As a urologist, one of my most commonly asked questions is, “Is this urine color normal?” It’s a great question because your urine can offer many useful clues about what is happening in your body. Everything from hydration, diet, medications, and urologic problems can change the appearance of urine. Most changes are benign and temporary. But some—especially red-colored urine—can be urgent and deserve prompt evaluation. Here’s what your urine might be telling you, and when to seek medical care.
What is a “normal” color of urine?
Urine most often is a shade of yellow. This coloring is tied to hydration—we should all aim for pale straw to light yellow, as this color range is usually a sign of good hydration. Darker yellow urine often is a sign of dehydration and should be a clue to increase your water intake, especially if you’ve been exercising, in hot weather, or drinking caffeine or alcohol.
Beyond shades of yellow, there are some medical conditions, medications or scenarios where urine can become almost any color imaginable. Commonly, certain supplements containing B-complex vitamins can make urine a neon yellow color. This is generally harmless but all over-the-counter supplements should be disclosed to your primary care doctor. Orange urine is commonly a side effect of phenazopyridine, a medication often used after urologic procedures and in the setting of urinary tract infections. Less common but often alarming for patients and loved ones, urine can be blue or green. The most common cause of this in hospitalized patients is the administration of a medication called methylene blue. There are also rare genetic conditions that can make urine change color to a purplish color when exposed to sunlight.
When to talk to your provider about the color of your urine
While most urine color variation is harmless, shades of pink, red and brown can be cause for alarm. Brown or tea-colored can be from foods (fava beans, rhubarb, or aloe) as well as certain medications or liver or kidney problems. If you are concerned, you should reach out to your doctor. Red and pink urine should always be a cause for concern. There are non-blood causes of red or pink urine, including some foods, such as beets, but if you are unsure, seek medical care. Blood in the urine should always be evaluated by your doctor. If it happens in the setting of a urinary tract infection, be sure to tell your doctor and have your urine tested for microscopic blood once the infection has passed. If you have microscopic blood in your urine or continue to see blood in your urine, you need to see a urologist.
Visible blood in the urine—what we call gross hematuria—is never “normal,” even if you notice it only once and it then goes away. While it can be a fluke, it can also be a sign of conditions that need timely diagnosis, including: bladder cancer, kidney stones, urinary tract infections, prostate or kidney problems. Blood thinners can also cause blood in the urine, but a full evaluation is still needed. While many people feel anxious about these conditions, problems caught sooner are almost always easier to treat.
If you see red, pink, or brown urine, reach out to your primary care provider. They will likely give you a referral to a urologist and order some imaging if it is not a straightforward infection. If you are passing clots, can’t urinate, have severe pain, or have fever or chills, go to urgent care or the emergency department.
Blood in the urine during menstruation
When menstruating, it is common to see blood when urinating. This is generally nothing to worry about, but if you experience any unusual pain when urinating while on your period, or have fever or chills or other signs of an infection, reach out to your primary care provider.
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