Siman 191 — Blood Found While Urinating (Dam BeHashtana): a Wound in the Bladder or Kidney, the Mokh Bedikah, and Medical Diagnosis
סימן קצ״א · דעת הרב והלכה למעשה
דם הנמצא במי רגליה — דם מכה בחלחולת או בכוליא
שיטת הצמח צדק וחב״ד · פסק הבית יוסף והרמ״א · נושאי הכלים והפוסקים בזמננו · בדיקת המוך והאבחנה הרפואית
🕯️ דעת הרב · פסק הלכה ולמעשה 🕯️
✦ ❖ ✦
Daat HaRav (Chabad) & Halacha lema'asse
The shitah of the Tzemach Tzedek of Lubavitch and Chabad on blood found while urinating,
then the halacha lema'asse of the nossei kelim and contemporary poskim — and always, hematuria goes to a Rav and a physician
Subject:
Shulchan Aruch Yoreh De'ah Siman קצ״א (1 seif)
Blood found in the urine: דם מכה of the חלחולת or the כוליא and not from the מקור → טהורה, standing / sitting and the vessel (ספל), the shared vessel, the chronic painful case (ידים מוכיחות), the bedikat ha-mokh, the painless case, and חול וחצץ (kidney stones)
Register (a medical and Taharat haMishpacha subject):
The subject is medical (hematuria, urinary infection, stones) and grave ; we present it
soberly, in clinical terms and without crudeness. Blood found in the urine is first
a medical diagnosis, and one never decides a personal case alone.
Every practical conclusion refers back to your Rav (or a Chabad Rav / Dayan / Yoetzet) AND a physician.
Authorship and iyun:
הרב יוסף חיים סממה · DAAT
How to read this level. Siman 191 treats a precise and common case: a woman who urinates and finds blood with the urine (דם בהשתנה). The Mechaber's fundamental rule: this blood is presumed to be דם מכה — blood from a wound in the bladder / urinary passages (חלחולת) or in the kidney (כוליא) — and not blood from the מקור (uterine), which is the blood of niddah ; she is therefore טהורה, and even if she felt a הרגשה, it is only the sensation of the urine, which does not come from the חדר. The siman has only one seif (1 seif), but a dense one: we break it into seven rules — (1) the basic rule (blood with the urine → טהורה) ; (2) the Rama on sitting / standing and the vessel (הספל) ; (3) the shared vessel ; (4) the chronic painful case (ידים מוכיחות) ; (5) the bedikat ha-mokh (the proof, by a clean swab, that the blood is not uterine) ; (6) the painless case (where we are stringent) ; (7) stones (חול וחצץ — sand and gravel from the kidneys). This level has two parts. (1) Daat HaRav — the shitah of Chabad: unlike kashrut, here there is a genuine Chabad halakhic tradition, whose authority of reference on Niddah is the Tzemach Tzedek of Lubavitch. (2) Halacha lema'asse: the general pesak (Beit Yossef, Rama, Shach, Taz, Sidrei Tahara, Chochmat Adam, Aruch haShulchan) and the contemporary pesak (Taharat haBayit, Shevet haLevi, Badei haShulchan ; Nishmat Avraham for the medical angle). We cite only real and attested positions ; where a specific Chabad ruling is not established with certainty, we indicate it at the level of principle — never inventing a responsum, a number, or a minhag. The major practical upshot of this siman is twofold: hematuria is at once a medical question (a physician — urologist / gynecologist — diagnoses the wound or the passages) and a halachic question ; therefore every conclusion (lema'asse) ends with referral to your Rav (or a Chabad Rav / Dayan / Yoetzet) and a physician — never self-diagnosis.
