Purple Urinereade mor Bag Syndrome (PUBS)

What is Purple Urine Bag Sysndrome?

Purple urine bag syndrome (PUBS) is a rare, benign condition which was first described medically in 1978 by Barlow and Dickson. It is usually a harmless condition and the individual will may be asymptomatic.

It can be identified when the urine drainage bag and tubing undergo purple discolouration.

(It is not associated with the effects of medication or food/fluid intake consumed by the individual).

What causes it to happen?

PUBS occurs in 10-15% of people with long-term indwelling catheters and is linked to the following risk factors:

• Elderly immobile females (70%)
• Constipation (due to increased transit time of tryptophan in the colon)
• Alkaline urine
• Co-existing urinary tract infection (UTI)
• Renal function
• Increased dietary tryptophan (found in meat, dairy, nuts, seeds & wholegrains)

PUBS is commonly associated with gram negative bacteria that produce sulfatase and phosphatase also Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella, Escherichia coli, Enterococci, and Group B Streptococci.

The bacteria produce the enzyme (indoxyl sulfatase) that change the colour of the tubing and drainage bag to purple.

How to manage Purple Urine Bag Syndrome?

Managing PUBS includes:

• Changing or removing the indwelling catheter
• Prescribed antibiotics
• Treatment for constipation
• Effective daily catheter management to avoid recurrence

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