All About Pee–Why that Color? What’s That Smell?

A patient, let’s call her Juno, who came in to see me recently asked about the color of her urine. She described it as bright neon yellow. I put on my medical sleuthing detective cap and asked more questions. 

Here’s a fun fact: our pee is a sunny color because one of the waste product chemicals that end up in our urine is yellow–it’s called urobilin. Healthy urine should be pale yellow, indicating that you are drinking enough water to dilute the urobilin. Super bright yellow urine can be caused by a high dose of B-vitamins. As it turns out, Juno is a vegan and doing the right thing by taking her B-vitamin supplements, which are water-soluble, meaning we store very little in our bodies and whatever is not needed, well, that comes out in our pee and is the cause of Juno needing sunglasses wondering about her neon yellow urine.  

Here are some more colors you might notice, and odors you might detect, what they mean, and which might be a sign of a health issue: 

Clear

If your pee is perfectly clear, consistently, without any trace of yellow, it probably means you are drinking more water than necessary. Staying hydrated is essential to good health, but overdoing it can throw off your body’s electrolyte balance. 

Possible Medical Problems:

Clear urine can also indicate liver problems like cirrhosis and viral hepatitis. If you are not consuming large amounts of water and have ongoing clear urine, you should contact your healthcare provider. 

Pink or Red 

Eating certain foods can cause your pee to turn reddish or pink, such as:

• Beets
• Rhubarb
• Blueberries/blackberries

Or medications: 

• Rifampin (Rifadin, Rimactane), an antibiotic often used to treat tuberculosis
• Phenazopyridine (Pyridium), a drug that numbs urinary tract discomfort
• Laxatives containing senna

Possible medical problems:

If you’ve eliminated food and medication as the cause, call your healthcare provider. Blood in your urine can be a serious symptom, the medical term is hematuria. It can indicate:  

• An enlarged prostate
• Kidney stones/cysts
• Tumors in the bladder and kidney
• Urinary tract infections
• Chlamydia
• Long-distance running can cause bleeding in some runners. The recommendation is to not pee right before your run, but a half hour or so before. The idea is that the liquid will cushion the bladder walls and avoid any trauma to the tissues.

Orange

If your urine appears orange, it could be a symptom of dehydration and not drinking enough or possibly a medical condition. This is one color that needs to be evaluated especially if it’s a dark orange. 

Orange urine can result from:

• Higher-dose supplements that contain vitamin C can change your urine bright yellow or orange.

• Vitamin C-rich foods like kiwis, bell peppers, and strawberries. 
• The beta-carotene in carrots or carrot juice could turn your pee a light orange.

Or medications: 

• Medications that can turn urine orange include the anti-inflammatory drug sulfasalazine (Azulfidine) 
• Phenazopyridine (Pyridium) 
• Laxatives
• Chemotherapy drugs

Possible medical problems:

• Jaundice which can be caused by both long standing or a newly acquired infectious hepatitis or other serious liver conditions can increase the amount of bile in the urine turning the urine orange. If you notice this and there are no other causes, do contact your healthcare provider for evaluation.

Blue or Green

Blue or green urine is primarily caused by dyes or food coloring. The dyes are ones sometimes used for medical tests on the bladder and kidneys. 

Foods: 

• Asparagus

Or Medications: 

• Amitriptyline (pain and migraine)
• Indomethacin (Indocin, Tivorbex) A nonsteroidal anti-inflammatory drug (NSAID)
• Propofol (Diprivan) A general anesthesia used in major surgery

Possible medical problems:

• The pseudomonas aeruginosa is a bacterial infection which is mainly found in hospital settings. It can cause urine to be greenish, blue, or indigo. 
• A rare, inherited disorder is Familial benign hypercalcemia, (also called “blue diaper syndrome”) causes urine to be blue.
• Green urine sometimes occurs during urinary tract infections caused by the pseudomonas bacteria.

Dark Brown

In most cases, urine that is dark brown indicates severe dehydration or other medical conditions. Other possibilities are:

In food:

• Eating large amounts of fava beans
• Rhubarb 
• Aloe

Or medications: 

• Antimalarial drugs chloroquine and primaquine 
• Antibiotics metronidazole (Flagyl) 
• Nitrofurantoin (Furadantin) an antibiotic
• Laxatives containing cascara or senna
• Methocarbamol, a muscle relaxant 

Possible medical problems:

• Liver and kidney disorders and some urinary tract infections can turn urine dark brown. Dark brown urine can also be an indicator of liver disease, as it can be caused by bile getting into your urine. 
• Porphyria is a rare hereditary disease in which the blood pigment hemoglobin is abnormally metabolized. Porphyrins in the urine turns it brown. 
• Extreme exercise. Muscle injury from extreme exercise can result in pink or cola-colored urine and kidney damage. 

Cloudy or Foamy

Cloudy urine can be a sign of a UTI, urinary tract infection. (Read about UTIs in my blog here) It can also be a symptom of some chronic diseases and kidney conditions, or simply being dehydrated. 

A little foam once in a while, especially in younger people who tend to have more forceful urination, is nothing to worry about. However, if your pee is consistently foamy over time it could indicate protein in your urine (proteinuria), which should be evaluated by your healthcare provider. Increased protein in urine can signal a serious kidney problem.

The Fragrances of Pee

Okay, pee doesn’t smell particularly great at its best, but sometimes it is extra stinky. Here are possible causes:

• Asparagus, of course! The most common cause of odd pee smell. 
• Garlic and onions
• Some high dose vitamins

Or medications:

• Sulfonamide antibiotics like Bactrim, which is commonly used to treat UTIs
• Diabetes medications (Diabeta, Glynase, PresTabs)
• Rheumatoid arthritis medications (Azulfidine)

Possible medical problems:

• Dehydration. When your pee is very concentrated its ammonia smell can be very strong.

• Urinary Tract Infection (UTI) 
• Cystitis (bladder inflammation)
• Diabetic ketoacidosis
• Gastrointestinal-bladder fistula (abnormal connection between the intestines and bladder)
• Maple syrup urine disease (rare genetic condition that becomes apparent during infancy)
• Metabolic disorder (a problem with the way your body converts the foods you eat into energy)
• Type 2 diabetes (uncontrolled)

I hope this helps reassure you. And as always, if you’re concerned, do talk to your healthcare provider.