📑 תוכן העניינים
שורש הסימן — דם מכה בחלחולת או בכוליא, ולא מן המקור (סעיף אחד)
פסק המחבר והרמ״א — מסגרת הסימן בשבע הלכות
שיטת הצמח צדק וחב״ד — דעת הרב על דם בהשתנה
עומדת / יושבת והספל — המחלוקת והכי נהוג
ספל משותף · רגילות וכאב (ידים מוכיחות)
בדיקת המוך — ההוכחה שאין הדם מן המקור
בלא כאב · חול וחצץ (אבני כליות)
האבחנה הרפואית — המטוריה, דלקת, אבנים
פסיקת הספרדים בזמננו — טהרת הבית, ילקוט יוסף
פסיקת האשכנזים וסיכום מעשי — סדרי טהרה, חכמת אדם, שבט הלוי
📜 The Text of the Shulchan Aruch — the Single Seif (1 seif)
— Shulchan Aruch, Yoreh De'ah 191:1 (1 seif) · talmudic basis: Niddah 59b (blood found in the urine) · Sefaria YD 191:1
1. שורש הסימן — דם מכה (Bladder / Kidney) and not דם המקור
The foundation. The whole siman rests on an anatomical presumption (אומדנא): urine comes from the bladder and urinary passages (חלחולת), or forms in the kidney (כוליא), not from the מקור (the uterus / חדר), whence comes the blood of niddah. If blood comes out with the urine, it is therefore presumed to come from a wound (מכה) of that urinary tract — a blood that does not forbid. That is why the woman is טהורה even when she felt a הרגשה: for this הרגשה is fully explained by the sensation of urinating, and we do not attribute to the חדר what is explained by the urinary passages.
הרגשת מי רגלים ≠ הרגשת דם. The delicate point is the הרגשה: elsewhere (siman 183), a הרגשה accompanying an emission of blood is precisely what renders טמאה by Torah law. Here the Mechaber rules that the הרגשה felt while urinating is the sensation of the urine itself (הרגשת מי רגלים), distinct from the הרגשה of the opening of the מקור. The Taz, the Shach, and the Sidrei Tahara discuss the conditions of this presumption — its scope, and the cases where it no longer holds (when the blood appears without urine, for example). Distinguishing these situations is precisely the matter of a שאלה to a Rav, coupled with a medical diagnosis.
2. פסק המחבר והרמ״א — the Map of the Siman (1 seif, Seven Rules)
Siman 191 has only one seif, yet the Mechaber and above all the Rama (הגה) condense several rules into it. Here is the map, faithful to the text: the Mechaber establishes the presumption of דם מכה ; the Rama (הגה) adds the sitting / standing distinction and the vessel (הספל), the shared vessel, the chronic painful case, the bedikat ha-mokh, the painless case, and the stones.
Rule
Case
Pesak (anchored in the text)
1
Blood with the urine
Standing or sitting → טהורה: it is דם מכה of the חלחולת or the כוליא, not from the מקור — even with הרגשה (which is the הרגשה of the urine).
2
Sitting / standing and the ספל (Rama)
י״א that we permit only sitting ; standing, only in a stream (מקלחת) with the blood inside the vessel ; on the rim (שפת הספל) → טמאה ; standing → always טמאה (והכי נהוג).
3
Shared vessel
Permitted only in a ספל where she alone urinates (so we know it is from her) ; if a man and a woman urinate there → טהורה בכל ענין.
4
Chronic painful case
A woman who regularly sees blood while urinating and feels pain (a urinary ailment) → we permit בכל ענין (ידים מוכיחות of a wound that pains her) ; even blood after urinating (when wiping) → טהורה.
5
The bedikat ha-mokh (machmirim)
י״א to permit only with a בדיקה: before urinating, examine herself (חורין וסדקין) ; insert a clean swab (מוך נקי) on the מקור within ; urinate ; wipe well ; remove the מוך — if clean, great proof the blood is not from the מקור (והכי נהוג). After 3 times clean → thereafter without a בדיקה (חזקת דם מכה).
6
Without pain
If she feels no pain and finds blood when examining herself after urinating: if there is no blood in the urine → certainly טמאה ; if there is blood in the urine and on the עד → a dispute (טמאה / טהורה by תמצית) → יש להחמיר.
7
קרטין / stones
If thereafter she finds only grains like sand and red gravel (חול וחצץ), and the like in the urine → טהורה: it is not blood but sand formed in the kidneys (stones).
