Differential Diagnosis for Per Vaginal Bleed with Urine Showing Blood

Single Most Likely Diagnosis

• Urinary Tract Infection (UTI) or Kidney Stone: The presence of blood in the urine (hematuria) alongside per vaginal bleeding could be indicative of a UTI or a kidney stone, especially if the patient is experiencing pain or discomfort. However, the per vaginal bleed suggests a gynecological issue might be primary.

Other Likely Diagnoses

• Menstrual Period or Miscarriage: Per vaginal bleeding is a common symptom of menstruation or a miscarriage. The blood in the urine could be due to contamination during urination if the bleeding is heavy.
• Pelvic Inflammatory Disease (PID): PID can cause both pelvic pain and irregular vaginal bleeding. Hematuria could be present if the infection involves the urinary tract.
• Endometriosis: Although less common, endometriosis can cause both pelvic pain and irregular bleeding. Hematuria is rare but can occur if endometrial implants are present in the urinary tract.

Do Not Miss Diagnoses

• Ectopic Pregnancy: Although less likely, an ectopic pregnancy is a life-threatening condition that must be considered, especially if the patient is of childbearing age and has a missed period. Hematuria could be present due to rupture.
• Ovarian Torsion: This is another emergency condition that could present with pelvic pain and possibly irregular bleeding. Hematuria might not be directly related but could be seen in severe cases.
• Uterine or Ovarian Cancer: While rare, especially in younger patients, these cancers can cause irregular vaginal bleeding and, less commonly, hematuria if the cancer has spread to the urinary tract.

Rare Diagnoses

• Vaginal or Urethral Trauma: Physical trauma to the vagina or urethra could result in both per vaginal bleeding and hematuria.
• Systemic Diseases (e.g., Bleeding Disorders): Certain systemic diseases, such as bleeding disorders, could potentially cause both vaginal bleeding and hematuria, though these would be rare and likely accompanied by other symptoms.
• Foreign Body in the Urinary Tract: A foreign body in the urinary tract could cause hematuria and, if the object is large enough or causes significant irritation, could potentially lead to vaginal bleeding due to pelvic pressure or infection.