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Dark urine can appear in very different facets and can be colored from yellowish brown to dark orange and reddish brown to deep brown or black. Different causes come into consideration for the different shades and intensities. In some cases, the change in color can be easily explained, for example, by a lack of fluid, which results in the urine appearing in a highly concentrated form and is therefore colored brown.
Taking certain medications, such as some antibiotics or tropical malaria, can be considered a "harmless" cause. On the other hand, dark urine can also be connected to a liver disease (e.g. hepatitis, cirrhosis), the metabolic disorder porphyria or Meulengracht's disease, as well as jaundice e.g. caused by a gallstone. In this case, for example, the bile pigment bilirubin can no longer be excreted through the intestine due to the occlusion of the bile duct, but is subsequently increasingly released through urine, which typically assumes a dark, beer-brown color. Depending on the various possible causes, a doctor should be consulted for clarification immediately in the case of dark-colored urine - especially if the discoloration continues after adequate hydration.
Definition of urine
Urine - also called urine - is a liquid excretion product, which arises from the blood plasma in the kidneys in the course of a complicated filtration and absorption process (diuresis). The urine then passes through the ureters into the bladder, from where it is finally released through the urethra (“micturition” or “urination”). Urination serves on the one hand to regulate the fluid and electrolyte balance, but also to remove metabolic breakdown products (e.g. urea, uric acid) and the remains of medicines and toxins that are washed out of the body together with the urine.
The urine consists mainly of water (95 percent), electrolytes and urea, in addition there are vitamins, organic acids such as citric acid, creatinine, uric acid, dyes and a very small proportion of proteins. Urine is usually clear and slightly yellowish or amber in color, the color being caused by metabolic products (urochromes) found in the urine. Accordingly, the emergence of the urochromes determines the extent of the yellowing, which can vary from an intense yellow (hypotonic urine) to colorless or transparent. The "scent" of fresh urine is normally neutral, but the subsequent bacterial decomposition of excreted substances quickly gives off the pungent, ammonia-like odor.
Urine is generally considered to be an important indicator of various diseases, for example, blood in the urine can indicate a kidney infection or a kidney infarction and a large amount of "urine sugar" can indicate diabetes mellitus. In addition to this, the color can also provide important insights when determining diseases, because a dark or yellow color, for example, usually indicates a sick liver.
The smell can also provide additional help - for example, a foul-smelling, smelly urine can be a clear sign of a metabolic disorder or certain bladder tumors. However, the smell can also be influenced by the diet, as is typical after eating asparagus. This partially penetrating, cabbage-like smell is due to an enzyme that converts the aspartic acid contained in the asparagus into sulfur-containing substances - however, this does not happen to everyone, because only about every second person produces this enzyme at all.
Causes of dark colored urine
A temporarily dark urine is in many cases no cause for concern and often has "harmless" causes such as taking certain medications or active ingredients (for example levodopa, methocarbamol, methyldopa or metronidazole) or eating food or beverages such as coffee which can turn the urine brownish to black. Nevertheless, as a precaution, a doctor should always be consulted for clarification - especially if the urine is cloudy - because darkening can also indicate more serious diseases such as cirrhosis of the liver or the metabolic disorder porphyria.
Lack of fluids
A common, relatively "harmless" cause of discolored urine is a lack of fluid, because the body is almost 70 percent water and therefore needs a lot of it to function properly. On the one hand, this is important in order to transport the absorbed nutrients into the individual cells for recycling; on the other hand, water is necessary to flush metabolic breakdown products out of the body - which primarily happens via the kidney.
In addition, the body needs liquid to regulate the body temperature, because this ensures to a certain extent a constant temperature in the body - even with strongly fluctuating ambient temperatures. If there is a deficiency, the body usually shows quite clearly about the feeling of thirst that "replenishment" is needed. This is usually the case with a loss of water in the body of around 0.5%, the case with a loss of around 10%, there is also a feeling of dryness in the mouth and speech disorders.