Note on method (important). This part presents the halakhic approach of Chabad on Niddah and, here, on blood found while urinating. Unlike kashrut, here there is a genuine Chabad tradition of pesak. We present it at the level of principle and authorities ; we attribute to the Tzemach Tzedek of Lubavitch and to no Rebbe any specific ruling, responsum number, or minhag that we cannot verify. For the detail of a case — and especially a real hematuria — the Chabad practice is to turn to a Chabad Rav or a Dayan and, in parallel, to a physician: one does not self-diagnose.
The Tzemach Tzedek of Lubavitch — Chabad's halakhic authority of reference on Niddah
The Tzemach Tzedek of Lubavitch — Rabbi Menachem Mendel Schneersohn (1789-1866), the third Rebbe of Lubavitch and grandson of the Alter Rebbe — is the posek of reference for Chabad, particularly in Taharat haMishpacha. His collection of responsa and pisqei dinim (the שו״ת צמח צדק) covers Yoreh De'ah and the laws of Niddah at length, and it is to him that the Chabad tradition first turns on these questions. At the level of principle, the Chabad school joins great stringency in Taharat haMishpacha to the care of seeking the real היתר where halakhah permits it. Now our siman illustrates exactly this balance: halakhah broadly exonerates blood explained by a wound of the urinary passages (טהורה, even with הרגשה), but the conduct — establishing the facts, the bedikat ha-mokh, assessing the pain — remains serious and goes through the Rav.
Daat HaRav and the core of the siman. On the very foundation of this siman — the presumption of דם מכה of the חלחולת or the כוליא, the practice of the seated woman urinating in a stream into the vessel (the Rama's והכי נהוג), the probative force of the bedikat ha-mokh, and the role of pain as ידים מוכיחות — the Chabad approach does not depart from the framework of the Shulchan Aruch and the Rama. Its specificity shows in the stringency of conduct, joined to the real use of the leniencies halakhah permits (foremost the exoneration of clearly urinary blood), and in the systematic referral to the Rav — and, for this subject, to the physician. We attribute to it no specific provision that is not attested.
Lema'asse (Daat HaRav). According to the Chabad tradition, in these matters one follows the Tzemach Tzedek of Lubavitch and the pisqei dinim transmitted in Chabad. For applying a real case — a hematuria, a urinary infection, stones, or whether to perform a bedikat ha-mokh —, consult your Rav (or a Chabad Rav / Dayan / Yoetzet) AND a physician: this level presents the principle, it does not decide your situation, and one never self-diagnoses a medical cause.
4. עומדת / יושבת והספל — Position and the Vessel (Rama)
— Shulchan Aruch YD 191:1 (Rama) · the Tur in the name of the Rosh ; Mordechai and Beit Yossef ; Taz ad loc.
The dispute over position and vessel
The Mechaber's shitah: permitted standing as well as sitting — the blood is presumed to come from the urinary passages.
The Tur in the name of the Rosh (י״א, in the Rama): we are concerned that, the מקור being narrow (צר), uterine blood may return and exit with the urine. Hence: sitting, yes ; standing, only in a stream (מקלחת) with the blood inside the vessel ; on the rim (שפת הספל) → טמאה.
Mordechai / Hagahot Maimoni (a stricter י״א): even sitting, only in a stream with the blood inside the vessel ; and standing → always טמאה. This is what the Rama concludes: והכי נהוג.
מקור צר וחוזר ומביא דם. The mainspring of the stringent position (Tur/Rosh, then Mordechai) is anatomical: as long as the blood is clearly within the projected urine (מקלחת), it is identified as urinary ; but if it trickles along the rim (שותתין על שפת הספל), we are concerned it may come from the מקור which, being narrow, has let blood return and emerge. The Taz specifies the particulars (the stream, the rim, the position). Assessing these signs in a real case belongs to the Rav, and the physiological cause itself is verified medically.
Lema'asse (position / vessel). The accepted practice (והכי נהוג): sitting, urinating in a stream into the vessel, with the blood found inside the vessel (not on the rim). But qualifying a real situation (stream? rim? position?) is not done alone. Consult your Rav (or a Chabad Rav / Dayan / Yoetzet) AND a physician — who will establish the urinary origin.
