare cases, cancer.
In many cases, the bleeding will not be visible (microscopic hematuria). In others, the bleeding and clots can be seen with the naked eye (gross hematuria). When blood clots develop, they tend to look like stringy worms.
This article looks at the causes of blood clots in urine, including those that occur with and without pain. It also describes what you should do if you have hematuria and when blood clots may indicate a medical emergency.
gan chaonan / Getty Images
How Do Blood Clots in Urine Look?
Gross hematuria occurs when your pee (urine) appears pink, red, or brown due to the presence of blood. Though this can be alarming, it only takes 1 milliliter of blood per liter (mL/L) of urine to cause a visible change in urine color.
If there is sufficient blood in your urine, a clot may form. The appearance of a clot can vary, but they often look like stringy wormlike or jellylike blobs that are red or brownish. At other times, they may look like red or darkish chunks or specks floating in normal-colored urine.
The color or shape of a clot cannot reveal if the cause is serious or not serious. Because of this, it is important to see a healthcare provider to have it checked out. Immediate action is needed when there are numerous clots, large clots, or deep red urine.
Sex and Gender DefinitionsFor the purpose of this article, “male” refers to people with penises, and “female” refers to people with vaginas, regardless of thegender or gendersthey identify with.
Sex and Gender Definitions
For the purpose of this article, “male” refers to people with penises, and “female” refers to people with vaginas, regardless of thegender or gendersthey identify with.
What the Color of Your Urine Means
Causes of Blood Clots in Urine Without Pain
Gross hematuria may or may not cause pain. Conditions or situations in which blood clots can form without pain include:
Strenuous Exercise
Post-exertional hematuria (PEH) is caused when vigorous or prolonged exercise places undue stress on the urinary tract, which is made up of thekidneys,bladder,ureters, andurethra.
Studies suggest that PEH affects 1 in 8 long-distance runners, particularly those under age 30, causing visible blood in urine lasting anywhere from a few hours to three days.
Traumatic Injury
Gross hematuria can occur after an injury of the urethra (the tube through which urine exits the body) or the bladder. This may be due to devices like aurinary catheterorcystoscopeinserted into the urethra or recent surgery on the urinary tract.
Vigorous sex can injure the urethra and cause hematuria and, in males,hematospermia(blood in semen).
When an Injury Is Serious
Enlarged Prostate
Blood in urine is a common occurrence in people with an enlarged prostate, otherwise known asbenign prostatic hyperplasia (BPH). BPH, common in males over age 60, can sometimes cause pain but is more often associated with difficulty peeing, frequent urination, and dribbling after urination.
Medications
Certain medications can cause hematuria and possibly the formation of clots in urine. These include common drugs like:
Cause of Hematuria in Females
Causes of Blood Clots in Urine With Pain
Blood clots in urine can cause pain if they grow to a certain size and block the flow of urine to the ureters (vessels that connect the kidneys to the bladder) or the urethra.
Other conditions associated with gross hematuria are characteristically painful. In such cases, hematuria and blood clots may be secondary to the pain rather than the cause of the pain.
UTI
Aurinary tract infectionis a bacterial infection of the urinary system. Most involve the urethra or bladder (cystitis), in the lower part of the urinary tract. Females are affected more than males.An infection of the kidneys is calledpyelonephritis.
Kidney and Bladder Stones
Kidney and bladder stones (known asrenal calculiandbladder calculi) are hardened deposits that develop when minerals in your urine start to crystallize.
The passing of a stone can sometimes occur without notice. However, larger stones can become stuck in a ureter or urethra and cause extreme pain, nausea, and vomiting. When the stone finally does pass, it can tear the walls of the urinary vessels and cause bleeding.
Stones that are stuck can also cause bleeding as the buildup of urine behind the blockage can cause small blood vessels to burst. When the stone is finally passed, there may be a rush of blood and large, visible clots.
Endometriosis
Endometriosisoccurs when tissue similar to the lining of theuterus(womb) grows outside the uterus. It is a condition that affects more than 11% of females in the United States between the ages of 15 and 44.
Pain is the most common symptom of endometriosis. On rare occasions, endometriosis can also cause hematuria when uterine tissues start to invade and penetrate the bladder wall.
The condition, known as bladder endometriosis or vesicle endometriosis, causes hematuria when the uterine tissue is shed during menstruation. As with normal periods, this causes bleeding and blood clots that can be passed from the body in urine.
