What causes swollen lips and yellow urine

Dark urine: what the color of the urine says

Dark urine can appear in very different facets and be colored from yellowish-brown to dark-orange and reddish-brown to deep brown or black. Various causes can be considered for the different color tones and intensities. In some cases, the change in color can easily be explained by, for example, a lack of fluids, as a result of which the urine appears in a highly concentrated form and is therefore brown in color.

The use of certain medications, such as some antibiotics or remedies for the tropical disease malaria, can be considered as a "harmless" cause. On the other hand, dark urine can also be associated with a disease of the liver (e.g. hepatitis, liver cirrhosis), the metabolic disorder porphyria or Meulengracht's disease, and it can also be caused by jaundice, e.g. as a result of a gallstone. In this case, for example, the bile pigment bilirubin can no longer be excreted via the intestine due to the blockage of the bile duct, but is subsequently increasingly released in the urine, which typically takes on a dark, beer-brown color. Depending on the various possible causes, if the urine is darkly colored, a doctor should be consulted immediately for clarification - especially if the discoloration persists after the appropriate fluid intake.

Definition of urine

Urine - also called urine - is a liquid excretion product that arises from the blood plasma in the kidneys during a complicated filtration and absorption process (diuresis). The urine then passes through the ureters into the bladder, from where it is finally released via the urethra (“micturition” or “urination”). Urination serves on the one hand to regulate the fluid and electrolyte balance, but also to remove metabolic waste products (e.g. urea, uric acid) and remnants of drugs and toxins that are flushed out of the body with the urine.

The urine consists mainly of water (95 percent), electrolytes and urea, with different proportions of vitamins, organic acids such as citric acid, creatinine, uric acid, colorants and a very small proportion of proteins. Urine is normally clear and slightly yellowish or amber in color, the color being caused by metabolic products (urochromes) in the urine. Accordingly, the appearance of urochromes also determines the extent of the yellow coloration, which can vary from intense yellow (hypotonic urine) to colorless or transparent. The “scent” of fresh urine is normally neutral, but the subsequent bacterial decomposition of excreted substances quickly leads to the typical pungent, ammonia-like odor.

Urine is generally considered to be an important clue for various diseases, for example blood in the urine can indicate an inflammation of the kidneys or a kidney infarction and a large amount of "urinary sugar" can indicate diabetes mellitus. In addition to this, the color can also provide important information when determining diseases, because a dark or yellow color, for example, usually indicates a sick liver.

The smell can also provide further assistance - foul-smelling, smelly urine can be a clear sign of a metabolic disorder or certain bladder tumors, for example. However, the odor can also be influenced by diet, as is typical after consuming asparagus. This partially penetrating, cabbage-like smell is caused by an enzyme that converts the aspartic acid contained in asparagus into sulfur-containing substances - but this does not happen to everyone, because only about every second person produces this enzyme at all.

Causes of dark urine

In many cases, temporarily dark urine is not a cause for concern and often has "harmless" causes such as the use of certain medications or active ingredients (for example levodopa, methocarbamol, methyldopa or metronidazole) or the consumption of foods or beverages such as coffee which can discolour the urine from brownish to black. Nevertheless, a doctor should always be consulted for clarification as a precaution - especially if the urine is cloudy - because a dark color can also indicate more serious diseases such as cirrhosis of the liver or the metabolic disorder porphyria.

Dehydration

A common, relatively "harmless" cause of discolored urine is a lack of fluid, because the body consists of almost 70 percent water and therefore needs a lot of it to function properly. On the one hand, this is important in order to transport the absorbed nutrients into the individual cells for utilization; on the other hand, water is necessary to flush metabolic degradation products out of the body - which primarily happens via the kidneys.

In addition, the body needs fluid in order to regulate the body temperature, because this ensures a constant temperature in the body to a certain extent - even with strongly fluctuating ambient temperatures. If there is a deficiency, the body usually shows quite clearly via the feeling of thirst that "replenishment" is needed. This is usually the case with a loss of water in the body of around 0.5%, with a loss of around 10% there is also a feeling of dryness in the mouth and speech disorders.