5. ספל משותף · רגילות וכאב — Yadayim Mokhichot (Rama)
— Shulchan Aruch YD 191:1 (Rama) · Hagahot Shaarei Dura in the name of the Maharil (resp. §203) ; Beit Yossef
Two of the Rama's leniencies
Shared vessel: we incriminate the woman only if the blood is found in a vessel where she alone urinates (then we know it is from her) ; if a man and a woman urinate there → טהורה בכל ענין, for the blood may come from another. The same holds, by extension, for shared toilets.
Chronic painful case (ידים מוכיחות): a woman who regularly sees blood while urinating and feels pain while urinating (a known urinary ailment) → we permit בכל ענין: the pain is manifest evidence (ידים מוכיחות) of a wound that pains her and from which the blood comes. Even blood found after urinating, when wiping → טהורה, since the pain establishes the origin.
Pain as a חזקה. The Rama's mechanism (in the name of the Maharil and the Maharam): a recurrent pain, linked to urination, founds a חזקה of a urinary wound — hence the leniency "בכל ענין" that even dispenses with the sitting / standing distinction. This is precisely where halakhah and medicine meet: "pain while urinating" is the cardinal symptom of an infection / inflammation of the urinary tract (cystitis), which the physician identifies. Halakhah reads this symptom as ידים מוכיחות ; the physician diagnoses it. Establishing that this pattern applies to the real case belongs to the Rav and the physician together.
Lema'asse (shared / pain). The principle: a shared vessel or toilet may exonerate (the blood may come from another) ; a recurrent pain while urinating is strong evidence of a wound (ידים מוכיחות) that permits broadly. But recognizing that these conditions are met — and having the cause of the pain diagnosed — is not a solitary act. Consult your Rav (or a Chabad Rav / Dayan / Yoetzet) AND a physician (urologist / gynecologist).
6. בדיקת המוך — the Proof the Blood Is Not Uterine (Rama)
— Shulchan Aruch YD 191:1 (Rama) · the view of the Maharil and the Mahari Weil ; Taz and Shach ad loc.
The logic of the bedikat ha-mokh. The machmirim (Maharil) are not content with the general presumption: they require direct proof. The method, described with clinical sobriety: the woman first verifies that she is clean (חורין וסדקין) ; she places a clean swab (מוך נקי) against the מקור, within ; she urinates and wipes carefully ; then she removes the מוך. If it is clean, this is great proof that the blood found in the urine does not come from the מקור (else the swab, which covered it, would be stained) — hence that it is indeed דם מכה. The Rama concludes והכי נהוג. And after three times with a clean מוך, the woman acquires a חזקה of דם מכה and is thereafter permitted without a בדיקה (outside the time of her וסת).
The exact role of the בדיקה
The bedikat ha-mokh is the practical heart of the siman: it is the instrument that turns a presumption into proof that the blood is not uterine. The nossei kelim (Taz, Shach, Sidrei Tahara) specify its particulars — for which woman (one with a וסת), the exact way of inserting the מוך, what a not-perfectly-clean מוך is worth, and the count of the three times. These are technical and intimate points that one does not decide alone: the way to perform a bedikat ha-mokh, and the reading of its result, are learned and verified with the Rav (or a Yoetzet), and the medical context with the physician.
Lema'asse (the bedikat ha-mokh). The principle: a clean מוך placed on the מקור during urination, removed clean, proves the blood is not uterine (and three times → חזקה of דם מכה, thereafter without a בדיקה outside the וסת). But the way to perform it, and the interpretation of the result, are not to be improvised. Consult your Rav (or a Chabad Rav / Dayan / Yoetzet) AND a physician — one learns the בדיקה and has the cause diagnosed ; one does not self-diagnose.
7. בלא כאב · חול וחצץ — the Painless Case and Stones (Rama)
— Shulchan Aruch YD 191:1 (Rama) · Mordechai Hilkhot Niddah ; Beit Yossef in the name of a responsum of the Ran (the sand)
Without pain, and the stones
Without pain, no blood in the urine: if she feels no pain, and on examining herself after urinating she finds blood on the עד but not in the urine → ודאי טמאה: nothing ties this blood to the urinary passages.
