Urine Bilirubin (Dipstick)

A dipstick test for bilirubin, a yellow pigment from old red blood cells. Urine normally has none, so the usual result is negative.

AI-verified against cited sources. Awaiting expert reviewLOINC 5770-3

What it is

Bilirubin is a yellow-orange pigment made when your body breaks down old red blood cells. Your liver processes it and sends it out in bile. A urine dipstick has a pad that changes color when bilirubin is present. Healthy urine normally has no bilirubin, so the usual result is negative. Only the water-soluble form, called conjugated or direct bilirubin, can pass into urine.

Why it matters

Bilirubin in the urine is linked to liver conditions, such as hepatitis or cirrhosis, and to blocked bile ducts. It can also be a false alarm, because some medicines that color the urine can make the strip look positive. Clinicians usually read it together with your symptoms, the urobilinogen result, and blood tests for bilirubin and liver enzymes before drawing any conclusion.

If it’s high

A positive result means conjugated bilirubin is showing up in your urine. This is linked to liver conditions such as hepatitis or cirrhosis, and to blocked bile ducts. It can also be a false positive, for example from phenazopyridine, a urinary pain reliever that turns urine orange. Your clinician can sort out which it is with other tests.

Common causes

Medicines that color the urine, such as phenazopyridine, which can make the strip look positive
Liver inflammation or injury, such as viral hepatitis or hepatitis linked to a medicine
Cirrhosis (scarring of the liver)
A blockage in the bile ducts, for example from gallstones
Inherited conditions that raise conjugated bilirubin (congenital hyperbilirubinemia), which are uncommon

What can help

Tell your clinician about every medicine and supplement you take, including urinary pain relievers
Mention symptoms such as yellow skin or eyes, dark urine, pale stools, itching, tiredness or belly pain
Ask whether blood tests for bilirubin and liver enzymes would help
Talk with your clinician about alcohol use and other things that affect liver health

What can affect your result

Light and time: bilirubin breaks down when a sample sits in light or goes stale, which can make the result read falsely negative
Medicines: phenazopyridine can cause a false positive, and chlorpromazine and selenium can cause a false negative
Type of bilirubin: only conjugated bilirubin passes into urine, so conditions that mainly raise unconjugated bilirubin usually don't turn the strip positive
Strongly colored urine from medicines or foods can make the pad harder to read
Strip brand: the amount of bilirubin needed to turn the pad positive varies by manufacturer
Phenazopyridine, a urinary pain reliever that turns urine orange, can cause a false-positive result.
Chlorpromazine and selenium can cause a false-negative result.
Bilirubin breaks down in light and as urine stands, so an old or poorly stored sample can read falsely negative.
Only conjugated (direct) bilirubin passes into urine, so conditions that mainly raise unconjugated bilirubin usually don't turn the strip positive.

A random midstream sample is fine. Test it promptly and keep it out of bright light, or refrigerate it. It reflects the sample at the moment of collection and can change from one sample to the next.

When to talk to a clinician

A positive bilirubin result is worth a call to your clinician, even if you feel well. Reach out soon if you also notice yellow skin or eyes, tea-colored urine, pale stools, itching, nausea or belly pain. Get urgent care if yellow skin or eyes come with severe belly pain, fever or chills, or confusion.

Questions you could ask

Does the rest of my urinalysis, such as urobilinogen, change how you read this?
Could one of my medicines or supplements explain this result?
Should we check blood tests for bilirubin and liver enzymes?
Should the urine test be repeated with a fresh sample?

Questions people ask

Why is there bilirubin in my urine when my skin isn't yellow?

Bilirubin in the urine and yellow skin are two separate signs, and either can show up without the other. A positive strip is a reason to talk with your clinician, who may look at your symptoms and blood tests for bilirubin and liver enzymes.

Can a medicine or supplement cause a false positive?

Yes. Phenazopyridine, a urinary pain reliever that turns urine orange, can make the strip look positive. Chlorpromazine and selenium can make the result read falsely negative. Tell your clinician and the lab about everything you take.

Is bilirubin in urine the same as bilirubin in blood?

No. A blood test measures how much bilirubin is circulating, split into total and direct. The urine dipstick only responds to the conjugated (direct) form that passes through the kidneys, so the two tests can tell different stories.

Does a negative result mean my liver is fine?

A negative result is the usual finding, but this one test can't rule out liver problems. Many liver conditions don't put bilirubin in the urine. If you have symptoms or other results that concern you, your clinician can order liver blood tests.

Does the way the sample is handled matter?

Yes. Bilirubin breaks down in light and as urine sits, so an old sample can read lower than the true level. Deliver the sample promptly, or keep it refrigerated and out of bright light, as your lab instructs.

Show the science and sources

For clinicians and researchers

Dipstick bilirubin pads use a diazo coupling reaction and report semi-quantitatively (negative, small, moderate, large, or 1+ to 3+). The threshold for a positive varies by manufacturer. Only conjugated (direct) bilirubin, which is water soluble, is filtered by the glomerulus. Unconjugated bilirubin is water insoluble and cannot pass through (AFP, 2005), so conditions that raise mainly unconjugated bilirubin, such as Gilbert syndrome and hemolysis, do not usually cause bilirubinuria. StatPearls associates a positive strip with liver dysfunction, viral or drug-induced hepatitis, cirrhosis, biliary obstruction and congenital hyperbilirubinemia (the conjugated forms include Dubin–Johnson and Rotor syndromes). Bilirubin is unstable in light and in stale specimens, so delayed examination can cause false negatives. Phenazopyridine and similar pigmented drugs cause false positives, and chlorpromazine and selenium cause false negatives (AFP, StatPearls). Urobilinogen is interpreted alongside it: bile duct obstruction can lower urobilinogen, while hemolysis and hepatocellular disease can raise it (AFP). A positive dipstick is usually compared with serum total and direct bilirubin and liver enzymes.

LOINC 5770-3 (primary), 50551-1, 20505-4, 1977-8. Specimen: urine.

Sources

Urinalysis, StatPearls Publishing (NCBI Bookshelf) (2023)
Urinalysis: A Comprehensive Review, American Family Physician (2005)
Bilirubin in Urine Test, MedlinePlus (National Library of Medicine)
Urinalysis, Complete With Microscopic Examination (test 003772), Labcorp

AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-03. How we build and check these pages.