Siman 191 — Lamdan level: blood found while urinating
The woman who finds blood while urinating — study and pilpul
סימן קצ״א
דם מכה מול דם המקור, עומדת ויושבת והספל, ידים מוכיחות ובדיקת המוך
עיון, פלפול, שיטות הראשונים והאחרונים
⚡ For lamdanim and talmidei hakhamim ⚡
✦ ❖ ✦
Pilpul and in-depth study
Sugyot, sources, the underlying chakira, machlokot of Rishonim and Acharonim,
nafka minot for practice and an examination of the shitot
The subject :
Shulchan Arukh Yoreh De'ah siman 191 — a single seif, which runs through several halakhot
with the nosei kelim: Shakh (Siftei Kohen), Taz (Turei Zahav), Pitchei Teshuva, and the Acharonim of hilkhot niddah
The root of the sugya :
Niddah 59b — the mishnah האשה שהיא עושה צרכיה וראתה דם(נדה נ״ט ע״ב) ; see also Ketubot 5–6 (blood of betulim against blood of niddah) ; and see siman 187 (blood of a wound) and siman 196 (bedikah and hefsek taharah)
Written and studied by :
הרב יוסף חיים סממה · DAAT
📑 Table of contents
Opening the sugya — blood that comes out with the urine, and the underlying division between the blood of a wound and the blood of the womb
The sensation of urine is not the sensation of blood — the chakira on hargashah and the nerve of the exemption
Standing, sitting, and the basin — the Tur in the name of the Rosh against the Mordechai and the Hagahot Maimoniyot, and the reason of the "narrow passage"
The shared basin — only a basin in which she alone urinates
Hands that prove, and a chazakah of a wound — pain as proof, the mokh examination and the chazakah after three times
Without pain — the machloket over blood on the examining cloth — the residue of the urine, and "one should be stringent"
Blood, or sand and gravel — the very nature of what is found, and the setting of a vesset
The isolated event against the habit — from a one-off occurrence to a settled illness
Chakira and nafka mina for practice
Summary tables
📜 The text of the Shulchan Arukh — the single seif (vocalised; the Rama's gloss is given here in abridged form)
This siman touches on a medical matter — blood found together with the urine (haematuria, urinary tract infection, kidney stones). The study that follows is theoretical only; any real case calls for a medical diagnosis from a physician (urologist or gynaecologist) in addition to a question put to a rav moreh hora'ah. The wording here is kept clinical and restrained.
1. Opening the sugya — the blood of a wound in the bladder or in the kidney
The foundation — where did the blood come out from
The foundation of the siman: a woman becomes a niddah only through blood that comes from the womb — what the seif calls החדר, the uterus. Blood that comes from another place in the body does not render her impure. Now the urinary tract (bladder and kidney) is a passage distinct from that of the womb; accordingly, blood found in the urine, since it came by the path of the urine and not by the path of the blood, is attributed to a wound in that passage — and not to the blood of the womb. This is what the Mechaber says: " ודם זה דם מכה הוא בחלחולת או בכוליא " (שו״ע יו״ד קצ״א:א)
Two passages, not one : the siman assumes that the path of the urine is separate from the path of the blood. On that basis: even though blood came out, as long as it came out עם מי רגליה and not on its own, it stands to reason that its origin lies in that same passage (kidney, bladder, urinary tract) and not in the womb. And there lies the nerve of the exemption: neither a doubt nor a nullification in a majority, but the fact that the assessment of the place shows this is not the blood of a niddah at all.
The link with siman 187 : the rule of "attributing to a wound" has its root in the sugya of the blood of a wound in a woman who bleeds heavily (see siman 187), where it is set out when blood is attributed to a wound she has in the womb or in the passage; here it is a particular branch — a wound located in the urinary tract, and therefore not in the womb at all.
2. The sensation of urine is not the sensation of blood
The chakira — what is "she felt her body and was shaken" : by law, hargashah is a condition of the Torah-level impurity of a niddah. If so, since the woman הרגישה גופה ונזדעזעה, why do we not suspect that it was a sensation of blood, and that she is impure?
The Mechaber's answer — two distinct sensations : the Mechaber explains that the sensation of urine is not the sensation of blood. The tremor she feels is that of the urine coming out — a familiar and common sensation that accompanies urinating — and not the sensation of the womb opening. And since the Mechaber lays down שאין מי רגליה מן החדר — that her urine does not come from the womb —, the tremor that accompanies it does not come from there either, and she therefore need not be concerned.
The foundation — assessing where the sensation comes from :
The division does not turn on whether she felt something or not — she certainly did — but on what she felt. A sensation that habitually accompanies the act of urinating is read as the sensation of urine; only a sensation that has no other explanation is read as the sensation of blood. This principle — attributing the sensation to the known act that accompanies it — recurs throughout the sugyot of hargashah (see siman 188).