Without pain, blood in the urine AND on the עד: a dispute — the Mordechai renders her טמאה (we permitted only blood found in the urine) ; others (in the name of the Rosh / Ran) render her טהורה (we attribute it to a residue — תמצית — of the urine). The Rama rules: יש להחמיר (we are stringent).
Stones (חול וחצץ): if thereafter she finds only grains like sand and red gravel, and finds the like in the urine → טהורה: it is not blood but sand formed in the kidneys (kidney stones), whose reddish color deceives the eye.
דם vs חול — the nature of what is found. The seif closes on a distinction of identification: not everything red is blood. The קרטין כמו חול וחצץ אדום (small reddish sandy grains) are, per the responsum of the Ran cited by the Beit Yossef, concretions of the kidneys (stones) and not blood of niddah. This, again, is a point where halakhah meets medicine: urinary lithiasis (stones) emits precisely such tinted "gravel," which a physician identifies. To distinguish, in a real case, blood from a stone — as to assess the "without pain" case where the Rama is stringent — belongs to the Rav, on the basis of the medical diagnosis.
Lema'asse (without pain / stones). The principle: without pain, blood on the עד alone (not in the urine) renders טמאה ; blood in the urine and on the עד → we are stringent (יש להחמיר) ; but mere reddish gravel (חול וחצץ), in the urine, are stones and not blood → טהורה. Identifying what is found — blood or stone — is not a judgment to make alone. Consult your Rav (or a Chabad Rav / Dayan / Yoetzet) AND a physician ; the physician identifies the cause, the Rav decides the din.
8. האבחנה הרפואית — Hematuria, Infection, Stones
Blood in the urine is first a medical question
What the siman calls דם בהשתנה bears a clinical name today: hematuria (blood in the urine). Now hematuria is not a diagnosis — it is a symptom, whose causes range from a benign urinary infection (cystitis) to kidney stones, and which must always be evaluated by a physician (urologist or gynecologist). The halakhah of siman 191 presupposes precisely this medical reality: this blood comes from a wound / ailment of the urinary passages (חלחולת) or from the kidney (כוליא), and not from the מקור. But it is the physician who establishes the real cause, and the Rav who draws the din. Hematuria is never left to self-diagnosis.
The case in the siman
Its medical reading (to be confirmed)
Conduct
דם עם מי רגליה (blood with the urine), with pain
Suggests a urinary infection / inflammation (cystitis, urethritis)
May reveal a cause to investigate ; the Rama is stringent halakhically
Physician without delay + Rav ; do not reassure yourself alone
חול וחצץ אדום (reddish gravel)
Urinary lithiasis (kidney stones) — this is not blood
Physician (confirms the nature) + Rav (טהורה if they are indeed stones)
בדיקת המוך
An intimate maneuver to be learned ; it does not establish the medical cause
Rav / Yoetzet (the way) + physician (the cause)
Halakhah and medicine, two distinct questions. The Nishmat Avraham and the contemporary pesak literature stress this point: hematuria raises two separate questions that must not be conflated. The first is medical — what is the cause, is it benign, must one treat or investigate? It is put to a physician, and one never dispenses with it by relying on the bare halakhic presumption of דם מכה. The second is halakhic — is the woman טהורה or טמאה, and under what conditions (sitting / vessel, pain, bedikat ha-mokh)? It is put to the Rav. The two nourish each other: the medical diagnosis illuminates the din ; but neither replaces the other.
Lema'asse (the medical angle). Any appearance of blood in the urine requires two parallel steps, never one without the other: have the cause evaluated by a physician (urologist / gynecologist) — for hematuria is a symptom not to be neglected —, and put the question of טהרה to your Rav. Consult your Rav (or a Chabad Rav / Dayan / Yoetzet) AND a physician. Never self-diagnose.
9. פסיקת הספרדים בזמננו — Contemporary Sephardic Psika
Note on method. The works cited below extend the principles of siman 191 to today's practice. They are cited as recognized currents of psika, to be confirmed with a Rav before any application — and, for a real hematuria, one always also consults a physician.
