Urobilinogen in Urine: Levels, Causes and Symptoms

Jun 29, 2024 | 4 min read

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Urobilinogen in urine indicates the breakdown and recycling of bilirubin. High levels can point to liver diseases like hepatitis, while low levels may signal bile duct obstructions. Managing this condition is crucial for liver health and overall well-being.

What is Urobilinogen?

Definition and Formation Process

Urobilinogen is a colorless by-product formed in the intestines during the breakdown of bilirubin. Bilirubin itself is created when old red blood cells are broken down in the body. 

This process starts in the liver, where bilirubin is produced and then secreted into the bile. The bile, which contains bilirubin, is stored in the gallbladder and released into the intestines during digestion.

In the intestines, bacteria break down bilirubin into urobilinogen. This urobilinogen has two main paths: some of it is excreted from the body through the stool, giving feces its brown color, and some is reabsorbed into the bloodstream. 

The urobilinogen that reenters the bloodstream is transported back to the liver, where it can be recycled into bile or excreted in urine. This recycling process is crucial for maintaining the body's balance of bilirubin and ensuring proper digestion and waste elimination.

Role in the Body

Urobilinogen has several important roles:

  • Breakdown and Excretion: Helps convert bilirubin into substances that can be excreted, preventing toxic buildup.
  • Recycling: Reabsorbed urobilinogen returns to the liver to be reused in bile production.
  • Urine Excretion: A small amount of urobilinogen is excreted in urine, contributing to its color.

Normal and Abnormal Levels of Urobilinogen

According to MedicineNet, the normal range of urobilinogen in urine is between 0.1 and 1.8 mg/dL. This range indicates a healthy balance of bilirubin breakdown and recycling processes in the body.

Urobilinogen Level

Range (mg/dL)
Normal 0.1 - 1.8
High > 1.8
Low < 0.1

Note: The units of measurement and the normal ranges can differ depending on the laboratory and the specific methods used

Results Interpretation

Your healthcare provider will consider your test results in the context of your overall health, symptoms, and medical history. This comprehensive approach ensures an accurate diagnosis and appropriate treatment plan.

For a quick and detailed interpretation of your urine test results, you can use our free Lab Test Interpretation tool. Simply upload your urine test results, and get an easy-to-understand analysis of your urobilinogen levels, along with potential implications and next steps. Remember, online tools are not intended to be a substitute for professional medical advice, diagnosis, or treatment.

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Clinical Significance

Implications of Elevated Urobilinogen

Elevated levels of urobilinogen in urine can be a significant indicator of underlying health issues, primarily related to the liver and red blood cell breakdown. Here are the main conditions associated with high urobilinogen levels:

Liver Diseases

  • Hepatitis: This inflammation of the liver can result from viral infections, excessive alcohol consumption, or autoimmune conditions. Elevated urobilinogen levels occur because the liver's ability to process bilirubin is compromised.
  • Cirrhosis: Advanced liver disease characterized by scarring (fibrosis) of the liver tissue. Cirrhosis can hinder the liver’s function, leading to increased bilirubin and urobilinogen levels in the urine.

Treatments may include lifestyle changes, medications, or in severe cases, a liver transplant. Management strategies focus on reducing liver inflammation and preventing further damage.

Hemolytic Disorders

According to Medscape, hemolytic anemia represents approximately 5% of all anemias.

Hemolytic anemia involves the rapid breakdown of red blood cells, which increases the production of bilirubin. As a result, more urobilinogen is formed in the intestines and excreted in the urine. Symptoms may include fatigue, dizziness, and jaundice.

Treatment may involve managing the underlying cause of red blood cell destruction, such as treating infections or immune disorders. Iron supplements and other supportive treatments may also be necessary.

Implications of Low Urobilinogen

Low levels of urobilinogen in urine can indicate issues with bile flow or the gut's bacterial environment. Here are the primary conditions associated with low urobilinogen levels:

Bile Duct Obstruction

Blockages in the bile ducts prevent bile (and thus bilirubin) from reaching the intestines. This obstruction can result from gallstones, tumors, or strictures. Without bilirubin in the intestines, less urobilinogen is produced, leading to lower levels in the urine.

Treatment typically involves removing the obstruction, which may require surgery or other medical procedures. In the case of gallstones, treatments might include dietary changes or surgery to remove the gallbladder.

Antibiotic Use

Certain antibiotics can disrupt the gut's bacterial flora, which is essential for converting bilirubin to urobilinogen. 

This disruption can significantly lower urobilinogen levels in the urine. It's important to monitor and manage antibiotic use to maintain a healthy gut environment.

Diagnostic Methods

Measuring urobilinogen levels in urine is a standard procedure in medical diagnostics, especially for assessing liver function and detecting hemolytic disorders. The measurement can be done using different methods:

Urine Test Strips

Urine test strips provide a rapid assessment of urobilinogen levels. These strips are dipped into a urine sample, and the color change on the strip is compared to a color chart that indicates different concentration levels. 

This method is widely used for its convenience and speed, although it may not be as precise as laboratory methods.


Laboratory analysis of urine samples, commonly known as urinalysis, offers a more accurate and detailed measurement of urobilinogen levels. 

In a lab setting, urine samples undergo chemical reactions that quantify the exact concentration of urobilinogen. This method is preferred when precise measurements are needed, especially for diagnosing and monitoring liver conditions.

Symptoms Associated with Abnormal Urobilinogen Levels

Abnormal urobilinogen levels in urine can be a sign of various health issues. It's important to recognize the symptoms that may indicate an imbalance in urobilinogen levels:

  • Fatigue: Persistent tiredness or lack of energy.
  • Jaundice: Yellowing of the skin and eyes.
  • Dark Urine: Urine that is darker than usual.
  • Light-colored Stools: Pale or clay-colored stools.
  • Nausea and Vomiting: Frequent feelings of nausea or actual vomiting.
  • Abdominal Pain: Discomfort or pain in the abdomen.
  • Swelling: Swelling in the abdomen, legs, or ankles.
  • Frequent Itching: Persistent itching without an obvious cause.
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