Why Does Blood in Urine (Hematuria) Occur With Kidney or Ureteral Stones?
Understanding the Link Between Urinary Stones and Hematuria
Visible or microscopic blood in the urine—known as hematuria—is one of the most common warning signs of urinary tract stones, including kidney stones, ureteral stones, and bladder stones. While not always painful, its presence signals underlying irritation or injury within the urinary system and warrants prompt medical evaluation.
Primary Cause: Mechanical Trauma to the Urinary Tract
The most frequent reason for hematuria in stone patients is physical abrasion or micro-tearing of the urothelium—the delicate lining of the ureters, bladder, or urethra—as a stone moves through the narrow passages of the urinary tract. Even small, sharp-edged stones can cause tiny lacerations, leading to bleeding that may appear pink, red, or cola-colored in the urine. This type of hematuria is often self-limiting but should never be ignored.
What You Can Do at Home (With Medical Guidance)
In mild cases with small, mobile stones (<5 mm), increasing daily fluid intake to 2–3 liters—especially water—can help flush the stone naturally and reduce mucosal irritation. Frequent urination supports this process and lowers the risk of secondary infection. However, home management alone is insufficient if symptoms worsen or persist beyond 48 hours.
When Conservative Measures Aren't Enough
Some stones become "impacted"—lodged tightly in the ureter or renal pelvis—and fail to pass on their own. These stuck or encapsulated stones can cause prolonged pressure, inflammation, and even partial obstruction, increasing the risk of complications like hydronephrosis or kidney damage. In such cases, evidence-based interventions—including extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), or percutaneous nephrolithotomy (PCNL)—are recommended to safely fragment or remove the stone.
Complication Alert: Stone-Related Urinary Tract Infection (UTI)
Urinary stones significantly raise the risk of bacterial colonization and infection—especially when they obstruct urine flow or create stagnant pockets where pathogens thrive. Patients with stone-associated UTIs often experience classic bladder irritation symptoms: urgency, painful urination (dysuria), increased frequency, lower abdominal discomfort, and sometimes low-grade fever.
Why Treating Infection Comes First
If a UTI is confirmed via urinalysis and urine culture, antibiotics must be initiated immediately—even before stone removal. Untreated or inadequately treated infections can escalate to pyelonephritis or sepsis, especially in the presence of obstruction. Only after infection is fully resolved (typically confirmed by follow-up urine testing) should definitive stone management proceed.
Less Common—but Critical—Contributing Factors
In some individuals, hematuria linked to stones may reflect an underlying systemic condition rather than mechanical injury alone. For example:
- Bleeding disorders, such as von Willebrand disease or acquired clotting deficiencies (e.g., due to anticoagulant use or liver disease), can amplify bleeding from even minor mucosal trauma.
- Chronic kidney disease or glomerular disorders may present with isolated hematuria—making comprehensive evaluation essential to distinguish stone-related bleeding from intrinsic renal pathology.
- Medications like NSAIDs, aspirin, or direct oral anticoagulants (DOACs) can increase bleeding tendency and complicate clinical interpretation.
Key Takeaway for Patients
Hematuria with known or suspected urinary stones is never "normal." It's your body's signal that something needs attention—whether it's a passing stone, an infection requiring antibiotics, or an underlying health issue affecting coagulation or kidney function. Early diagnosis, personalized treatment planning, and preventive strategies (like dietary modification and metabolic testing for recurrent stone formers) are vital for long-term urinary health and kidney protection.