3. Standing, sitting, and the basin — the machloket over the blood returning to the womb
The root of the machloket — when do we say that "they return to the womb" :
Shitah
How the permission is framed
Source
The Tur in the name of the Rosh
Sitting — pure; standing — only if the stream falls into the basin, but if it runs down the rim of the basin, impure (the blood has returned to the womb)
Rama (first "there are those who say")
The Mordechai and the Hagahot Maimoniyot
Even sitting — only if the stream falls and the blood is found inside the basin; on the rim of the basin, impure; and standing — impure in every case
Rama (second "there are those who say") — " והכי נהוג " (רמ״א יו״ד קצ״א:א)
The reason of the "narrow passage" : the ground for the stringency when the liquid runs down the rim of the basin is that דהואיל והמקור צר חוזרין למקור ומביאים דם(רמ״א יו״ד קצ״א:א). That is: when the blood does not come out in a firm, direct stream into the basin but drips and runs slowly down its rim, we suspect that it came by a narrow, winding path, and that along the way it touched the womb and drew out the blood of a niddah. Hence it is precisely a stream — straight and detached — into the basin, and not onto its rim, that reveals the blood came by the path of the urine alone.
The reason for the division between standing and sitting : standing, the blood's course is longer and passes closer to the region of the womb; that is why the Rishonim were stringent there (and on the second shitah — in every case). Sitting, the path is short and direct into the basin, and they were therefore lenient (and on the first shitah — in every case). And the ruling for practice (והכי נהוג) follows the stringent shitah: standing, impure in every case; sitting, only when the stream falls into the basin.
4. The shared basin — only a basin in which she alone urinates
Chakira — why does a shared basin render her pure : at first sight this seems surprising: if we were stringent about a basin in which she alone urinates, all the more so should we be stringent about a basin that someone else also uses?
Answer — it is not attributed to her with certainty : the opposite is true. The whole stringency holds only where it is known that the blood is hers — a basin in which she alone urinates. But in a shared basin it is not known at all that the blood is hers, and perhaps it came from the man; she is therefore " טהורה בכל ענין " (רמ״א יו״ד קצ״א:א). It follows that the doubt about the blood's origin is a leniency here, since the whole law of impurity requires certainty that the blood is hers.
For today's application: shared facilities (a toilet used by several people) may sometimes form one side towards leniency, since it is not known that the blood is specifically hers. But this is a delicate assessment that depends on the details of the case — and so every case goes to a rav moreh hora'ah.
5. Hands that prove, and a chazakah of a wound — the mokh examination
This is the heart of the siman: the passage from the one-off occurrence to the settled illness, and the way of proving that the blood does not come from the womb.
The foundation — two ways of proving :
The siman offers two distinct means of showing that the blood does not come from the womb:
• ידים מוכיחות — "hands that prove": a regular pain at the time of urinating. The pain attests to a real wound in the path of the urine, and that wound "proves by hand" that the blood comes from it — and not from the womb. On this point the Maharil is lenient even for blood found after wiping.
• בדיקת המוך — the mokh examination: for a woman who has a vesset and has no marked pain, she places a clean mokh on the womb, within, before urinating; and when the mokh comes out clean, that is direct proof that no blood is issuing from the womb itself.
Pain as "hands that prove" :ידים מוכיחות is a known notion — an umdena not fully established, yet pointing clearly to the cause. Regular pain while urinating is an assessment at once medical and halakhic: a body that hurts at a given place at the time of a given act indicates a lesion — a wound — at that place. That is why the Maharil is lenient even for blood found after urinating, while wiping; the gloss puts his reason thus: " דמאחר דמרגשת כאב ואינה מוצאה דם רק אחר הטלת מי רגלים ודאי דם מכה הוא " (רמ״א יו״ד קצ״א:א)
The chakira on the chazakah — a chazakah of a wound after three times : what is the nature of the חזקה that follows three mokh examinations that came out clean? Is it a chazakah from the outset — that this is always how things are with her — or a chazakah established by the examination, three times amounting to establishment?
What emerges from the Rama — a chazakah established by the three : it emerges from the Rama that this is a chazakah that is established: once she has examined herself three times and the mokh was found clean, it is settled in her case that this blood is the blood of a wound, and she is " מותרת אחר כך בלא בדיקה שלא בשעת וסתה " (רמ״א יו״ד קצ״א:א). Three is the customary measure of a chazakah — as with the three times for setting a vesset — and, joined to the reason the Rama gives, "since she finds it only after urinating", the umdena and the chazakah combine with one another.
