7 most common cause(s)
What is dark brown urine?
Healthy urine is relatively clear and light yellow in color. When it turns a darker yellow, gold, or brown, it’s usually because you’re dehydrated or it’s just more concentrated.
If it turns a brownish hue, it may be from certain foods you’ve eaten like beets, fava beans, blackberries, or rhubarb.
Sometimes the cause of dark brown urine is more serious. Darker urine can be a sign that your kidneys or liver isn’t working properly from issues such as inflammation, cirrhosis, or kidney stones. Problems that affect other parts of the urinary tract—such as the ureters (tubes), bladder, urethra, and prostate—can also cause dark brown urine.
What brown urine indicates
Brown urine usually occurs when blood is in the urine, though in some cases the urine may appear more red than brown. Certain diseases, viruses, and medications can change the color of your urine.
Other symptoms you may have with dark-colored urine include:
- Fatigue
- Abdominal pain
- Vomiting
- Fever
- Burning with urination
- Foul-smelling urine
- Cramping
- Dizziness or lightheadedness
- Yellowing of the skin and eyes
Causes
1. Dehydration
Dehydration occurs when you don’t drink enough or if your body loses too much fluid from vomiting, diarrhea, heavy sweating, or too much exercise. When you’re dehydrated, your urine typically turns dark yellow, gold, or even brown. It happens because there isn’t enough fluid in your urine to dilute the toxins that are released when you urinate.
Common in elderly people: Dehydration affects 20–30% of older adults. [Source: Journal of Gerontological Nursing].
Other symptoms:
- Lightheadedness
- Dizziness
- Fatigue
- Muscle cramps
- Racing heart (palpitations)
Treatment and urgency: If you have dark urine, the first thing you should do is drink fluids, preferably water. If you can’t keep fluids down because you’re vomiting, your doctor can prescribe a medication to prevent nausea. Severe dehydration should be treated immediately at a hospital. You may need to receive IV fluids to recover.
Pro Tip
Drinking fluids such as soda or coffee can worsen dehydration due to caffeine content, which can cause the body to eliminate more water from the body. —Dr. Chandra Manuelpillai
2. Rhabdomyolysis
Rhabdomyolysis is a breakdown of muscle tissue. It often occurs with excessive exercise but it can also be caused by trauma, illicit drug use, prolonged inactivity, and certain medications. When muscle breaks down, it releases a protein (myoglobin) into the blood. Myoglobin is filtered by the kidneys, causing a tea- or “Coca-Cola”-colored urine.
Rare: Approximately 25,000 cases of rhabdomyolysis are reported each year. [Source: National Institutes of Health].
Other symptoms:
- Sore muscles or cramping
- Fatigue
- Nausea/vomiting
- Decreased urination
- Agitation and confusion
Treatment and urgency: Rhabdomyolysis is a serious condition that should be treated immediately because it can damage the kidneys and cause kidney failure. Treatment includes rehydration with oral fluids (if you have less severe rhabdomyolysis). If you have moderate to severe rhabdomyolysis, you should go to an emergency department to get IV fluids. In extreme cases, you may need dialysis until your kidneys recover.
3. Kidney stones
Kidney stones are pebble-like deposits that form in the kidneys if you have high levels of certain minerals, like calcium, in your urine. A stone can irritate and cause bleeding in your urinary tract, causing blood in your urine.
Common: About 11% of men and 6% of women in the U.S. have a kidney stone at least once during their lifetime [Source: National Institutes of Health].
Other symptoms:
- Intense pain on the sides of your torso, in your back below your rib cage, or in your groin
- Nausea/vomiting
- An urgent need to urinate
- Difficulty urinating
- Fever and chills (if you have an infection)
Treatment and urgency: Talk to your doctor right away if you have symptoms of kidney stones. Treatment is based on the size and location of the stone, how much pain you have, and if you have an infection. You should be able to pass the stone yourself at home if the stone is relatively small. It is helpful to drink a lot of fluids and you can take over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for the pain.