Contemporary Sephardic psika (the school of Rav Ovadia Yossef) starts from the Beit Yossef and the Shach. The practical reference is the Taharat haBayit of Rav Ovadia Yossef (and its abridgment Yalkut Yossef — Taharat haBayit, by Rav Yitzchak Yossef), which treats דם הבא ממכה and blood found while urinating: the presumption of דם מכה, the place of the בדיקה, and the role of medical diagnosis. The spirit of this school — faithful to the fact that this blood is not uterine — tends to make full use of the exoneration that halakhah grants to clearly urinary blood or to stones, while entrusting the establishment of the facts, and any real case, to a Rav and a physician.
Point of the siman
Sephardic orientation (to be confirmed)
דם מכה / בהשתנה
The presumption of a wound of the urinary passages is broadly accepted → Taharat haBayit / Yalkut Yossef, to the Rav for the case and the physician for the cause.
בדיקת המוך / chronic pain
The pain (ידים מוכיחות) and the בדיקה as means of establishing the origin → the Rav's decision.
חול וחצץ / medical angle
Stones identified as non-blood ; recourse to diagnosis (cf. Nishmat Avraham) → Rav + physician.
10. פסיקת האשכנזים וסיכום מעשי — Ashkenazic Psika and the Summary
Note on method. The same remark: these works extend the Rama and the nossei kelim ; they are cited as landmarks of psika, to be confirmed with a Rav — and, for a real hematuria, with a physician.
Ashkenazic psika starts from the Rama, the Shach, and the Taz (developed here on sitting / standing, the ספל, the בדיקה and דם מכה), then from the great commentary specific to Niddah, the Sidrei Tahara, and from the codifiers: the Chochmat Adam (and his Binat Adam) and the Aruch haShulchan (Yoreh De'ah), developed on דם הבא מן המכה. For the twentieth century, the major practical reference is the Shevet haLevi of Rav Shmuel Wozner, often accompanied by the Badei haShulchan (the reference commentary on Hilkhot Niddah), which codifies these dinim and stresses recourse to a moreh hora'ah. The Pitchei Teshuva of the siman further gathers the responsa of the Acharonim (on the bedikat ha-mokh, the chronic case, the stones) ; and the Nishmat Avraham (Rav A. S. Avraham) articulates halakhah with the medical diagnosis of hematuria.
Point of the siman
Ashkenazic orientation (to be confirmed)
עומדת / יושבת והספל
Taz, Sidrei Tahara: the accepted practice (sitting, in a stream, inside the vessel) ; assessing the case → moreh hora'ah.
בדיקת המוך / ידים מוכיחות
Sidrei Tahara, Chochmat Adam, Aruch haShulchan: the בדיקה and the pain as proofs ; the way → Rav / Yoetzet.
חול / medical angle
Shevet haLevi, Badei haShulchan ; Nishmat Avraham (hematuria, stones). To the Rav and the physician.
Chabad within the psika
For Chabad practice on this foundation, one refers to the Tzemach Tzedek of Lubavitch (whose שו״ת covers Hilkhot Niddah) and to the decisions transmitted in Chabad, with the care proper to the school — stringency joined to the real use of the leniencies halakhah grants. We attribute no specific ruling that is not verifiable ; for a real hematuria and the detail of a case, one turns to a Chabad Rav or a Dayan and a physician.
טבלה — the axes of the siman, in practice
Notion
In substance
Reference
דם מכה / not from the מקור
Blood with the urine = a wound of the passages (חלחולת) or the kidney (כוליא) → טהורה, even with הרגשה
Mechaber (191:1)
עומדת / יושבת והספל
והכי נהוג: sitting, in a stream, blood inside the vessel (not on the rim)
Rama ; Taz
ספל / shared toilet
If a man and a woman urinate there → טהורה בכל ענין
Rama (Tur ופוסקים)
רגילות וכאב
Recurrent pain = ידים מוכיחות of a wound → permitted broadly
Rama (Maharil)
בדיקת המוך
A מוך נקי removed clean = proof the blood is not uterine ; 3× → חזקה
The basic rule: blood with the urine = דם מכה of the חלחולת or the כוליא, not from the מקור → טהורה, even with הרגשה (which is the הרגשה of the urine).