Polycystic Kidney Disease
Polycystic kidney disease (PKD)is an inherited disorder affecting people of all sexes that causes fluid-filled cysts to form in the kidneys. In addition to hematuria, symptoms of PKD include back or flank pain, a swollen belly, high blood pressure, and an increased risk of UTIs.
A person may pass multiple clots in their urine in cases like this.
Sickle Cell Disease
Sickle cell disease (SCD)is an inherited blood disorder most commonly seen in Black people that causesred blood cellsto become deformed. This can lead toanemiaand symptoms like periodic pain, swelling of the hands and feet, frequent infections, and vision problems.
Renal Vein Thrombosis
Renal vein thrombosis (RVT) is a rare condition in which a clot forms in one or bothrenal veinsthat carry blood away from the kidneys. RVT is a serious condition usually resulting from an underlying kidney problem likenephrotic syndromeor kidney tumors.
RVT can cause severe damage to the kidneys, leading to significant bleeding and the formation of clots. Other symptoms include lower back or flank pain, nausea, vomiting, fever, and decreasing urine output as the condition worsens.
In severe cases, a blood clot can get carried from the kidneys to the lungs and cause a potentially life-threatening condition known as apulmonary embolism.
Cancer
Several urological cancers (cancers of the urinary tract) can cause gross hematuria and the formation of clots. These include:
Hematuria may be the first sign of cancer and something that tends to occur when the disease is advanced. Over time, the bleeding can become more persistent, causing pain, rust-colored urine, and the formation of clots.
Causes of Hematuria in Males
What Should You Do About Blood Clots in Your Urine?
To start the investigation, the healthcare provider will review your medical history and risk factors for hematuria (including older age, family history, recurrent UTIs, and smoking).
A physical exam of the lower abdomen, back, groin, and genitals may be performed. Adigital rectal exam (DRE)may be used in males to check for an enlarged prostate.
Urine testsare central to diagnosis and can check for blood in urine,protein in urine(a sign of kidney disease),reduced kidney function, or excessive white blood cells or pus in urine (a sign of infection). Blood tests can also check for signs of infection, anemia, orprostate inflammation.
Based on the initial findings, other tests or procedures may be ordered, such as:
How Blood Clots Are Diagnosed
Complications of Untreated Blood Clots in Urine
Mild hematuria can sometimes be a relatively benign condition that will resolve on its own. But whenever hematuria is visible, is persistent, or is causing clots, it needs to be looked at.
Blood clots in urine can sometimes be a sign of an undiagnosed kidney disease likeglomerulonephritisandlupus nephritis. If left untreated, conditions like these can lead to:
Gross hematuria is also associated with an increased risk of urological cancers (like bladder or kidney cancer) compared to microscopic hematuria. In fact, over 60% of people with urological cancers have visible blood in their urine.
For males over 60, persistent gross hematuria is predictive of urological cancer in 1 in 5 cases. This is particularly true in those who smoke, have chronic UTIs, haveindwelling catheters, or have chronic trouble urinating.
Sign of Urological CancerSee a healthcare provider immediately if you have signs and symptoms of a urological cancer, including:Blood in the urineProblems with urinationLower back or flank painOverly frequent urinationPainful urinationSwelling of the ankles and legsSudden increases in blood pressureLoss of appetiteUnexplained weight loss
Sign of Urological Cancer
See a healthcare provider immediately if you have signs and symptoms of a urological cancer, including:Blood in the urineProblems with urinationLower back or flank painOverly frequent urinationPainful urinationSwelling of the ankles and legsSudden increases in blood pressureLoss of appetiteUnexplained weight loss
See a healthcare provider immediately if you have signs and symptoms of a urological cancer, including:
At a Provider’s Office: What Happens Next?
Other cases may clear when the underlying condition is treated or controlled. This may involve treatments or procedures like:
Cancer Treatment and HematuriaCertain cancer treatments can cause blood in the urine. This includespelvic radiation(radiation-induced hematuria) and chemotherapy drugs likeCytoxan (cyclophosphamide)andIfex (ifosfamide).
Cancer Treatment and Hematuria
Certain cancer treatments can cause blood in the urine. This includespelvic radiation(radiation-induced hematuria) and chemotherapy drugs likeCytoxan (cyclophosphamide)andIfex (ifosfamide).
Summary
Blood clots in urine develop in response to strenuous exercise, trauma, medications, or an enlarged prostate. Potentially serious causes include bladder or kidney infections, bladder or kidney stones, endometriosis, polycystic kidney disease, sickle cell anemia, renal vein thrombosis, and bladder, kidney, or prostate cancer.
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