Noticing blood clots when you urinate can be alarming, but this symptom requires careful medical attention. Visible blood in the urine is medically termed gross hematuria. Clots form when blood loss is significant enough to activate the body’s clotting factors within the urinary tract. These clots, which can look like dark red specks, jelly-like blobs, or worm-like strings, indicate bleeding originating somewhere along the urinary system, from the kidneys down to the urethra. The presence of clots is a sign of irritation or inflammation and always warrants a thorough evaluation by a healthcare provider.
When Blood Clots in Urine Require Urgent Care
While any instance of visible blood should be evaluated, certain accompanying symptoms signal a medical emergency requiring immediate care. The most concerning situation is the inability to pass urine, which suggests a complete blockage of the urethra or bladder outlet by a large blood clot, known as clot retention. This obstruction causes extreme discomfort and can lead to damage if urine cannot drain from the kidneys.
Seek emergency assistance if you experience lightheadedness, significant weakness, or a rapid heart rate, as these are signs of substantial blood loss. Severe, sudden pain in the abdomen, side, or back, especially combined with fever and chills, also necessitates urgent evaluation. These symptoms might indicate a serious infection or a large kidney stone causing both bleeding and obstruction.
Preparing for Medical Consultation
Before consulting a medical professional, note details regarding the bleeding, such as the color, the shape of the clots, and whether the blood appears at the beginning, middle, or end of the urine stream. Gather information about recent activities, like strenuous exercise or trauma, and list all current medications, including blood thinners. This detailed history aids the diagnostic process.
Underlying Conditions Causing Urinary Clots
The formation of urinary blood clots is caused by conditions that lead to bleeding within the tissues of the urinary system.
One of the most common causes is a Urinary Tract Infection (UTI). Bacterial inflammation irritates the mucosal lining of the bladder or urethra, causing small blood vessels to rupture. A more severe kidney infection, known as pyelonephritis, can lead to widespread inflammation and bleeding higher up in the urinary tract.
Kidney or bladder stones are a frequent source of trauma and bleeding. These hardened mineral deposits scrape against the delicate inner walls of the urinary tract as they attempt to pass, causing injury and subsequent hemorrhage. The resulting clots may sometimes take on a distinctive “worm-like” shape as they form in the narrow ureter tubes.
Blunt force trauma to the lower back or abdomen, such as from a fall or accident, can cause direct injury to the kidneys or bladder. Even intense physical exertion, like long-distance running, can sometimes cause temporary, minor bleeding. Any trauma-related bleeding should be medically assessed to rule out serious internal injury.
In men, an enlarged prostate gland, known as Benign Prostatic Hyperplasia (BPH), is a common cause of visible hematuria and clotting. The enlarged gland contains fragile, highly vascular blood vessels that are easily irritated or compressed by straining during urination, leading to bleeding. Inflammation of the prostate, or prostatitis, can also cause localized swelling and bleeding that results in noticeable clots.
For all adults, especially those over 50 or those with risk factors like a history of smoking, the possibility of bladder or kidney cancer must be investigated. Tumors in the urinary tract erode blood vessel walls, causing blood to leak into the urine and form clots. Bleeding from a tumor, particularly bladder cancer, is often painless, meaning the visible clots may be the only initial symptom.
How Doctors Determine the Cause
The medical investigation begins with a comprehensive physical examination and detailed medical history review. The doctor asks specific questions about the timing, nature of the clots, and any associated symptoms, which helps localize the source of the bleeding within the urinary system. Information about medication use, especially blood thinners, is also gathered.
Laboratory tests are conducted first, beginning with a urinalysis to confirm the presence of red blood cells and check for signs of infection, like white blood cells or bacteria. A urine culture may be ordered to identify the specific type of bacteria causing an infection, guiding the appropriate antibiotic treatment. Blood tests, such as a complete blood count and kidney function markers, help assess the overall impact of the bleeding and the health of the renal system.
Imaging procedures are employed to visualize the upper urinary tract, including the kidneys and ureters. A Computed Tomography (CT) scan, often performed with intravenous contrast (CT urogram), is effective at detecting structural abnormalities like stones, tumors, or signs of trauma. Ultrasound imaging may also be used, offering a non-invasive way to visualize the kidneys and bladder without radiation exposure.
To examine the lower urinary tract and bladder lining, a procedure called cystoscopy is often performed. This involves inserting a thin, flexible tube equipped with a camera through the urethra into the bladder. Cystoscopy allows the doctor to directly inspect the internal surface, identifying the exact location of the bleeding, detecting tumors, or locating areas of inflammation.