6. Without pain — the machloket over blood on the examining cloth
The root of the machloket — blood in the urine and on the examining cloth :
The situation
The law
Source
Without pain — blood on the examining cloth and no blood in the urine
ודאי טמאה — certainly impure: there is here no proof at all that the blood came by the path of the urine
Rama
Blood in the urine and also on the examining cloth — first opinion
Impure — they permitted only blood found within the urine (the Mordechai)
Rama (first "there are those who say")
Blood in the urine and also on the examining cloth — second opinion
Pure — the blood found on the cloth is attributed to a remnant of the urine (the Beit Yosef, from what emerges from the Rosh and the Ran)
Rama (second "there are those who say")
The reasoning of the "residue" : the point of the machloket is blood found on the examining cloth where there is no pain. For the lenient opinion — since there is blood also within the urine, it stands to reason that the blood on the cloth too comes מתמצית מי רגלים — from a remnant of the urine's moisture that stayed and clung to the cloth while wiping, and not from blood of the womb. For the stringent opinion — the Rishonim attributed in this way only blood found genuinely within the urine, whereas blood found on the examining cloth may be the blood of a niddah. And the Rama concludes " ויש להחמיר " (רמ״א יו״ד קצ״א:א); what the Acharonim say on this is to be looked up in place (Sidrei Taharah, Chokhmat Adam).
A remark in parentheses within the gloss : the gloss adds " ולפע״ד לא משמע מהרא״ש מידי " (רמ״א יו״ד קצ״א:א) — that is, it doubts whether the Rosh really furnishes a proof for the lenient opinion. The conclusion "one should be stringent" therefore rests on the proof not being clear. And in any event, " אם בדקה עצמה שלש פעמים ומצאה טהורה שוב אינה צריכה בדיקה " (רמ״א יו״ד קצ״א:א).
7. Blood, or sand and gravel — the nature of what is found
The foundation — not blood but sand :
Here the question is not where the blood came from, but what it is that was found. What was found is not liquid blood at all, but קרטין קרטין כמו חול וחצץ אדום — hard, reddish granules. And the nature of these — kidney stones, the "sand of the kidneys" — is to form in the kidneys and to come out with the urine. And since they are not blood but sand, there is in them no impurity of niddah whatsoever.
In today's terms: granules of "red sand and gravel" are stones of the kidneys or of the urinary tract. Establishing this — that what is found is a concretion and not blood — is strictly medical (urinalysis and imaging with a physician). One does not decide on one's own that it is sand: the finding requires a physician, and the halakhic permission a rav.
The indications that combine towards permission : the permission in the matter of "sand" does not rest on its appearance alone, but on the combination of several assessments, which the gloss lists: (a) that she finds it only after the urine, in the way of sand that comes out with urine; (b) that the like of it is found in her urine as well; (c) that at the time of her vesset she sees real blood like other women — a sign that the womb is working as it ordinarily does and that there is no disturbance in it. The combination of the three establishes that what is found is sand of the kidneys and not blood of the womb.
8. The isolated event against the habit — from a one-off occurrence to a settled illness
The overall chakira — occurrence or settled state : the siman distinguishes two situations: a נמצא דם במקרה — blood found by chance, a one-off occurrence — and a אשה שרגילה לראות דם במי רגליה — a woman accustomed to seeing blood in her urine, a chronic state. What is the halakhic difference between them?
Two regimes of proof :
The occurrence — a one-off event: the permission here depends on the assessment of the place alone (sitting or standing, and the basin), since there is as yet no known pattern. It is on this that the Rishonim differ regarding standing and sitting, and for practice the stringency was followed.
The habit with pain — a settled illness: here the כאב, the pain, is added as "hands that prove", and a chazakah of a wound can be established by the mokh examination three times. And once the chazakah is acquired, she is permitted even without examination, outside the time of her vesset.
The passage from the occurrence to the regular state is not merely quantitative but qualitative: in the settled state there are added means of proof — pain, repeated examination, chazakah — that do not exist in the one-off event.
Setting a vesset for the "sand" (the end of the gloss) : the Rama adds that if she is not accustomed to seeing it but sees it from time to time — קובעת לה וסת אם הוא בדרך קבע(רמ״א יו״ד קצ״א:א), she sets herself a vesset if it occurs in a regular way, whether an even vesset or a vesset by intervals. That is: even the chronic sighting of sand or blood, if it recurs regularly, enters the reckoning of setting vessatot (see the laws of vessatot in their place), and this is a further way in which the occurrence becomes a known and established pattern.
The overall chakira of the siman : what establishes that the blood does not come from the womb, and from what point does one rely on that establishment?
The assessment of the place — the path of the urine is distinct from the path of the blood; hence blood that comes out with the urine is attributed to a wound of the bladder or the kidney.
The assessment of the sensation — the sensation of urine is not the sensation of blood, and the tremor therefore does not render her impure.
The assessment of the pain — hands that prove there is a wound, and by that even blood found after wiping is permitted.