Rama (הגה)
Sitting / standing and the ספל (והכי נהוג) ; shared vessel (טהורה בכל ענין) ; chronic painful case (ידים מוכיחות) ; bedikat ha-mokh and חזקה after 3× ; without pain (יש להחמיר) ; חול וחצץ (stones).
Taz
The main development: sitting / standing, the ספל and the "מקור צר," the בדיקה, and the nature of דם מכה.
Shach (Siftei Kohen)
On the principles of דם מכה and the בדיקה (to be completed by Sidrei Tahara / Chochmat Adam, major references on Niddah).
Pitchei Teshuva
Responsa of the Acharonim on the borderline cases (the bedikat ha-mokh, the chronic case, the stones).
טבלה — Daat HaRav and contemporary currents (to be confirmed)
Chabad (Daat HaRav): the Tzemach Tzedek of Lubavitch (Rabbi Menachem Mendel Schneersohn, 3rd Rebbe of Lubavitch, 1789-1866) is the posek of reference for Chabad on Niddah ; his שו״ת covers Hilkhot Niddah. The Chabad school joins stringency and the search for the real היתר. For a real hematuria and the detail → Chabad Rav / Dayan and a physician. (No specific ruling is attributed here without a source.)
Sephardic: Taharat haBayit (Rav Ovadia Yossef) ; Yalkut Yossef — Taharat haBayit (Rav Yitzchak Yossef). They extend the Beit Yossef and the Shach: the presumption of דם מכה, the בדיקה, and recourse to the Rav and the physician.
Ashkenazic: Sidrei Tahara (a key commentary on Niddah) ; Chochmat Adam / Binat Adam ; Aruch haShulchan (YD) ; Shevet haLevi (Rav Wozner) ; Badei haShulchan ; and Nishmat Avraham for the medical angle. One brings hematuria to a moreh hora'ah and a physician.
On the substance, retain the axes: blood coming out with the urine is דם מכה (bladder / kidney) and not uterine → טהורה, even with הרגשה (which is the הרגשה of the urine) ; the accepted practice (sitting, in a stream, blood inside the vessel) ; the shared vessel that exonerates ; the recurrent pain as ידים מוכיחות ; the bedikat ha-mokh that proves the blood is not uterine (3× → חזקה) ; the painless case (יש להחמיר) ; and the stones (חול וחצץ) that are not blood.
Daat HaRav (Chabad): one follows the Tzemach Tzedek of Lubavitch and the pisqei dinim of Chabad, with the care of the school (stringency joined to the real use of the leniencies) ; any hematuria is verified with a Chabad Rav / Dayan and a physician.
Halacha lema'asse: Beit Yossef, Rama, Shach, Taz, Sidrei Tahara, Chochmat Adam, Aruch haShulchan, and the contemporary pesak (Taharat haBayit, Shevet haLevi, Badei haShulchan ; Nishmat Avraham for the medical) — all on these same axes.
The golden rule of this siman: hematuria is at once a medical question and a halachic question. The physician (urologist / gynecologist) establishes the cause — infection, a wound of the passages, stones ; the Rav decides the din. One never relies on the bare presumption of דם מכה, and one never self-diagnoses: for any appearance of blood while urinating, consult your Rav (or a Chabad Rav / Dayan / Yoetzet) AND a physician.
~ ~ ~ ~ ~ DAAT · הרב יוסף חיים סממה
תלמיד חכם · מעביר שיעורים בהלכה ובחסידות Daat HaRav and Halacha lema'asse on blood found while urinating · Siman קצ״א · 🕯️ Level 4 — Daat HaRav (Chabad) & Halacha lema'asse
⚠️ This content is for study, on a medical and intimate subject (Taharat haMishpacha). The positions cited (Daat HaRav / Chabad, Sephardic and Ashkenazic currents) are landmarks, not a personal pesak, and authorize no self-diagnosis. Blood found while urinating is at once a medical and a halachic question: for any practical application (lema'asse), consult a qualified Rav (or a Chabad Rav / Dayan / a Yoetzet) AND a physician (urologist / gynecologist).