Purple Urine Bag Syndrome Causes and Treatment

Purple urine syndrome

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The purple urine bag syndrome (PUBS) is a medical condition where urine gets a purple discoloration. Yes, it appears purple in color. The disease is common among people with urinary catheters.

Do you know what a urinary catheter is? This is silicone, latex or polyurethane tube that is inserted into the urinary bladder through the urethra. However, it can also be inserted directly by piercing a hole in the lower abdomen and when this is done, it is known as a suprapubic catheter.

Purple urine syndrome

Purple urine syndrome

Through catheterization, urine flows freely from the bladder to a collection bag. The collection bag is known as the urine bag. In that bag, one can easily tell the amount of urine collected as well as its color.

If the urine inside the bag is purple in color, then one is said to be suffering from PUBS.

Is catheterization the only cause of this syndrome? The answer is no. Purple discoloration can also be because of urinary tract infection. Your doctor should perform some tests to ascertain the cause of the purple discoloration.

Symptoms PUBS?

How can you tell if you are having PUBS? What are the things to look for?

According to, this syndrome does not come along with any pain. Actually, there is no feeling that can let you know that you are having this condition. The symptoms to check on depending on whether the condition is caused by the catheter or existence of an infection.

For many people, the purple discoloration of urine is because of body’s reaction to the catheter. Therefore, the main symptom noted is purple color in urine. The color is easily identified while it is in the bag.

Presence of a catheter in the body may also trigger some infections. According to, the catheter is a foreign material inserted into the body. Its presence causes numerous urinary tract infections.

In case of an infection, the following symptoms are noted alongside the purple discoloration of urine:

  • Excessive itching
  • Pus in urine
  • Burning sensation in the urethra
  • Blood stains in urine
  • Chills and fever

Causes of purple urine bag syndrome

According to, PUBS is uncommon among young people. However, it is common among the elderly, especially those who have chronic urethral catheterization.

Like earlier noted in this article, PUBS is mainly attributed to two main factors:

  • Chronic urethral catheterization
  • Bacterial infection

Urethral catheterization

Research has shown that this condition is common among people who have undergone catheterization. In fact, the purple color is noted hours or a few days after catheterization.

Being a foreign material, the body reacts to its presence. As a result, some bacteria in the body trigger the body to fight it. One such bacteria include indoxyl sulfate degrading bacteria. As a result of this bacterium, alkaline urine turns purple.

This purple discoloration, however, is only noted among the elderly, particularly those above 60 years. Young people, in this case, can go for months of catheterization without their urine turning purple.

Bacterial infection

This syndrome may also be an indication of a bacterial infection, especially when it occurs among people below 50 years.

The common bacterial infections that may result in purple urine include:

  • Pseudomonas sp
  • Morganella sp
  • Proteus sp
  • Providencia sp
  • Klebsiella sp
  • Enterobacter sp

All these bacteria result in urinary tract infections. Because of these infections, the urine turns purple, thus the syndrome.

Who is most susceptible to PUBS?

PUBS is common among patients who are in the geriatric wards. These are mainly the elderly, particularly those in their 80s.

In terms of gender, PUBS is more prevalent among the females than males. The reason behind this gender specificity is not known. Research is, however, underway to ascertain why this syndrome is gender selective.

Research is also underway to establish why those with chronic urethral catheterization are at a high risk of having this condition. Commonly, insertion of a catheter increases urinary pH. This may explain why some bacteria mentioned above thrive in this environment.

Treatment and prevention

According to, there is no specific medication for this condition. In case of catheterization, it is only administered to those who have chronic urinary disorders. Some of them are in their advanced years and controlling urine flow is an issue.

In this case, doing away with the catheter is not an option. However, doctors can prescribe drugs that lower the urine pH. Commonly, bacteria that cause PUBS thrive well in the alkaline environment, a condition common among people with catheters. Therefore, lowering the pH can be effective in managing if not controlling the condition.

Identifying the microbial organisms causing the purple discoloration can also be a milestone towards treating this condition. The bacteria noted above are the ones behind this UTI. Therefore, administering antibiotics targeting these specific organisms can help in treating the condition.

Constipation was noted to be a risk factor as far as PUBS is concerned. Therefore, physicians should seek to control it. Drugs that make the stool lose can play an essential role in managing constipation.

General care can also help in preventing and controlling purple urine syndrome. For example, indwelling catheters should be changed regularly. Research has shown that staying with one catheter for a long time can be a risk factor for this condition. Some people heal once the old catheter is replaced with a new one.

In terms of prevention, it is unknown of any practice that can help in preventing the condition. Actually, catheterization is always the last result for many physicians. In some cases, catheterization is the only options towards helping people with chronic urinary issues. Therefore, research has not given any prevention measure.


  1. Purple Urine Bag Syndrome in an Elderly Nursing Home Resident
  2. Purple Discoloration in a Urinary Catheter Bag
  3. Urinary Catheterization
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