In addition to the feeling of thirst, the body sends other alarm signals - frequently there are suddenly occurring headaches, which result from the fact that the blood thickens due to the lack of fluid and can no longer pass on sufficient oxygen to the brain. Since the brain is largely made up of water, a lack of supply can quickly lead to problems with concentration and attention as well as inner restlessness, nervousness and fatigue, in many cases dizziness also occurs. The skin also suffers, because if the water content in the body is too low, the remaining resources are first made available to the organs, because they need the water particularly urgently, especially the liver, intestine, heart and brain. As a result, the skin suffers from “withdrawal symptoms” and becomes dry, flaky and itchy, and chapped and chapped lips are also a frequent sign of a lack of fluid.
In addition to this, the digestive system also suffers, because due to insufficient fluid, the stool volume decreases and hard stool occurs, which is often difficult and difficult to excrete. As a result, sufferers often feel that the intestine is never completely empty, and there are other symptoms such as flatulence, nausea or abdominal pain, which can develop into cramps.
Dark urine can be another signal here, because if you drink too little, there is no thinning of the urine, which means that it is not excreted in the "normal" light yellow, but in a concentrated, dark-colored form. In most cases, this is not a cause for concern and regulates itself relatively quickly if supplies are appropriately taken care of - but if the urine remains dark despite sufficient hydration, a doctor should always be consulted to clarify the cause.
Another cause of dark-colored urine can be "porphyria", which is a group of metabolic disorders that are characterized by a disturbed build-up of the red blood pigment heme, the iron-containing component of hemoglobin. The heme, which is part of the hemoglobin and is responsible for the oxygen binding and red color of the blood, is formed in eight steps, with a specific enzyme being required for each step. If there is porphyria, one of these enzymes is impaired in its function, so that the biosynthesis of the heme cannot be completed. As a result, more and more metabolic products (porphyrins) accumulate in the body - which exactly depends on which enzyme is defective, and in some cases several enzymes can be affected. In most cases, porphyria is caused by an inherited genetic defect, which means that the disease often shows up in childhood.
There is also the possibility that this is asymptomatic for a lifetime or initially remains undetected and only later in life through triggers such as certain medications (e.g. sulfonamides, sedatives), birth control pills, smoking, stress, excessive alcohol consumption or increased hunger as part of Diets or fasting cures are typical symptoms. In rare cases, however, the disease can also be acquired without a genetic connection (secondary porphyria) in the course of life, for example as a result of poisoning with lead or certain pesticides or even a disturbance in bilirubin transport (for example, rotor syndrome).
There are various forms of porphyria (e.g. hereditary coproporphyria or erythropoietic protoporphyria), which are divided into "acute" and "cutaneous" porphyrias depending on the symptoms - however, there may also be overlap in the signs of the disease. Typical of the acute form is the sudden onset of massive abdominal pain, which often lasts for days and includes nausea and vomiting, back pain, arm pain, leg pain, constipation, neurological failures such as paralysis or nerve pain, but also hypertension and psychiatric symptoms such as depressive mood, lack of motivation or one Psychosis can be accompanied.
On the other hand, cutaneous or skin-related porphyrias are characterized by a strong, very painful sensitivity to light on the part of the skin, which quickly causes severe itching, blisters on the skin and later scars when in contact with sunlight. Depending on the shape of the porphyria, serious damage to the skin and tissue or even loss of parts of the body such as the nose, lips or finger parts can occur - this can be accompanied by severe skin pigmentation, increased body hair (hypertrichosis) or embedding of the porphyrins in the teeth (erythrodontia, "Blood teeth") come, in addition, the liver can be damaged by storage of the porphyrin up to a liver cirrhosis.
In addition, since the defective metabolites of the red blood pigment are excreted through the kidneys, both forms of the disease may cause the urine to be dark or darken after standing for a long time.
