Why is urine red or pink?

A red or pink urine color is often associated with blood in the urine (hematuria) but most cases can be attributed to other factors like dyes in foods and beverages that stain the urine. Hematuria in most cases does not stain the urine to the extent that it will be visibly red or pink. In severe cases where there is significant bleeding in the lower urinary tract then the urine may have a red to pink hue. This is known as gross hematuria. Similarly pain is not a reliable indication of whether red urine or pink urine is due to hematuria, as there are many causes of painless hematuria which can be due to serious diseases like bladder cancer.

Causes of Red Urine and Pink Urine

There are a host of causes of red to pink colored urine. Blood in the urine is not the only cause. Therefore the possible cause of the discoloration should be viewed in conjunction with other symptoms. Further testing of the urine, through urine dipstick tests and urinalysis should also be undertaken to confirm the diagnosis.

Lifestyle

Strenuous exercise and physical activity can cause blood in the urine which can lead to red to pink urine.  This is known as marcher’s hematuria. Dehydration can also cause discoloration of the urine, usually leading to a dark yellow to brown color.

Foods and Beverages

  • Rhubarb
  • Beets
  • Blackberries
  • Red or pink colorants in foods and beverages

Medication and Toxins

  • Laxatives especially those containing senna
  • Antibiotics like rifampicin and metronidazole
  • Antipsychotics like chlorpromazine and thioridazine
  • Anesthetics like propofol
  • Anticoagulants like warfarin
  • Metals like lead and mercury

Some of these drugs and toxins may cause hematuria (blood in the urine) which turns the urine red or pink. In other cases, it is the break down products of these drugs that may stain the urine.

Blood in the Urine

Red or pink urine may be due to the presence of whole red blood cells, free hemoglobin, porphyrin or myoglobin in the urine. Blood in the urine (hematuria) may not always be due to any disease (pathological) as is the case with strenuous exercise.

The presence blood in the urine may also not be caused by bleeding from the urinary tract. In women, menstrual blood may pass into the toilet bowl and stain the urine pink or red. Sexually transmitted diseases that cause skin lesions like ulcers and sores may also cause blood to drip into the urine.

Hematuria may also cause the blood to appear dark yellow to a yellowish-brown color. Blood clots and urinary clasts may be visible in the urine and sometimes described as ‘coffee grounds’. A diagnosis of hematuria needs to be confirmed with a urine dipstick or laboratory analysis of a urine sample (urinalysis). Diseases that cause hematuria include inflammatory conditions and tumors of the urinary tract, kidney diseases and systemic conditions.

Red to Pink Urine Symptoms

Red to pink discoloration of the urine is not a disease on its own. It is a symptom of an underlying disease. Even hematuria (blood in the urine) is a symptom. Other urinary related symptoms should also be noted such as :

  • Abdominal, perineal and flank pain
  • Pain and burning during urination
  • Foul odor of urine
  • Cloudy urine
  • Foamy urine
  • Frequent urination
  • Excessive urine, minimal or no urine

Other symptoms may also be present which are related to the underlying disease. This includes :

  • Fever
  • Leg and arm swelling
  • Discoloration of the skin
  • Difficulty breathing
  • Confusion
  • Lethargy
  • Loss of appetite

Causes in Men

The causes mentioned above affect both men and women. Specific conditions that men need to focus on includes :

  • Prostate cancer
  • Sexually transmitted infections
  • Balanitis (foreskin inflammation)

Causes in Women

As with men, women may experience red to pink discoloration of the urine for the same reasons as mentioned above. In addition, women need to be cautious of :

  • Menstrual blood staining the urine
  • Intermenstrual blood
  • Urinary tract infections which are more common in females.
  • Sexually transmitted infections.
  • Cancer of the cervix and other parts of the female reproductive system.
  • Sexual abuse in young females.

Red to Pink Urine Diagnosis

A clinical examination and medical history may indicate the possible cause but it is usually necessary to conduct various tests in order to confirm the diagnosis. Tests may include :

  • Urine dipstick which can be done within the doctor’s office.
  • Urinalysis which requires laboratory testing.

Other tests like a complete blood count (CBC) and urea and electrolyte blood test may also be conducted where necessary. It is important to remember that blood in the urine (hematuria) may not be visible to the naked eye (microscopic hematuria). Sometimes bleeding occurs for no specific reason and then quickly resolves thereafter. This is known as benign hematuria.

Red to Pink Urine Treatment

There is no specific treatment for red to pink discoloration of the urine. The treatment has to be directed at the underlying cause which has to first be diagnosed. Effective treatment will see the symptoms gradually ease, including the red to pink discoloration of the urine. Some measures that may be helpful in general includes :

  • Maintaining a healthy water intake of 1 to 2 liters per day.
  • Abstaining from sexual contact.
  • Thoroughly washing the genitals. Men should also look at retracting the foreskin during washing to prevent a condition known as balanitis.
  • Avoiding heavily dyed foods and those foods mentioned above which may alter the color of the urine.
  • Resting where various other symptoms like fever and lethargy are present.

 


Article reviewed by Dr. Greg. Last updated on May 26, 2012