In addition to the feeling of thirst, the body sends further alarm signals - often sudden headaches are caused by the fact that the blood thickened due to the lack of fluids and can no longer pass sufficient oxygen to the brain. Since the brain consists for the most part of water, an insufficient supply can quickly lead to concentration and attention disorders as well as inner restlessness, nervousness and fatigue, in many cases dizziness also occurs. The skin is also affected, because if the water content in the body is too low, the remaining resources are first made available to the organs, because they need the water particularly urgently, especially the liver, intestines, heart and brain. As a result, the skin suffers from "withdrawal symptoms" and becomes dry, flaky and itchy, and chapped and chapped lips are also a common sign of a lack of fluids.

In addition to this, the digestive system also suffers, because the stool volume decreases as a result of insufficient fluid and hard stool, which is often difficult and difficult to pass. In the course of this, those affected often have the feeling that the intestine is never completely emptied, and there are other symptoms such as flatulence, nausea or abdominal pain, which can develop into cramps.

Dark urine can be a further signal here, because if too little is drunk, the urine is not diluted, which means that it is excreted in a concentrated, dark-colored form rather than in the "normal" light yellow. In most cases, this is not a cause for concern and regulates itself relatively quickly if there is an appropriate replenishment - if the urine remains dark despite sufficient fluid intake, a doctor should be consulted in any case to clarify the cause.

Porphyria

Another cause of dark-colored urine can be "porphyria", which is a group of metabolic diseases that are characterized by an impaired structure of the red blood pigment heme, the iron-containing component of hemoglobin. The heme, which is a component of the hemoglobin responsible for the oxygen binding and the red color of the blood, is formed in eight steps, whereby a specific enzyme is required for each step. If there is porphyria, one of these enzymes is impaired in its function, so that the biosynthesis of the heme cannot be carried out to the end. As a result, more and more metabolic products (porphyrins) accumulate in the body - which one exactly depends on which enzyme is defective, sometimes several enzymes can be affected. In most cases, the cause of porphyria is an inherited genetic defect, which means that the disease often manifests itself in childhood.

There is also the possibility that this will be asymptomatic for a lifetime or initially remain undetected and only later in life due to triggers such as certain medications (e.g. sulfonamides, sedatives), birth control pills, smoking, stress, excessive alcohol consumption or increased hunger in the context of Diets or fasting cures cause typical signs of illness. In addition, in rare cases, the disease can also be acquired without a genetic connection (secondary porphyria) in the course of life, for example as a result of poisoning with lead or certain pesticides or a disruption of the bilirubin transport (e.g. rotor syndrome).

There are different forms of porphyria (e.g. hereditary coproporphyria or erythropoietic protoporphyria), which are divided into "acute" and "cutaneous" porphyrias according to the respective symptoms - however, there can also be overlapping symptoms. Typical for the acute form is the sudden onset of massive abdominal pain, which often lasts for days, and of nausea and vomiting, back pain, arm pain, leg pain, constipation, neurological failures such as paralysis or nerve pain, but also high blood pressure and psychiatric symptoms such as depressive moods, listlessness or a Psychosis can be accompanied.

For cutaneous or skin-related porphyrias, on the other hand, a strong, very painful sensitivity to light of the skin is characteristic, which quickly leads to severe itching, blisters on the skin and later scars on contact with sunlight. Depending on the type of porphyria, this can lead to serious damage to skin and tissue or even to the loss of body parts such as nose, lips or finger parts - in addition, strong skin pigmentation, increased body hair (hypertrichosis) or the storage of porphyrins in the teeth (erythrodontia, "Blood teeth"), and the liver can be damaged by deposits of porphyrin up to cirrhosis of the liver.