Jaundice / jaundice
If the urine is brown or even dark brown in color, jaundice comes into consideration, which is colloquially referred to as "jaundice". This is a yellowing of the skin, mucous membranes and the dermis of the eyes (sclera), but this is not a separate disease, but a symptom of various diseases. The yellow-brownish bilious pigment "bilirubin", a degradation product of the red blood pigment hemoglobin, is responsible for the yellowing and is present in too high a concentration in the blood due to various diseases of the liver, the biliary tract and the blood.
In jaundice, a liver disease is usually suspected, but it can have a variety of causes and may not affect the liver at all. However, since the liver plays a central role in bilirubin metabolism, a distinction is made between three types of jaundice, depending on where it exists. With a "preopathic" (or also "hemolytic") jaundice, a disorder "before" (composition of Latin pre = before and Hepar = liver) of the liver is shown, as a result of a premature or increased breakdown of red blood cells (hemolysis) increases bilirubin in the blood, but the liver can no longer break down the dye. As a result, this is deposited in the tissue and the typical yellowing of the skin and eyes develops.
In most cases, preopathic jaundice is caused by blood disorders (such as "spherical cell anemia"), but various immune-related disorders can also be considered, such as malaria or poisoning. This form of jaundice can also lead to fever, tiredness or nausea, stool and urine usually remain “normally” dark or light, but in extreme cases the urine can also turn red-brown.
The second form of jaundice is called "hepatic jaundice", in which bilirubin is no longer absorbed by the liver cells or only in limited form. The causes can be found directly in the liver, in many cases there is hepatitis (inflammation of the liver), which can be triggered by viruses (e.g. hepatitis B), medication (e.g. paracetamol, certain antibiotics), various fungal toxins or toxic chemicals , pregnancy or the "Epstein-Barr virus" are also possible.
Mostly, however, excessive, excessive alcohol consumption is responsible for the inflammation of the liver, which in severe cases can lead to cirrhosis of the liver or even liver cancer. In addition to the yellow skin and the yellow eyes, this form shows symptoms such as tiredness, nausea and vomiting as well as abdominal pain. The stool is usually normal or a little lighter in color, but the urine becomes a little darker.
The third form, "posthepatic jaundice" (or "cholestatic jaundice"), on the other hand, is a disorder that only occurs after bilirubin has passed through the liver (post-hepatic = "after" the liver). The cause here is a blockage of the bile outflow (cholestasis), whereby the bilirubin in the bile cannot get into the intestine, but instead accumulates in the blood and leads to the typical yellowing. Due to the increased bile acid, this variant of jaundice often results in a strong, constant itching, another sign is a light-colored stool, which can almost turn white. This arises because the bilirubin no longer arrives in the intestine and consequently there are no breakdown products (stercobilinogen), which otherwise ensure the “normal” light to dark brown color of the stool. While it is getting lighter and lighter, however, the urine turns dark brown ("beer brown") because, since the outflow of the yellow-brown bile pigment through the bile is disrupted, it first collects in the blood and is finally excreted in the urine via the kidneys.
The cause of the blocked bile drainage is often a gallstone, but tumors (e.g. in gallbladder cancer or liver cancer) as well as sticking as a result of surgery or inflammation are also possible. Gallstones do not necessarily have to cause complaints, which is why they are often only discovered accidentally, for example during an ultrasound or X-ray examination. However, about a quarter of those affected experience symptoms such as discomfort in the upper abdomen in the form of a feeling of pressure or bloating, frequent belching and bloating - often especially after eating fatty foods. In more severe cases, the stones can also cause major problems by causing severe, colic-like pain in the right middle and upper abdomen, which can radiate in part to the back or the right shoulder area. If the bile duct is blocked, inflammation of the gallbladder or pancreas can also occur, which can be accompanied by severe pain, fever and chills.
