Bilirubin is a yellowish substance created by the breakdown of red blood cells. Detecting it in your urine can be a sign of a health problem, such as liver or gallbladder disease.
The detection of bilirubin in your urine is medically called bilirubinuria. It may be detected during a dipstick urine test, where medical professionals look to see if a special plastic strip changes color when lowered into your urine sample.
The build-up of bilirubin in your skin also causes jaundice, which is a yellowing of your eye whites and skin. Bilirubin in your urine may be detected before visible jaundice occurs, leading to a quicker diagnosis and treatment for people with liver problems.
Read on to learn more about what may cause bilirubin in your urine and what other symptoms you may develop.
Finding bilirubin in your urine is usually caused by problems with your liver or gallbladder. Some potential
- Liver diseases: Any conditions that cause compromised liver function may lead to bilirubin in your urine. These include:
- viral hepatitis
- liver cancer
- hemochromatosis
- Wilson disease
- autoimmune hepatitis
- metabolic dysfunction-associated steatotic liver disease (MASLD), previously called non-alcoholic fatty liver disease
- alcohol-related liver disease
- Hereditary disease: Some genetic diseases you inherit from your parents, such as Dubin-Johnson syndrome and Rotor syndrome, can lead to bilirubin in your urine.
- Pregnancy: Bilirubin isn’t a normal finding in the urine of pregnant people, but may be present in
those who develop liver problems like cholestasis of pregnancy. - Gallbladder or duct problems: Problems with your gallbladder or ducts can lead to elevated bilirubin. These include:
- Other health conditions: Other conditions that may lead to bilirubin in your urine include:
Bilirubin in your urine doesn’t directly cause symptoms. Symptoms develop due to whatever underlying condition leads to this bilirubin build-up.
Symptoms can vary depending on the cause, but general signs and symptoms of compromised liver function can include:
- dark or tea-colored urine
- jaundice
- fatigue
- weakness
- abdominal pain or discomfort, especially in your upper right side
- nausea and vomiting
- loss of appetite
- itchy skin
It’s important to note that these symptoms are mostly general and have many causes other than liver disease.
Bilirubin in urine color
The presence of bilirubin in your urine may turn your urine brownish-orange. However, there are other reasons why your urine may change color. For example, dehydration may also turn your urine dark or orangish.
As with the symptoms of bilirubinuria, the presence of bilirubin in your urine isn’t harmful to your health, but it’s a sign you may have a condition that can be serious. For example, it can be a sign of liver failure.
Liver failure is often progressive and can eventually cause complications, such as:
- portal hypertension, where the blood pressure rises in the blood vessel that supplies your liver
- ascites, which is the accumulation of fluid around your belly
- hepatic encephalopathy, cognitive changes due to poor liver function
- esophageal varices, which are dilated blood vessels that can rupture
- problems with blood clotting or bleeding
- problems with breathing
- increased risk of serious infections
- liver cancer
- impaired ability to break down and store carbohydrates
It’s critical to seek prompt medical attention if you notice dark urine not due to dehydration, especially when accompanied by symptoms such as jaundice, abdominal pain, persistent nausea, or unexplained fatigue.
It’s also critical that you or somebody you’re with seek immediate care if you develop:
- confusion
- swelling in your legs or abdomen
- signs of severe infection, like fever and chills
To diagnose bilirubinuria, your healthcare professional will likely start by:
- reviewing your personal medical history
- reviewing your family medical history
- asking you about your symptoms
- performing a physical exam
The main test used to diagnose bilirubinuria is a urine dipstick test, where a chemically treated plastic strip is lowered into your urine sample to see if it changes color.
Other tests you may receive include:
- liver function tests to measure
- total and direct conjugated bilirubin
- enzymes like ALT and AST
- albumin
- other blood tests like a complete blood count or viral hepatitis test
- imaging tests to look at your organs
- liver biopsy if liver cancer is suspected
- endoscopic procedures to look at your liver, ducts, and gallbladder
Bilirubin in urine normal range
Bilirubine
Treating high bilirubin in your urine involves treating the underlying cause. A few examples include:
- removing gallstones
- cancer treatment
- stopping certain medications
- surgery
- medications
Dehydration doesn’t directly cause bilirubin in your urine. It may cause changes to your urine color that are similar to that of a bilirubin build-up. It may also make bilirubin more concentrated in your urine if it’s already present.
In adults, a UTI is not directly caused by high bilirubin, but some people with UTIs have dark urine due to the build-up of blood and other substances.
It’s not normal to see bilirubinuria in your urine if you’re pregnant. Finding bilirubin may be a sign of a pregnancy-related liver problem.
Next Steps
Here are some next steps you can take if you have bilirubin in your urine
- Speak with your healthcare professional about why it may be happening.
- Seek medical attention if you’re not already at a hospital or clinic.
- Follow your healthcare professional’s advice in terms of tests you may need.
- Follow their treatment recommendations.
Bilirubin isn’t normally found in your urine. More than trace amounts might be a sign of a liver or other medical problem.
It’s important to seek medical attention if a urine test shows bilirubin in your urine. Many potential causes have a better outlook when treated early.