Since the defective metabolic products of the red blood pigment are excreted through the kidneys, both forms of the disease can cause the urine to be dark in color or, if left to stand for a long time, darken.

Jaundice / jaundice

If the urine is brown or even dark brown in color, jaundice can also be considered, which is colloquially referred to as "jaundice". This is a yellow discoloration of the skin, mucous membranes and the dermis of the eyes (sclera), which, however, is not an independent disease, but a symptom of various diseases. The yellow-brownish bile pigment "bilirubin", a breakdown product of the red blood pigment hemoglobin, is responsible for the yellow color, which is present in too high concentrations in the blood as a result of various diseases of the liver, the biliary tract and the blood.

Jaundice is usually suspected to be liver disease, but it can have a variety of causes and in some cases may not affect the liver at all. However, since the liver plays a central role in the bilirubin metabolism, a medical distinction is made between three types of jaundice - depending on where it exists. In the case of "pre-hepatic" (or "hemolytic") jaundice, there is a disorder "before" (composition of Latin pre = before and hepar = liver) of the liver, in which a premature or increased breakdown of red blood cells (hemolysis) Increases the accumulation of bilirubin in the blood, but the liver can no longer break down the pigment. As a result, this is deposited in the tissue and the typical yellow coloration of the skin and eyes occurs.

In most cases, pre-hepatic jaundice is caused by blood diseases (such as "ball cell anemia"), but various immune-related diseases can also be considered, such as malaria or poisoning. This form of jaundice can also lead to fever, fatigue or nausea, stool and urine usually remain “normally” dark or light, but in extreme cases the urine can also take on a red-brown color.

The second form of jaundice is known as “hepatic jaundice”, in which the bilirubin is no longer absorbed by the liver cells or is only absorbed to a limited extent. The causes are to be found directly in the liver, in many cases there is hepatitis (inflammation of the liver), which can be triggered, among other things, by viruses (e.g. hepatitis B), medication (e.g. paracetamol, certain antibiotics), various fungal toxins or toxic chemicals , pregnancy or the "Epstein-Barr virus" are also possible.

In most cases, however, heavy, excessive consumption of alcohol is responsible for liver inflammation, which in severe cases can develop into cirrhosis of the liver or even liver cancer. In this form, symptoms such as tiredness, nausea and vomiting, as well as abdominal pain, appear in addition to yellow skin and eyes. The stool is usually normal or a little lighter in color, while the urine is a little darker.

The third form, "posthepatic jaundice" (or "cholestatic jaundice"), is a disorder that only occurs after the bilirubin has passed the liver (post-hepatic = "after" the liver). The cause here is a blockage of the bile outflow (cholestasis), which means that the bilirubin in the bile cannot get into the intestine, but instead builds up in the blood and leads to the typical yellow color. In this variant of jaundice, the increased bile acid often leads to severe, constant itching; another sign is a pale stool that can become almost white. This arises because the bilirubin no longer arrives in the intestine and consequently the degradation products (steroid mobilinogen) that otherwise ensure the "normal" light to dark brown color of the stool are absent. While this becomes lighter and lighter, the urine turns dark brown ("beer brown"), because since the outflow of the yellow-brown bile pigment via the bile is disturbed, it first collects in the blood and is then excreted with the urine via the kidneys.

The cause of the blocked bile outflow is often a gallstone, but tumors (e.g. in gallbladder cancer or liver cancer) as well as sticking as a result of an operation or inflammation are conceivable. Gallstones do not necessarily have to cause symptoms, so they are often only discovered by chance, for example during an ultrasound or X-ray examination. In around a quarter of those affected, however, there are symptoms such as discomfort in the upper abdomen in the form of a feeling of pressure or fullness, frequent belching and flatulence - often especially after eating fatty foods. In more severe cases, the stones can also cause greater problems by causing severe, colicky pain in the right middle and upper abdomen, some of which can radiate into the back or the right shoulder area. If the bile duct is blocked, it can also lead to inflammation of the gallbladder or pancreas, which can be accompanied by severe pain, fever and chills.