In addition, the metabolic disorder Meulengracht's disease (also Gilbert syndrome) can be the cause of dark urine, which affects about 5% of the population. Meulengracht's disease belongs to the so-called familial hyperbilirubinemia syndromes, which are characterized by a disturbance in the bilirubin metabolism. The cause is a congenital enzyme defect, through which the activity of the enzyme UDP-glucuronyltransferase only reaches about 30% of the “normal value”. As a result, the yellow-brown bilirubin cannot be sufficiently converted and excreted, which in most cases leads to a slightly increased concentration of the bile pigment in the blood.
Since this metabolic disorder does not lead to liver damage, it is usually not regarded as a "disease" in the narrow sense - but can nevertheless lead to unpleasant symptoms and result in intolerance to certain medications (for example, hormones containing estrogen, buprenorphine, paracetamol or flavonoids) .
In many cases, Meulengracht's disease is largely asymptomatic; as soon as the bilirubin level rises, there are often the typical signs of jaundice, such as yellow eyes, yellow skin and dark-colored urine. This is usually relatively easy, but is particularly pronounced in connection with infections, alcohol consumption, stress or prolonged fasting and in these cases is often accompanied by malaise, fatigue, difficulty concentrating, nausea, diarrhea and an uncomfortable feeling in the area of the liver.
Another possible cause is so-called melanuria. This occurs in connection with a malignant melanoma or black skin cancer, which means a highly malignant tumor of the pigment cells (melanocytes), which tends to spread early metastases via the lymphatic and bloodstream and accordingly represents the most frequently fatal skin disease. In this disease, the urine contains the body pigment melanogen, which is oxidized to melanin in the air and thereby turns the urine deep brown or even black.
Dark-brown or black urine can also occur with so-called alkaptonuria. This is a very rare, hereditary pathological change in the tyrosine metabolism, which is caused by a defect or deficiency in the enzyme homogentisic acid dioxigenase. As a result, the degradation product homogentisic acid builds up, which leads to a brown discolouration in the connective tissue of the skin and in the articular cartilage (ochronosis), in addition there are gout-like joint inflammations, dark spots in the dermis of the eye and an increased risk of kidney stones and Damage to the heart valves or aorta. Since the increasing amount of homogentisic acid that occurs in alkaptonuria forms a dark brown-black dye in alkaline liquids and in the air, the urine darkens only when it has been standing for a long time or is alkaline - for example, after a carbohydrate-rich diet.
Even if there is currently no treatment method that can completely cure the disease, there are still some therapeutic options, such as reducing the formation of dyes by high doses of ascorbic acid (vitamin C) in combination with a diet that is as low as possible in phenylalanine tyrosine ( little meat, sausage, fish, cheese, eggs and milk-based sweets).
In equally rare cases, the "black water fever" comes into consideration. This is a complication of malaria, often triggered by taking quinine or antipyrine. In this disease, the acute breakdown of red blood cells (hemolysis) causes the blood pigment (hemoglobin) to be excreted in the urine (hemoglobinuria). Accordingly, the typical symptom is deep dark to black-red urine, severe exhaustion, bilious, sometimes insatiable vomiting, headache, anxiety and jaundice, and degeneration of the kidneys, liver and heart. Since the mortality rate for black water fever is relatively high, fast medical care is particularly important here, however, if intensive medical treatment is not given, death usually occurs within a short time due to kidney failure.
Once the urine has darkened, treatment can begin. There are a number of different approaches and options here to solve the cause of the problem.
Therapy for lack of fluids
If a lack of fluids is the cause of dark urine, the most important measure is to drink water, unsweetened tea or juice spritzer first to restore the balance.
If hard defecation or constipation occurs in the course of the deficiency, you should ensure that you exercise enough and have a high-fiber diet (e.g. with whole grains, lentils, beans, fruit and vegetables) in parallel with drinking to stimulate or normalize bowel activity .