Your doctor may give you medications such as tamsulosin (Flomax) to help your body push out the stone, or medications for nausea such as ondansetron (Zofran), and stronger pain medications when needed. If you cannot pass the stone at home, you may need a procedure to either break up the stone (lithotripsy) or remove it.
Dr. Rx
Your goal may not be to have clear urine. Everyone’s urine color is unique to them. —Dr. Manuelpillai
Dark brown urine quiz
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4. Hepatitis
Hepatitis is an inflammation of the liver. Hepatitis occurs when the liver is unable to filter blood properly, causing a yellow-orange substance called bilirubin to build up in your blood and urine. Excess bilirubin can turn your urine brown.
The most common types of hepatitis in the U.S. are hepatitis A, B, and C. Other causes of hepatitis include autoimmune diseases, certain medications, and excessive use of alcohol.
Common: About 2.4 million people are living with hepatitis C in the U.S., 850,000 are living with hepatitis B, and less than 20,000 get a hepatitis A infection each year [Source: Health and Human Services].
Other symptoms:
- Fatigue
- Nausea/vomiting
- Diarrhea
- Unexplained weight loss
- Abdominal pain or swelling
- Yellowing of the skin and eyes
Treatment and urgency: See a doctor right away if you have signs of hepatitis, as early treatment can prevent more liver damage. Treatment varies based on the type of hepatitis you have and how long you’ve had it. If you have chronic hepatitis B or C, you may be treated by a liver specialist. They can prescribe antiviral medication.
5. Liver disease (cirrhosis)
Cirrhosis occurs when the liver becomes permanently scarred and damaged. The most common causes are chronic hepatitis B and C, alcoholic liver disease, and non-alcoholic fatty liver disease. Cirrhosis can also be caused by autoimmune disease, acetaminophen (Tylenol) overdose, and diseases that affect the bile ducts. The scarring is permanent and can lead to serious complications.
Common: An estimated 1 in 400 American adults have cirrhosis [Source: National Institutes of Health].
Other symptoms:
- Itchy skin
- Yellow (jaundice) skin
- Yellow eyes (scleral icterus)
- Easy bruising and bleeding
- Confusion
Treatment and urgency: Get treated right away to avoid more damage and liver failure. There is no cure for cirrhosis but some of the causes can be treated with medication and lifestyle changes, like stopping drinking alcohol. This may help prevent cirrhosis from worsening. Your liver specialist will try to treat some of the symptoms. A liver transplant may be recommended if you have liver failure.
6. Cholestasis
Cholestasis is a reduction or stoppage of the flow of bile, the digestive fluid produced by your liver. This leads to a build-up of bilirubin in your blood, which darkens your urine.
There are two types of cholestasis. Intrahepatic cholestasis occurs inside of the liver and is caused by the breakdown of hemoglobin. This can be caused by sickle cell disease, trauma, pregnancy, and hemolytic anemia. Extrahepatic cholestasis occurs outside of the liver and can be triggered by issues such as gallstones, bile duct or pancreatic tumors, and stones in the bile duct.
Uncommon: 1–2 of 1000 pregnant women get cholestasis.
Other symptoms:
- Itchy skin
- Nausea/vomiting
- Pain in the upper right part of the abdomen
- Yellowing of the skin and eyes
- Light-colored stool
Treatment and urgency: See your doctor or ob/gyn right away if you have symptoms of cholestasis because early treatment can improve the odds you’ll make a full recovery. Treatment depends on the cause. Surgery may be needed for bile duct blockages. If you have itching related to cholestasis, your doctor may prescribe medication to help relieve it.
7. Infections
Certain infections, like a bladder infection or a prostate infection (prostatitis), can cause blood in your urine, making it darker than usual. Bladder infections are often caused by bacteria and can be transmitted through sex as well as certain habits, such as not drinking enough fluid and holding in your urine for too long.
Some health problems, including diabetes and an enlarged prostate, can also make you more prone to bladder infections. Prostatitis occurs when bacteria infect the prostate.
