Why blood that came out with the urine is טהור (דם מכה of the חלחולת or כוליא), standing or seated and the ספל, the chronic case with pain (יָדַיִם מוכיחות), the מוך bedikah, blood without pain, and kidney stones (חול וחצץ) — a medical topic treated with dignity (Shulchan Aruch, Yoreh De'ah 191 — 1 seif)
אִשָּׁה שֶׁהִשְׁתִּינָה מַיִם וְיָצָא דָּם עִם מֵי רַגְלֶיהָ, בֵּין שֶׁהִשְׁתִּינָה מְעֻמֶּדֶת בֵּין שֶׁהִשְׁתִּינָה מְיֻשֶּׁבֶת, טְהוֹרָה; וַאֲפִלּוּ הִרְגִּישָׁה גּוּפָהּ שֶׁנִּזְדַּעְזַע, אֵין זוֹ הַרְגָּשַׁת דָּם אֶלָּא הַרְגָּשַׁת מֵי רַגְלַיִם הִיא, שֶׁאֵינָהּ בָּאָה מִן הַחֶדֶר, וְדָם זֶה דַּם מַכָּה הוּא בַּחֲלָחֹלֶת אוֹ בַּכּוּלְיָא.
A woman who urinates and from whom blood comes out with the urine, whether she urinated standing or seated, is טהורה; and even if she felt her body shudder, this is not the sensation of blood but that of the urine, which does not come from the חדר (the womb) — and this blood is דם מכה, the blood of a wound in the חלחולת (bladder) or the כוליא (kidney).
Shulchan Aruch, Yoreh De'ah 191:1LEVEL 01
The single seif vocalized, with a fluent English translation, broken into its rules: the blood as טהור דם מכה, standing or seated and the ספל, the shared vessel, the chronic case with pain, the מוך bedikah, and kidney stones — explained with contemporary practical cases (hematuria, cystitis, lithiasis).
📖 StudyLEVEL 02
In-depth pilpul: דם מכה בחלחולת/כוליא versus דם המקור and the nature of הרגשת מי רגלים, the מחלוקת on עומדת / יושבת and the return to the מקור צר in the ספל, the יָדַיִם מוכיחות and the חזקת מכה after three times, the move from a chance event to the chronic case, and the מחלוקת of blood without pain (תמצית). חקירות and נפקא מינות.
📖 StudyLEVEL 03
Comparative tables (standing / seated, blood in the vessel or on the rim of the ספל, with pain or without, blood in the urine and on the עד), golden rules, classic pitfalls (הרגשת מי רגלים, דם מכה, חזקה, חול) and memorization of the single seif.
📖 StudyLEVEL 04
The shitah of the Tzemach Tzedek of Lubavitch and the Chabad mesorah on דם מכה of the urinary tract and the מוך bedikah, then the halacha lema'asse according to the Beit Yossef, the Rama, the Shach, the Taz, the Sidrei Tahara, the Chochmat Adam, the Aroukh haShulchan and contemporary pesak (Taharat haBayit, Shevet haLevi, Nishmat Avraham for the medical angle). A medical topic: every conclusion refers to the Rav and the physician.
📖 StudyThe Shulchan Aruch (YD 191:1) rules that a woman who urinates and whose blood comes out with the urine — whether standing or seated — is טהורה, even if she felt her body shudder (הרגשה): that sensation is only that of the urine, which does not come from the חדר (the womb). This blood is held to be דם מכה, the blood of a wound in the bladder (חלחולת) or kidney (כוליא), and not דם המקור (uterine blood). Medically, blood in the urine (hematuria) calls for a physician — a urologist or gynecologist — to find its cause; halachically, consult your Rav.
Some (י״א) permit only by means of a bedikah with a מוך: before urinating, the woman checks herself in the folds (חורין וסדקין), inserts a clean מוך resting on the מקור inside, urinates, wipes well, then removes the מוך. If it comes out clean, this is strong proof that the blood is not from the מקור but from a wound in the urinary tract (והכי נהוג). After three times that the מוך comes out clean, she is thereafter permitted without a bedikah (חזקת דם מכה). This is the halachic counterpart of a medical examination locating the source of the bleeding; carrying it out requires the Rav, and the diagnosis, a physician.
A woman who regularly sees blood in her urine and feels pain while urinating is permitted in every case: the pain is a יָדַיִם מוכיחות, a clear indication of a wound (מכה) that causes her pain. Even blood found after urination, when wiping, is then טהור. Pain while urinating or chronic bleeding medically suggest a cystitis, a urinary tract infection, or a lesion of the urinary tract: the course of action is set with the Rav and with a physician.
If, on checking, she then finds only grains resembling sand or reddish gravel (חול וחצץ), and likewise in the urine, she is טהורה: this is not blood from the מקור but sand coming from the kidneys — what medicine calls kidney stones (lithiasis). Here too, the sandy cause is confirmed by a physician, and the halachic status with the Rav.