If this does not help, hard bowel movements can also be treated with medication. Here, the active ingredient "lactulose" is usually used as a laxative, which makes the stool softer again and thus ensures simplified bowel emptying. However, side effects such as flatulence often occur, and this form of therapy is also unsuitable, for example, for people with an innate intolerance to galactose. Self-medication with laxatives is therefore strongly discouraged, instead treatment with lactulose should only take place under medical supervision.
If, due to a lack of fluids, concentration difficulties, severe fatigue or dizziness also appear, drinking a banana can work wonders in parallel with drinking, because this quickly brings new energy to the body through an optimal combination of vitamins, minerals, carbohydrates and protein. Nuts are also wonderful as nerve food because they contain a high amount of trace elements (such as iron, zinc and sulfur), minerals and B vitamins as well as amino acids, unsaturated fatty acids, vitamin E and vegetable protein, which provides the brain with energy and concentration and performance are particularly strongly promoted.
In principle, you should not wait until the body indicates with the signal "thirst" that fluid is missing, as there is already a certain deficit at this point. Instead, it is advisable to drink again and again throughout the day so that the body remains well supplied, healthy and productive throughout. If you often forget to drink, you can support yourself by, for example, using an alarm clock to remind you to drink a glass of water every hour, which can help to prevent headaches, dizziness and irregular digestion. For older people in particular, it is very important to think about drinking regularly, as the feeling of thirst decreases with age and a lack of fluids can quickly occur.
Treatment for porphyria
If the dark urine is due to porphyria, the therapy depends on the type of disease. Since this is genetically determined in most cases, complete healing cannot take place here - instead, the focus is on the therapy of the respective symptoms. In the case of acute porphyria, it is advisable to consistently avoid alcohol and smoking as well as hunger due to irregular eating in order to minimize the risk of a relapse. If medication needs to be taken or medication is due to be changed, an expert in porphyria should also be consulted to avoid taking potentially relapsing medication (such as barbiturates, diazepam, phenytoin or theophylline). It is also possible to treat an acute episode with high carbohydrates or hemin by infusion.
Since there is no causal therapy for cutaneous porphyria, attempts are usually made to reduce the porphyrins in the body in order to alleviate the symptoms of the disease. Since there is a massive sensitivity to (sun) light in this form of the disease, this should be avoided as far as possible, as well as substances harmful to the liver (alcohol, medication, etc.).
In the case of jaundice, treatment is initially based on the underlying disease. For example, if the bile cannot flow out due to barriers, the bile ducts are cleared of gallstones or tumors as part of an endoscopic operation. Small tubes made of plastic or metal (stents) are then inserted into the bile duct to keep it wide and to ensure that the bile is stowed away. If there is hepatitis, various therapeutic measures are again possible: for acute virus-related hepatitis, the main focus is on bed rest and alcohol prohibition, whereas in chronic hepatitis B, antiviral substances such as lamivudine and tenofovir are often used. Chronic hepatitis C is generally treated with a combination of pegylated interferon-alpha (PEG-IFN) and ribavirin.
In addition to these measures, sufferers should avoid alcohol at the first sign of liver inflammation and find out which drugs could have harmful effects on the liver. In addition, more attention should be paid to a balanced diet and, in the case of acute inflammation, sufficient rest.If you are infected with a virus type B or C, it is also important to inform family members and sexual partners in order to avoid infection.
Therapy for Meulengracht's disease
There is no therapy for this metabolic disorder, since the defective enzyme UDP-glucuronyltransferase is neither repairable nor can it be compensated. However, this is normally not a problem, because in most cases the “illness” causes no or only very slight complaints and in no way limits the life expectancy of the person concerned. Accordingly, the only possibility is to adapt your own lifestyle to such an extent that Meulengracht's disease does not cause any major problems. This includes in particular the avoidance of alcohol, smoking, stress, long hunger or fasting and irregular sleeping, but also the best possible protection against infections, as this can also lead to an increase in bilirubin.