Other symptoms:
- Burning with urination
- Frequent and urgent need to urinate
- Pain in the lower abdomen or lower back
- Fever, chills, vomiting, and pain in the flanks of mid-back (if the infection worsens)
Treatment and urgency: If you have symptoms of an infection such as fever, abdominal or back pain, or vomiting, go to urgent care or the ER. If you just have symptoms of a urinary tract infection such as burning and frequent urination, see your doctor or go to urgent care.
Treatment may include antibiotics, medications for pain and fever, and medications that relieve the burning sensation that occurs with urination.
8. Nephritic syndrome and glomerulonephritis
Nephritic syndrome is inflammation of the kidneys and glomerulonephritis is inflammation of the glomerulus, which is the portion of the kidneys that filters waste from your blood.
Inflammation may be from an autoimmune disease (such as Goodpasture’s syndrome and lupus) or certain infections, like strep and meningococcal infections.
Uncommon
Other symptoms:
- Decreased urination
- High blood pressure
- Swelling
Treatment and urgency: Go to the ER immediately if you have these symptoms. Treatment depends on the underlying cause but includes medications to treat autoimmune diseases or the infection. If the damage to the kidneys gets worse, you may need to get dialysis or receive a kidney transplant.
9. Anemia
When you have anemia, your blood doesn’t contain enough hemoglobin, a protein that helps red blood cells carry oxygen. Certain types of anemia can cause dark urine, such as hemolytic anemia, in which red blood cells are broken down faster than they can be replaced.
It can be inherited or it may be triggered by certain infections, medication such as penicillin, or autoimmune disorders. The tick-borne disease babesiosis can also lead to hemolytic anemia.
Sickle cell anemia can also turn urine dark brown, bright red, or pink. This is an inherited type of anemia that you are born with and occurs mostly in Black people.
Uncommon: Hemolytic anemia affects 1-3 in 100,000 people. Sickle cell disease affects 1 in 500 Black people [Source: National Institutes of Health].
Other symptoms:
- Weakness
- Shortness of breath
- Dizziness
- Fast or irregular heartbeat
- Pounding or “whooshing” in your ears
- Headache
- Cold hands or feet
- Pale or yellow skin
- Chest pain
Treatment and urgency: Call your doctor if you have these symptoms. Treatment for hemolytic anemia may include lifestyle changes, medication, blood transfusions, blood and blood marrow transplants, and surgery to remove the spleen. Blood transfusions are also used to treat sickle cell anemia.
Other causes of dark brown urine
- Cancer. Certain types of cancer, such as kidney cancer and liver cancer
- Certain medications, such as pyridium and rifampin or chemotherapy
- Injury to internal organs
- Porphyria, a rare inherited blood disease
- Malaria
Pro Tip
The cause of dark urine can be from something as benign as dehydration or something more serious such as cancer or organ failure. That is where your physician can help, whether it is educating you on things you can do at home or referring you for additional testing or treatment. —Dr. Manuelpillai
Is dark urine normal during pregnancy?
Dark urine in pregnancy is not necessarily normal. You may be more likely to be dehydrated when pregnant because of decreased appetite, morning sickness, and hormone changes that cause increased urination. Dehydration during pregnancy can lead to complications for both the mom-to-be and the baby, so it’s very important to stay well hydrated.
If your urine is persistently darker in color, see your ob-gyn to rule out infections, such as urinary tract infections (UTIs). Untreated UTIs can also pose a threat to the baby. Also, cholestasis can occur in later stages of pregnancy.
Dark urine in the morning
Urine tends to be darker in the morning because it is more concentrated. As the day begins and you start drinking fluids, you should notice that your urine gradually gets lighter.
If you notice that your urine is dark throughout the day even though you’re drinking enough fluids, see your doctor to make sure this isn’t a sign of a health problem.
Treatment
If your urine is darker than usual, try to drink more water and other electrolyte-rich fluids throughout the day. If you’re exercising, be sure to drink regularly throughout your workouts.
If this doesn’t help or you have other symptoms, like fatigue, abdominal pain or swelling, vomiting, back or side pain, pain with urination, fever, or unexplained weight loss, see your doctor. They will likely order a urine test as well as blood tests. Treatment will depend on the cause.
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