Sunday June 3, 2007
Purple Urine Bag Syndrome

The purple urine bag syndrome is characterized by the purple discoloration of the urine, of collecting bag, and of draining tube. It is a rare condition associated with chronic catheterization of urinary tract. It is also called The King's Royal Urine as England's "Mad" King George III in early 19th century reported to have bouts of bluish/purplish color urine. Exact etiology is unknown and many explanations have been described. It is said to be a triad of

• constipation,
• alkaline urine and
• bacteria in the urinary tract that produce the enzyme sulphatase/phosphatase like Pseudomonas aeruginosa, Proteus mirabilis, Morganella morganii and E. coli.

It has been said that constipation lead to bacterial overgrowth in colon and in combination with UTI produce this syndrome.Purple color is produced by combination of red and blue color. indirubin (red) is produced in this process and get dissolved in the plastic of the drainage bag, ostomy pouch, or urinary catheter, and indigo crystals (blue) in the urine coat the bag or tube, combining to form the purple color.The longer the drainage system is used, the deeper the purple color becomes. A strong odor often is associated with PUBS which gets stronger as temperature in the room rises ! Due to unknown reason, it is more common in female patients.Overall it is a benign condition. Treatment includes good hygiene, changing catheters as needed, avoiding constipation and if needed antibiotics.