Naturopathy with dark urine
In order to prevent darkening naturally, you should first make sure that you drink enough at all times, because in the event of a lack of liquid, the urine is not diluted, but highly concentrated and therefore darker than normal. This can also be promoted by heavy sweating (for example during sports), which is why it is particularly important here to "replenish" the body's fluid balance quickly.
However, there may also be a serious liver disease - therefore, medical clarification or care in the case of conspicuously dark urine is necessary in any case. At the same time, however, the field of naturopathy also offers various options to strengthen the health of the largest organ in the human body and thereby prevent complaints and symptoms such as the darkening of urine.
For example, the dandelion is considered a true "miracle plant" for liver health, since it has a choleretic effect by stimulating the production of bile in the liver, causing the excretion of a thin bile and thus improving the fat metabolism. For this reason, the herb is very popular as a medicinal plant for jaundice, gallstones or cirrhosis of the liver - although this can of course only be done in consultation with an experienced alternative practitioner or doctor to avoid further damage to health.
Dandelion is often used as tea or press juice from fresh plants, but besides that, the leaves can also be enjoyed in the form of vegetables, soup or smoothies. In view of the upcoming summer, a dandelion salad is also a delicious and extremely healthy alternative to other leafy salads, because in addition to its liver-strengthening ingredients, dandelion contains about nine times as much vitamin C as lettuce. For four people, about 400 g of dandelions are washed, spun dry and cut into strips on plates.
In the next step, a spring onion is cleaned and cut into fine rings and about 12 black olives are halved and then both are added to the dandelion. The salad is then refined with 200gr sheep's cheese in small cubes, a tablespoon of pine nuts and, if necessary, finely chopped garlic. For the dressing, 4 tablespoons of olive oil with 3 tablespoons of mild herbal vinegar, a tablespoon of mustard, salt and black pepper from the grinder are mixed well and poured over the salad just before serving.
From a naturopathic perspective, regular detoxification is also very useful for liver health in order to remove or metabolize accumulated toxins that are stressful for the body. Wer seine Leber entgiften möchte, kann dabei auf unterschiedliche Maßnahmen wie zum Beispiel Glaubersalz zurückgreifen. Dabei handelt es sich um Natriumsulfat (Natrium sulfuricum), welches an zwei aufeinander folgenden Tagen zusammen mit Grapefruitsaft und Olivenöl eingenommen wird und auf diesem Wege als natürliches Abführmittel wirkt. Diese Form der Kur sollte jedoch aufgrund teilweise starken Erbrechens und massivem Durchfall zum einen nur nach Absprache mit einem Arzt oder Heilpraktiker und zum anderen im besten Falle am Wochenende durchgeführt werden, damit sich der Körper am nächsten Tag ausreichend erholen kann.
Sanfter kann die Gesundheit der Leber mit Schüssler-Salzen unterstützt werden. In Frage kommen hier vor allem das Schüssler Salz Nr.6 (Kalium sulfuricum), welches die Leber und damit die Entgiftung anregt und den Fettstoffwechsel ankurbelt sowie das Salz Nr. 10, welches ebenfalls anregend wirkt und auf diese Weise die Ausscheidung von Giftstoffen aus dem Körper unterstützt. Auch hier sollte vor einer Einnahme jedoch immer mit dem Arzt oder Heilpraktiker Rücksprache gehalten werden, um die ideale Dosierung und Potenz abzustimmen.
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Social Science Nina Reese
- Thomas Gasser: Basiswissen Urologie, Springer Verlag, 6. Auflage, 2015
- Jesse M. Civan: Leberzirrhose, MSD Manual, (Abruf 04.10.2019), MSD
- Stephan vom Dahl et al.: Angeborene Stoffwechselkrankheiten bei Erwachsenen, Springer Verlag, 2014
- Steven K. Herrine: Gelbsucht, MSD Manual, (Abruf 04.10.2019), MSD
- Deutsche Leberhilfe e.V.: Morbus Meulengracht, (Abruf 04.10.2019), leberhilfe.org