Meulengracht's disease

In addition to this, the metabolic disorder Morbus Meulengracht (also Gilbert syndrome) can be the cause of dark urine, which affects around 5% of the population. Meulengracht's disease is one of the so-called familial hyperbilirubinemia syndromes, which are characterized by a disorder of the bilirubin metabolism. The cause is a congenital enzyme defect, through which the activity of the enzyme UDP-glucuronyltransferase only reaches about 30% of the "normal value". As a result, the yellow-brown bilirubin cannot be sufficiently converted and excreted, which in most cases leads to a slightly increased concentration of the bile pigment in the blood.

Since this metabolic disorder does not lead to liver damage, it is usually not regarded as a "disease" in the narrow sense of the word - but it can nevertheless lead to unpleasant symptoms and result in an intolerance to certain medications (for example, estrogen-containing hormones, buprenorphine, paracetamol or flavonoids) .

In many cases, Meulengracht's disease is largely asymptomatic, but the typical signs of jaundice such as yellow eyes, yellow skin and dark colored urine often occur as soon as the bilirubin level rises. This is usually relatively easy, but becomes more pronounced in connection with infections, alcohol consumption, stress or prolonged fasting and in these cases is often accompanied by malaise, tiredness, difficulty concentrating, nausea, diarrhea and an uncomfortable feeling in the liver area.

Other causes

Another possible cause is what is known as melanuria. This occurs in connection with a malignant melanoma or black skin cancer, which means a highly malignant tumor of the pigment cells (melanocytes), which tends to spread early metastases via the lymphatic and blood vessels and is accordingly the most frequently fatal skin disease. In this disease, the urine contains the body pigment melanogen, which oxidizes to melanin in the air and thus turns the urine deep brown or even black.

Dark brown or black urine can also occur in so-called alkaptonuria. This is a very rare, hereditary, pathological change in the tyrosine metabolism, which is caused by a defect or deficiency in the enzyme homogentisic acid dioxigenase. As a result, the degradation product homogentisic acid builds up, which leads to a brown discoloration in the connective tissue of the skin and in the articular cartilage (ochronosis), gout-like joint inflammation, dark spots in the dermis of the eye and an increased risk of kidney stones and Damage to the heart valves or aorta. Since the homogentisic acid, which occurs more frequently in alkaptonuria, forms a dark brown-black dye in alkaline liquids and in the air, the urine only turns dark when it is left standing for a long time or is alkaline - for example after a diet rich in carbohydrates.

Even if there is currently no treatment method by which the disease can be completely cured, there are still some therapeutic options such as reducing the formation of colorants through high doses of ascorbic acid (vitamin C) in conjunction with a diet that is as low in phenylalanine tyrosine as possible ( little meat, sausage, fish, cheese, eggs and sweets containing milk).

In just as rare cases, “blackwater fever” can also be considered. This is a complication of malaria, often triggered by the ingestion of the active ingredients quinine or antipyrine. In this disease, the acute breakdown of red blood cells (hemolysis) causes the blood pigment (hemoglobin) to be excreted in the urine (hemoglobinuria). Accordingly, the typical symptom is a deep dark to black-red colored urine, plus severe exhaustion, bilious, sometimes insatiable vomiting, headache, anxiety and jaundice as well as the degeneration of the kidneys, liver and heart. Since the mortality rate in blackwater fever is relatively high, rapid medical care is particularly important here, but if intensive medical treatment is not provided, death usually occurs within a short time due to the failure of the kidneys.

treatment

Once the cause of the dark urine has been clarified, treatment can begin. There are a number of different approaches or possibilities to remedy the cause of the problem.

Therapy for dehydration

If a lack of fluids is the cause of dark urine, the most important measure is to first drink water, unsweetened tea or juice spritzer to restore the balance.

