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The Rollin' RN's

My, What a Colorful Bag You Have

Today, we’re here to chat about the color purple. And no, we’re not talking about the movie starring Oprah. We’re talking about when urinary catheters, bags and even the urine become a purple color. This is known as purple urine bag syndrome (PUBS). We’ve seen some discussion about this topic in our spinal cord injury (SCI) groups but what’s it all about?

PUBS is rare and was first reported in the 70s and is signified by purple discoloration of the urine usually seen in people with long term indwelling (Foley) urinary catheters (urethral or suprapubic) and usually associated with a urinary tract infection (UTI), which we all know too well.

What are the signs and symptoms?

Aside from discoloration in the urine bag, catheter, or urine, the signs and symptoms of PUBS can be similar to those of a UTI and include:

  • Increased spasms

  • Autonomic dysreflexia

  • Mild lower back pain or other aches

  • Fatigue

  • Fever or chills

  • Urinary leakage or having to catheterize more often

  • Nausea

  • Headache

  • Blood or sediment in the urine

  • Cloudy urine or a foul odor to the urine

Who's at risk?

People who use indwelling urinary catheters are at risk for developing PUBS. The longer a catheter or a urine bag is in place, the darker the purple color may become. Other factors that might increase the chance of developing PUBS include constipation and dehydration.

But how can I avoid PUBS?

  • Avoid UTIs if possible. (See our article: UTIs: Another Annoyance of SCI)

  • Maintain a regular bowel program. Avoid constipation.

  • As long as there are no fluid restrictions in place, drinking at least 2000 to 3000 ml of water every day is important. This is equivalent to about 8 to 12 eight-ounce glasses or about 3 quarts of water every day. It is best to avoid beverages with sugar, caffeine, and alcohol. Doing so will also support the two above mentioned points.

The cause of PUBS is unknown. However, there are theories about why it occurs. Some think that it’s different bacteria in the urine that produces the purple color. It’s also been reported that a slowed-down gut is enough to increase the chances of developing PUBS. Others believe it is a reaction between tryptophan, an amino acid found in food, and bacteria in the gut that create red and blue dyes making the purple color that is seen. And so far, it is not believed there’s any relationship for developing PUBS with any certain type or brand of catheter or urine bag.


  • Change the catheter and the urinary bag

  • Antibiotics as appropriate and prescribed by your health care provider

And last but not least, because the cause is unknown, if you find yourself sporting a purple urine bag, check in with your health care professional for a once over to be safe.

We, The Rollin’ RNs try to focus on writing articles about topics discussed in our SCI groups and this one is no different. If you have a topic that you’d like more information about, please feel free to message us. We will research and report back.

It’s all good, so keep on rollin’.

Patty, BSN, RNC and Roberta, RN

The Rollin’ RNs ™


Purple urine bag. Retrieved May 17, 2020 from

Purple Urine Bag Syndrome. Retrieved May 17, 2020 from


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