I hate orange urine

Urinary tract infections (UTIs) are a very common problem, especially in women. The link provided offers some very good information, but briefly, women’s urethrae (the tube the urine comes out of), are closer to the rectum than those of men (who have a built-in “spacer”). This allows bacteria from the colon to creep over to the urinary tract and cause burning, pelvic pain, frequent urination, etc. I treat UTIs daily. Most are uncomplicated, but some are quite serious (usually in the elderly and chronically ill). As medical problems go, I love UTIs. When a healthy, young woman comes in with the usual symptoms, a quick test can confirm the diagnosis, and, usually, three days of inexpensive antibiotics fixes it. The patient is happy, I’m happy, everyone’s happy. But then there’s the orange stuff.

A few years back, a medication called “phenazopyridine” became more widely available as an over-the-counter drug. It is marketed to treat the symptoms of UTIs. It turns urine and other body fluids bright orange. This medication is useful for reducing the symptoms of UTIs, but does not cure them. The FDA does mandate certain labeling for the OTC preparations, but I can tell you from experience, the subtlety of this distinction is, well, subtle. Fortunately, you don’t have to rely on my experience. Someone bothered to study the question. Most patients do not realize the difference between treating the symptoms and treating the disease. This leads to delay of treatment, and the infection can become more serious. To add insult to injury, phenazopyridine’s orange pigment interferes with the most common tests we use to diagnose UTIs.

In discussions of medical ethics, the concepts of “paternalism” and “patient autonomy” are often thought of as being in opposition to each other. It is sometimes in the name of autonomy that medications are made more easily available to patients by skipping the physician prescribing process. (Also, over the counter meds are quite profitable). This can be very useful for medications such as ibuprofen, or Plan B (post-coital contraception), but any time you cut out the expert, certain risks accrue. Paternalism isn’t the opposite of autonomy. The two work together. Patients see me for my expertise. They don’t consult me about movies, art, or (thankfully) religion—just medicine. They do this because I’m the one with the training. Giving a patient knowledgeable advice is not paternalistic—it’s what they came here for. I don’t paternalistically command my patients to do anything. I dole out advice, and they are free to follow it or not.

Orange urine not only removes the expert, it fools the patient. It does not increase autonomy, it actually decreases it by deceiving the patient, perhaps causing them to become more ill.

<End of rant>


  1. Darn, you medical establishment types sure are greedy! Trying to make us see Allopathic doctors instead of being able to treat ourselves. Ha! You won’t fool me. In fact, I’m skipping your whole Allopathic Hegemony and I’m off to go pick up a homeopathic treatment for this intense abdominal pain and rigidity! Stupid Allopaths…

  2. I’ve often thought my urine was orange after a 5 day weekend in New Orleans…. but I digress.

  3. Buttercup

    Good post, good distinction.
    One additional comment:
    Patient’s (sic) don’t see you for your grammar, either 🙂

  4. working on it…

  5. Actually, Buttercup, more precisely, his orthography, though spelling and grammar are interrelated. Either way, PalMD has moved Deinalism up to the top of my Newsreader’s medical science section. Orac’s suspicious illness is Pal’s chance 🙂

  6. I have learned the distinction between treating symptoms and treating the disease, but most of us patients do still need the expertise to understand why something is prescribed. Unfortunately, this distinction is not always made clear to us. For instance, when I had bronchitis last year and saw a P.A., I was prescribed DM/GFN. The DM was pretty harsh, and I stopped using it after a few days after my symptoms were under control. I felt pretty sure that the DM just controlled symptoms. I understood that I likely had a lower respiratory viral infection. However, when I saw a physician next I asked about these drugs, and his opinion was that the DM had a role in treating the disease. If I was coughing less I could heal better.

    So I am glad you are interested in helping your patients learn the symptoms vs. disease distinction.

  7. Oldfart

    Moving some drugs to over-the-counter status is NOT a plot to shift profit from doctors to drug companies. It is because people like my wife cannot afford to see doctors but they can afford to buy some drugs. As far as I’m concerned, a pox on both your houses until such time as you all bring fees into some semblance of reality where a minor condition or infection won’t force a family to go without food for a week.

  8. Julie Stahlhut

    I’ve had those day-glo-orange meds prescribed for me on numerous occasions, and found them completely ineffective at relieving any UTI symptoms at all. Aspirin works a lot better for immediate pain relief, and antibiotics usually stop the pain in its tracks within 24 hours anyway.

    That said, Oldfart has a good point. If your health insurance coverage is nonexistent or inadequate, even minor medical problems can quickly become a serious expense. Most of us would rebel against having to see a physician (and pay medical bills) to get pain relief for a mild headache, because most headaches are minor, and there are already OTC drugs that are relatively safe, effective, and affordable for that purpose. But if you come down with an illness that really requires medical expertise to diagnose and treat, you’re in a tough position if you’re uninsured. So, do you risk an OTC remedy that might not be appropriate, or an expensive doctor visit that might not be necessary?

    Rhetorical question: How many industrialized nations put their citizens through this?

  9. Treating the symptoms and treating the disease… Sounds to me like the distinction between medicine and alternative approaches to treatment. E-coli strains sometimes won’t easily succumb to antibacterial drugs, particularly if underlying systemic conditions are prevailing that trigger its onset. Likewise, administering higher doses of antibiotics for every recurrence could impair the immune defenses in the long run that makes it even difficult to treat the disease. Right, I would probably consider FDA approved herbal or homeopathic remedies for persistent UTIs.

  10. Gary, your “reasoning” is not logical, nor biological. Perhaps you could explain yourself better.

    Most UTIs are exquisitely sensitive to common antibiotics. Sometimes there are resistance problems, especially in hospitalized patients.

    But, just because the first medication you choose doesn’t work doesn’t mean you should use herbs and risk death by sepsis.

    In fact, if I read your comment correctly, it is completely irresponsible, and outright stupid.

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