The mokh examination and the chazakah — direct proof that the blood does not come from the womb; and after three times — a chazakah of a wound.
The nature of what is found — red sand and gravel are not blood but kidney stones.
Nafka mina for practice (following the Rama's ruling as the gloss frames it) :
Blood coming out with the urine — sitting, with the stream falling into the basin — pure; standing — impure in every case (" והכי נהוג " (רמ״א יו״ד קצ״א:א)).
The liquid running down the rim of the basin — impure: we suspect it returned to the narrow womb.
A basin in which a man and a woman urinate — pure in every case: it is not known that the blood is hers.
Accustomed to seeing it with pain — hands that prove, and she is permitted; and for those who are stringent — by the mokh examination, with a chazakah after three times.
Without pain, blood on the examining cloth (even with blood in the urine) — one should be stringent.
Red sand and gravel alone (kidney stones) — pure, for it is not blood.
And for practice — ask your rav; and in matters of health (blood in the urine, infection, kidney stones) a specialist physician as well (urologist or gynaecologist).
To be emphasised : all the permissions in this siman assume that the blood comes from a wound in the urinary tract and not from the uterus. Determining that this is indeed so — that there is a wound, an infection or a stone in the urinary tract — is a medical diagnosis. Every case therefore calls for two parallel enquiries: a physician, to determine the source of the blood, and a rav moreh hora'ah, to determine the law; and in matters of taharat hamishpachah, a certified yoetzet halakhah as well.
Blood with the urine — sitting, the stream falling into the basin
Pure: the blood of a wound of the bladder or the kidney
Mechaber; Rama — " והכי נהוג " (רמ״א יו״ד קצ״א:א)
Standing
Impure in every case, according to the halakhah as practised
Rama in the name of the Mordechai
The liquid running down the rim of the basin
Impure: the womb is narrow, the blood returns there and draws blood out
Rama in the name of the Tur and the Rosh
Shared basin (a man and a woman)
Pure in every case: it is not known that the blood is hers
Rama in the name of the Tur and the poskim
Accustomed to seeing it + pain
Hands that prove — permitted, even for blood found after wiping
Rama in the name of the Maharil
A clean mokh examination three times
A chazakah of a wound — permitted without examination, outside the time of her vesset
Rama — " וְהָכִי נָהוּג " (רמ״א יו״ד קצ״א:א)
Without pain — blood on the examining cloth (with blood in the urine)
Machloket — and one should be stringent
Rama in the name of the Mordechai / the Ran
Red sand and gravel (kidney stones)
Pure: it is not blood
Rama in the name of a teshuvah of the Ran
Table — the central machlokot of the siman
Subject
First shitah
Second shitah
Standing and sitting
The Tur and the Rosh — sitting, permitted in every case; standing, only if the stream falls into the basin
The Mordechai and the Hagahot Maimoniyot — standing, forbidden in every case (" והכי נהוג " (רמ״א יו״ד קצ״א:א))
Permission without examination
The Maharil — accustomed, with pain, permitted in every case
Those who are stringent — only for a woman who has a vesset, and by the mokh examination
Blood on the examining cloth (without pain)
The Mordechai — impure: they permitted only blood within the urine
What emerges from the Rosh and the Ran — it is attributed to the residue of the urine (pure)
The nature of the chazakah
A chazakah from the outset — this is how it is with her
A chazakah established by three mokh examinations — and this is what emerges from the gloss
Table — the sources of the sugya
The root in the Shas and in the Mechaber : Niddah 59b — the mishnah האשה שהיא עושה צרכיה וראתה דם(נדה נ״ט ע״ב) · see the sugyot of the blood of a wound for the rule of attributing to a wound · Shulchan Arukh Yoreh De'ah siman 191, a single seif (Shulchan_Arukh,_Yoreh_De'ah.191.1) · and in connection with simanim 187 (blood of a wound), 188 (hargashah and mar'ot) and 196 (bedikah and hefsek taharah)
Rishonim and poskim named in the Rama's gloss : the Rosh · the Tur · the Mordechai (hilkhot niddah) · the Hagahot Maimoniyot · the Ran (in a teshuvah) · the Maharam (in his teshuvot) · the Maharil (in a teshuvah) · the Maharash · the Agur · the Hagahot Sha'arei Dura · the Beit Yosef
Acharonim : Shakh · Taz · Sidrei Taharah · Chokhmat Adam · Arukh HaShulchan · Pitchei Teshuva · and the poskim of our time in matters of taharat hamishpachah and medicine
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⚠️ This content is written for study and analysis only. This siman touches on a medical matter (blood in the urine, infection, kidney stones); for any practical ruling (לְמַעֲשֶׂה) — ask your rav, and in matters of health a specialist physician as well (urologist or gynaecologist), and in matters of taharat hamishpachah a certified yoetzet halakhah as well.