A woman’s urine turns purple after the rare side effect of extreme constipation and UTIs

Doctors in Kentucky have described a rare case in which an elderly woman’s urine turned deep purple due to a complication of a bladder infection.

The 76-year-old unnamed patient, who was suffering from heart failure, kidney failure and bladder cancer, was taken to hospital and connected to a catheter to drain her urine.

An infection in her urinary tract set off a biochemical reaction that produced blue and red pigments in her urine, which turned dark purple as they oxidized in the catheter bag.

Doctors issued the rare diagnosis of purple urinary sac syndrome (PUBS), which occurs in up to 42 percent of patients who have been on catheters for a long time.

A chemical reaction in the liver produces an indigo pigment and indirubin, a red pigment. These pigments combine and oxidize to turn purple in the urine bag.

Purple Urine Bag Syndrome (PUBS) is usually a complication of urinary tract infections (UTIs), as is the case with this 76-year-old woman, in whom the catheter bags and tubes turn purple. While almost always benign, the intense purple hue can be alarming to patients, families, and clinicians

Doctors at the University of Pikeville in Kentucky revealed the case in the Oxford Medical Case Reports journal.

In the report they write: “Elderly and bedridden patients with multiple comorbidities are more likely to require long-term indwelling catheters, which increases their risk of UTIs.

“Such patients are more likely to be infected by the rarer bacteria that can later cause PUBS.”

The patient had a long history of serious medical problems including congestive heart failure, chronic kidney disease and bladder cancer.

She went to the hospital for shortness of breath related to her cardiovascular problems.

To empty her bladder, doctors connected the woman to a catheter and then treated her with IV medications to reduce swelling associated with congestive heart failure.

After four days in the hospital, the patient’s urine bag turned an intense purple hue.

Test strip tests revealed that her urine was extremely alkaline at a pH of 8.5, a symptom that her kidneys weren’t working properly.

She also had high levels of the bacterium Proteus mirabilis, a common cause of complicated urinary tract infections.

PUBS was first clinically described in 1978.

The condition is almost always benign, but it can be alarming for patients and their loved ones.

In addition to age and frailty, female sexual intercourse and renal insufficiency, alkaline urine and constipation are also primary risk factors.

The phenomenon is the result of a multi-stage biological process in the intestine.

Bacteria help break down the amino acid tryptophan, which becomes a compound called indole in the gut, where it’s then transported to the liver and converted into indoxyl sulfate.

Indoxyl sulfate is metabolized to indoxyl in the urine with the help of bacteria that produce phosphatase and sulfatase.

Indoxyl turns into indigo, the blue color, and indirubin, the red color, in alkaline urine, and these colors then mix to form a violet color.

Purple urine usually signals doctors that the patient has a UTI, although not always.

Chronic constipation is often associated with bacterial overgrowth in the colon, which increases the conversion of tryptophan to indole.

Most people who experience PUBS will be fine, but immunocompromised patients are prone to serious illness, doctors said. Fournier’s gangrene, for example, can develop as a result of a urinary tract disease. It is a rare, life-threatening bacterial infection in the scrotum (including the testicles), penis, or perineum that causes body tissue to die and slough off.

Doctors said: “Medical management of PUBS requires catheter replacement and administration of appropriate antimicrobial therapy to treat the underlying bacterial infection.

“Her constipation cleared and a 5-day course of antibiotics was completed. The patient was discharged to a nursing facility with recommendations for outpatient follow-up with her nephrologist and urologist.’

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