The possible causes of painful urination with blood in women are: 1. Acute urinary tract infections, such as acute cystitis urethritis, can occur with painful urination with blood. It can also be accompanied by significant urinary urgency, painful urination or with back pain, fever and other symptoms. The diagnosis needs to be confirmed with further urine routine and urine culture tests.2. Stones in the urinary tract, such as ureteral stones and kidney stones, can cause pain, accompanied by lumbar pain or abdominal pain, with symptoms of hematuria. 3. Tumors in the urinary tract, such as renal pelvis tumors, kidney tumors or bladder tumors, can cause significant bleeding. They can cause obvious bleeding, painful urination, back pain or abdominal pain. It is common in elderly women and further CT examination of the urinary tract is needed to rule out the presence of tumors. 4. Trauma to the urinary tract, such as kidney contusion and bladder contusion, can cause painful urination, lumbago and abdominal pain, or obvious hematuria, usually with a clear history of injury.