If hard stool or constipation occurs as a result of the deficiency, attention should be paid to sufficient exercise and a diet that is very high in fiber (for example with whole grain products, lentils, beans, fruit and vegetables) parallel to drinking in order to stimulate or normalize bowel activity .

If this does not help, hard bowel movements can also be treated with medication. The active ingredient "lactulose" is usually used here as a laxative, which makes the stool softer again and thus facilitates emptying of the bowel. However, side effects such as flatulence often occur, and this form of therapy is not suitable, for example, for people with a congenital intolerance to galactose. Self-medication with laxatives is therefore strongly discouraged; instead, treatment with lactulose should only take place under medical supervision.

If you have difficulty concentrating, severe tiredness or dizziness as a result of a lack of fluids, consuming a banana can work wonders at the same time as drinking a banana, because it quickly provides the body with new energy thanks to its optimal composition of vitamins, minerals, carbohydrates and protein. Nuts are also wonderful food for the nerves, because they contain a large amount of trace elements (such as iron, zinc and sulfur), minerals and B vitamins as well as amino acids, unsaturated fatty acids, vitamin E and vegetable protein, which provide the brain with energy and the ability to concentrate or perform is particularly strongly promoted.

In principle, one should not wait until the body indicates with the signal "thirst" that there is a lack of fluid, since at this point there is already a certain deficit. Instead, it is advisable to drink again and again throughout the day so that the body remains consistently well supplied, healthy and productive. Anyone who often simply forgets to drink can support themselves, for example by being reminded by an alarm clock to drink a glass of water every hour, which can be useful in preventing headaches, dizziness and irregular digestion. For older people in particular, it is very important to think about drinking regularly, as the feeling of thirst decreases with age and this can quickly lead to a lack of fluids.

Treatment for porphyria

If the dark urine is due to porphyria, the therapy depends on the type of disease. Since this is genetically determined in most cases, a complete cure cannot take place here either - instead, the focus is on treating the respective symptoms. In the case of acute porphyria, it is advisable to consistently refrain from alcohol and smoking as well as starvation as a result of irregular eating in order to minimize the risk of a relapse. If medication has to be taken or a change of medication is pending, an expert for porphyria should also be consulted in order to avoid the intake of relapsing medication (such as barbiturates, diazepam, phenytoin or theophylline). There is also the option of treating an acute attack with high amounts of carbohydrates or hemin by infusion.

Since there is no causal therapy for cutaneous porphyria either, an attempt is usually made to reduce the porphyrins in the body in order to be able to alleviate the symptoms of the disease. Since this form of the disease is extremely sensitive to (sun) light, it should be avoided as much as possible, as should substances that damage the liver (alcohol, medication, etc.).

Treatment for jaundice

In the case of jaundice, treatment is initially based on the underlying disease. If, for example, the bile cannot drain due to barriers, the bile ducts are cleared of gallstones or tumors as part of an endoscopic operation. Small tubes made of plastic or metal (stents) are then inserted into the bile duct to hold it wide and to ensure the drainage of the blocked bile. If hepatitis is present, various therapeutic measures come into question: In acute virus-related hepatitis, bed rest and a ban on alcohol are in the foreground, whereas in chronic hepatitis B, antiviral substances such as lamivudine and tenofovir are often used. Chronic hepatitis C is generally treated with a combination of pegylated interferon-alpha (PEG-IFN) and ribavirin.

In addition to these measures, those affected should refrain from alcohol at the first signs of liver inflammation and find out which drugs could have harmful effects on the liver. In addition, greater attention should be paid to a balanced diet and, in the case of acute inflammation, sufficient rest; in the case of an infection with virus type B or C, it is also important to inform family members and sexual partners in order to avoid infection.

