Urine colour that is not straw-yellow can sometimes indicate an underlying health issue. The colour of the urine can change depending on food, medications, disease or infections.
Published Dec 15, 2024 | 7:00 AM ⚊ Updated Jan 10, 2025 | 1:10 PM
Colour of your urine can tell your health (Wikimedia Commons)
Your urine’s colour might be telling more about your health than you think. From hydration levels to serious medical conditions, the hues in your toilet bowl can serve as a vital clue to what’s happening inside your body.
Speaking to South First, Dr Sundar Sankaran, Nephrologist and Director, Aster Hospitals provided information about the colour of one’s urine and how it can be an indicator of several health issues.
Citing several cases, Dr Sundar argued that one must take note of the colour of their urine. The thumb rule, he said, one must look into the 4Ds which can change the colour of the urine.
“Diet, Drugs, Disease, and Dehydration are the 4Ds to remember when you are checking the colour of your urine since all of these can change the colour,” he said.
Narrating the interesting history of diagnosing diseases through the examination of urine colour, known as uroscopy, Dr Sundar said it dates back to ancient times and reached a peak during the medieval period.
Theophilus, a Greek physician, is often depicted receiving flasks of urine for analysis, symbolising the importance of this practice in early medicine. Physicians would observe the colour, clarity, sediment, and even smell of urine to infer the health of a patient.
A picture shows Theophilus receiving a flask of urine along with 21 other flasks containing urines of progressively changing colours. This chart represented a spectrum of potential health conditions, from pale yellow indicating good health to darker or reddish tones suggesting fever, dehydration, or other ailments.
Medieval physicians believed urine served as a “window” to the body’s internal state, as it was considered a filtered product of the blood.
“Pale yellow or straw-colored urine is generally a sign of good hydration,” Dr Sundar explained. “This color comes from urochrome, a pigment your body produces when breaking down hemoglobin.”
It is important to know the normal urine colour since it means one can easily tell any irregularity.
Dehydration is more common during extreme heat conditions. Dr Sudhir Kumar, in an earlier interview with South First, said that one could keep well hydrated by drinking water, electrolytes, or fresh fruit juices. People should avoid sodas, energy drinks, and excessive coffee intake.
If your urine is clear, it might indicate overhydration. “While not as dangerous as dehydration, overhydration can dilute essential electrolytes in the body, potentially leading to issues,” Dr Sundar added.
According to doctors, overhydration could dilute sodium levels which is essential for maintaining nerve, muscle, and cellular function. When its concentration drops, it can lead to nausea, vomiting, headaches, confusion, and in severe cases, seizures or even coma.
Also, overhydration puts excessive strain on the kidneys. In people with kidney issues, it may cause problems as well.
Dark yellow urine often points to mild dehydration. “If you notice darker urine, it’s your body’s way of telling you to drink more water,” Dr Gopalakrishnan S, general physician, explained.
He said the increased concentration of waste products like urea and urochrome (the pigment that gives urine its yellow colour) leads to a darker shade. Some medications can also cause dark yellow urine.
It can also be a sign of underlying health issues like liver problems or bile duct blockages, especially if accompanied by other symptoms like yellowing of the skin or eyes.
Seeing red or pink in your urine can be alarming. While foods like beetroot or berries can lead to such colours in urine, doctors warned that “Blood in the urine, known as hematuria, is a potential sign of urinary tract infections, kidney stones, or even more serious conditions like bladder cancer. Always consult a doctor if this happens,” Dr Sundar recommended.
Some medications, especially cancer drugs can also turn urine into a reddish or pink hue. Dr Sundar referred to a recent study that mentioned that a woman’s lipstick obsession resulted in red urine.
A 28-year-old woman in Srinagar, India presented with a five-day history of red-coloured urine without any pain, rigors, or chills. The woman had denied any history of recent exposure to medications or beetroot intake or colouring agents in food. The only feature they noted was her bright red lipstick.
Interestingly, her blood count, serum creatinine, liver sterile, and other tests were all normal. She said that she would apply her lipstick 20 to 25 times a day and was finding it difficult to get rid of this obsession.
The doctors then asked her to replace her bright lipstick with colorless lip balm for a few days. Interestingly, in just two days her urine became clear. A week later, the doctors asked her to restart the same red lipstick and the urine showed a red colour.
After “diagnosing” her “ailment”, the doctors referred her to a psychiatrist and also asked her to change the brand of lipstick.
Dr Sundar said oral absorption of the colouring agent in sufficient amounts changed the colour of the urine.
Orange-coloured urine may be the result of medications like rifampin or certain laxatives. Doctors suggested that orange urine tends to occur after people take vitamins or some forms of medication, especially when drugs are used to treat infections.
Interestingly, overconsumption of carrots can also cause orange-coloured urine. It could also be due to liver or gallbladder problems.
Brown or tea-coloured urine: Dehydration or more serious issues
Brown or cola-coloured urine could mean severe dehydration or signal the presence of myoglobin, a protein released during muscle injury.
Dr Sundar said dark brown urine could be due to kidney conditions called nephritis which means inflammation of the kidneys.
Black urine indicates a rare inherited disorder that prevents the body from fully breaking down two protein building blocks (amino acids) called tyrosine and phenylalanine.
It results in the depositing of a chemical called homogentisic acid in the body which can turn urine and parts of the body black. One of the earliest signs in children is the dark-stained nappies. This causes urine to turn black when exposed to air for a few hours.
If this is missed or overlooked in a baby, the disorder may go unnoticed until the person reaches his/her late 20s or early 30s.
People with Alkaptonuria may experience joint problems, lower back pain, stiffness, etc., showing early symptoms of osteoarthritis. Many people may even develop brown or black spots on the whites of their eyes. They may have other conditions as well.
Dr Sundar added that black urine could also be a symptom of blackwater fever (BWF), a rare but life-threatening complication of severe malaria. BWF is characterised by dark-red to black urine, fever, anemia, jaundice, and acute kidney injury.
Unusual colours like green or blue can occur due to specific medications, dyes used in medical tests, or rare genetic conditions.
A condition called Phenylketonuria (PKU) can turn urine blue-green when ferric chloride is added to it, Dr Sundar said. He added that this happens because of the presence of phenylpyruvate in the urine, which reacts with the ferric chloride to form a complex.
“PKU is a metabolic disorder that occurs when the body has too much phenylalanine. Other symptoms include a musty odour in the breath, skin or urine, lighter skin, hair, and eye colour than other family members, an eczema-like rash, seizures, nausea and vomiting, hyperactivity, behavioural, emotional and social problems, mental health disorders,” he explained.
Cloudy or foamy urine may indicate the presence of protein or a urinary tract infection (UTI). “Foaminess might be linked to kidney issues, especially if persistent. Cloudiness is often a sign of infection or high phosphate levels,” Dr Gopalkrishna explained.
However, it could also be due to chyluria secondary to filariasis doctors said.
Speaking about this condition, Dr Rampradeep discussed in detail a case study where a patient had presented with white-coloured urine. Later, tests proved it was Chyluria. Bedside ether test detected this condition.
Apparently, the addition of ether turned urine into straw coloured, denoting Chyluria. In some cases, tumors in the abdomen with rupture of lymphatics in the bladder can also lead to cloudy urine.
When to seek medical attention
While occasional changes in urine colour can be harmless, consistent discolouration, pain during urination, or unusual odours warrant a visit to the doctor.
Paying attention to the colour of your urine can help you identify early signs of health issues. A balanced diet, adequate hydration, and regular check-ups remain key to maintaining a healthy urinary system.
(Edited by Majnu Babu).
