You may not be in the habit of looking into the toilet bowl before you flush, but evaluating your urine color could help you gauge your liver health. This is especially true if you’re living with primary biliary cholangitis (PBC). Some myPBCteam members say they noticed orange or dark urine when they got their PBC diagnosis.

One member shared that they kept going to the emergency room, due to symptoms such as itchy feed and vomiting. “I gave a urine sample, it was orange. … I was finally diagnosed with PBC.”

Another member said, “I had itchy skin, my urine was the color of tea, and my liver enzymes were off. I had a liver biopsy and was diagnosed with PBC.”

If you’ve ever noticed that your urine was darker than expected or orange in color, you may have questions about its connection to liver disease. Read on to discover what may be behind this issue.

How Liver Function and Urine Color Are Linked

If you’re in the early stages of PBC, you may not experience any symptoms at all, including discolored urine. But as this autoimmune disease progresses, dark urine may occur. In fact, healthcare providers consider orange or dark-colored urine to be a common symptom of liver damage. This is due to a substance called bilirubin being present in your urine.

Bilirubin is a substance in the body that’s also known as bile pigment because of its yellow color. Your liver makes bile so you can digest food. Bile travels through small tubes in the body called bile ducts, which connect your liver to your intestines. If these bile ducts become blocked, it can cause bilirubin to build up and get into your urine.

In people with PBC, inflammation causes damage to the bile ducts. Those ducts then get blocked, and bile can’t flow freely. The bile then flows back to the blood, then through the kidneys and finally it comes out in your urine, causing it to look orange or brown in color. A healthcare provider can test for bilirubin in the urine by performing a urine test.

Dark urine isn’t usually the only sign of PBC. It’s often accompanied by other symptoms, such as fatigue, itching, dry eyes, and jaundice (yellowing of the skin and eyes).

If PBC gets worse, it can lead to fibrosis (scarring of the liver tissue). Over time, fibrosis can progress to cirrhosis, a more advanced and serious form of liver damage. Cirrhosis interferes with how the liver works and can eventually lead to liver failure if not managed.

Other Causes of Dark or Orange Urine

While orange or dark urine can be a symptom of PBC, it may also result from other causes. These include:

• Dehydration — Your urine may look orange if you aren’t drinking enough fluids.
• Vitamin supplements — Vitamins such as B12 or vitamin A may cause orange urine.
• Certain foods — Rhubarb, aloe, and fava beans are among the foods that can lead to dark-colored urine.
• Medications — Certain chemotherapy drugs or medications used for constipation may cause orange urine, while some antibiotics and cholesterol drugs may lead to dark urine.
• Muscle injuries — Exercising too hard may lead to muscle injuries that cause brown urine.
• Other liver or bile duct abnormalities — Any condition that affects your bile ducts or liver could cause orange urine.

Because there are multiple risk factors for discolored urine, it’s essential to talk to a hepatologist (liver expert), gastroenterology specialist, or other healthcare provider if your urine is a different color than usual. They can help pinpoint the cause and help you develop a treatment plan for the issue that’s affecting you.

Talk With Others Who Understand

On myPBCteam, the social network for people with primary biliary cholangitis and their loved ones, members come together to ask questions, give advice, and share their tips with others who understand life with primary biliary cholangitis.

Have you experienced discolored urine since you got your diagnosis of PBC? Has it improved since you began managing your condition? Share your experiences in the comments below, or start a conversation by posting on your Activities page.