Therapy for Meulengracht's disease

There is no therapy for this metabolic disorder, as the defective enzyme UDP-glucuronyltransferase can neither be repaired nor compensated for. However, this is usually not a problem, because in most cases the "disease" causes no or only very slight symptoms and does not in any way limit the life expectancy of the person affected. Accordingly, the only option is to adapt your own lifestyle to such an extent that Meulengracht's disease does not cause any major problems. This includes in particular avoiding alcohol, smoking, stress, long starvation or fasting and irregular sleep, but also the best possible protection against infections, because even such protection can lead to an increase in bilirubin.

Naturopathy for dark urine

In order to prevent darkening in a natural way, care should be taken to drink enough at all times, because in the event of a lack of fluid, the urine is not diluted, but rather concentrated and therefore darker than normal. This can also be promoted by profuse sweating (for example during sport), which is why it is particularly important here to quickly “replenish” the body's fluid balance.

However, there can also be a serious disease of the liver - therefore a medical examination or care is necessary in any case if the urine is noticeably dark. At the same time, however, the field of naturopathy also offers various possibilities to strengthen the health of the largest organ in the human body and thereby prevent complaints and symptoms such as the dark color of the urine.

For example, the dandelion is considered a true “miracle plant” for liver health, as it has a choleretic effect by stimulating the production of bile in the liver, causing the excretion of a thin fluid bile and thus improving the lipid metabolism. For this reason, the herb is very popular as a medicinal plant for jaundice, gallstones or cirrhosis of the liver - although this can of course only be done in consultation with an experienced naturopath or doctor in order to avoid further damage to health.

Dandelions are often used as tea or pressed juice from fresh plants, but the leaves can also be enjoyed in the form of vegetables, soup or smoothies. In view of the upcoming summer, a dandelion salad is a delicious and extremely healthy alternative to other leafy salads, because in addition to its liver-strengthening ingredients, dandelion contains around nine times as much vitamin C as lettuce, for example. For this purpose, about 400 grams of dandelions are washed, spun dry and cut into strips on plates for four people.

In the next step, a spring onion is cleaned and cut into fine rings and around 12 black olives are halved and then both are added to the dandelion. Finally, the salad is refined with 200g sheep's cheese in small cubes, a tablespoon of pine nuts and, if necessary, finely chopped garlic. For the dressing, mix 4 tablespoons of olive oil with 3 tablespoons of mild herb vinegar, a tablespoon of mustard, salt and black pepper from the mill and pour over the salad just before serving.

From a naturopathic perspective, regular detoxification is also very useful for liver health in order to remove or metabolize accumulated toxins that are stressful for the body. If you want to detoxify your liver, you can use various measures such as Glauber's salt. This is sodium sulphate (sodium sulfuricum), which is taken on two consecutive days together with grapefruit juice and olive oil and in this way acts as a natural laxative. However, due to sometimes severe vomiting and massive diarrhea, this form of treatment should only be carried out after consulting a doctor or alternative practitioner and, in the best case, at the weekend so that the body can recover sufficiently the next day.

The health of the liver can be supported more gently with Schüssler salts. Above all, the Schüssler Salt No. 6 (potassium sulfuricum), which stimulates the liver and thus detoxification and stimulates the fat metabolism, as well as the salt No. 10, which also has a stimulating effect and in this way the elimination of toxins from the body, come into question Body supports. Here, too, you should always consult your doctor or alternative practitioner before taking it in order to coordinate the ideal dosage and potency.

Author and source information

This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.

Dipl. Social Science Nina Reese
  • Thomas Gasser: Basic knowledge of urology, Springer Verlag, 6th edition, 2015
  • Jesse M. Civan: Liver Cirrhosis, MSD Manual, (accessed October 04, 2019), MSD
  • Stephan vom Dahl et al .: Congenital metabolic diseases in adults, Springer Verlag, 2014
  • Steven K. Herrine: Jaundice, MSD Manual, (accessed October 04, 2019), MSD
  • Deutsche Leberhilfe e.V .: Morbus Meulengracht, (accessed October 04, 2019), leberhilfe.org

Important NOTE:
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.