Key Takeaways

  • A doctor may request a bilirubin urine test if you have risk factors or symptoms of conditions affecting the liver, gallbladder, or bile ducts.
  • You may need a rapid urine test or a 24-hour collection, with the latter requiring refrigeration of samples.
  • The presence of bilirubin in urine suggests that further tests may be needed to evaluate liver function and identify potential underlying causes.

Bilirubin is an orange-yellow pigment that’s produced when red blood cells break down. The natural process of red blood cells dying while new cells are produced means that everyone has bilirubin in their bodies.

Bilirubin is not typically found in urine, as a healthy liver will process it for excretion during digestion. However, if bilirubin accumulates, it could have health implications.

Although not always, it can also be a sign of liver disease in children and adults.

Your healthcare team may request a bilirubin urine test if you have specific risk factors for liver damage. Risk factors include:

  • history of liver disease in the family
  • alcohol use disorder (AUD)
  • diabetes
  • obesity or a high body mass index
  • exposure to hepatitis
  • taking specific medications known to cause liver damage

They may also request a bilirubin urine test if you show signs of a liver, gallbladder, or bile duct condition. Symptoms to look out for may include:

  • nausea
  • vomiting
  • reduced appetite
  • fatigue
  • feeling weak
  • feeling itchy
  • jaundice
  • abdominal pain
  • ankle and leg swelling
  • dark-colored urine
  • light-colored feces

Some prescription medications can cause a false positive or a higher-than-normal bilirubin reading. False positives indicate high bilirubin levels that aren’t necessarily associated with liver disease, so it’s important to discuss your medication usage with your doctor or another healthcare professional.

The doctor’s office requesting the test will advise you where to collect a sample pot, how to collect the urine sample, and which lab to return it to.

Testing bilirubin levels through urinalysis is easy. A doctor may provide a sample pot on the day of your consultation for you to provide a urine sample right away. This is called a rapid urine test, and results can determine whether further testing is required.

Depending on your symptoms and other test results, the doctor may request a more thorough and accurate test that requires you to collect your urine over 24 hours.

In this case, on the day you begin the bilirubin urine test, don’t collect urine the first time you pee. This is because your first specimen of urine is usually more concentrated. After your first pee, start collecting samples. This means that each time you pee throughout the day, collect the urine in the sample container rather than flushing it down the toilet.

You may use a clean, small cup to collect the urine first and then pour it into the container to make the process easier. Cover the container tightly after each use and refrigerate it during the 24-hour collection period.

Collect your urine again on the morning of the second day. This is your last collection, and it should be your first morning pee. You will usually be asked to label the container with your name and the date, and then return the full container to the lab or office.

Newborn babies often have jaundice. This is because their livers aren’t as efficient at removing bilirubin from the body. Increased bilirubin and the resulting jaundice can be dangerous to infants if the underlying condition isn’t treated.

Doctors will typically begin treating babies for jaundice if their unconjugated (unprocessed) bilirubin levels are between 20 and 25 milligrams per deciliter (mg/dl). If bilirubin levels increase to 25 mg/dl or above, there is a significant risk of brain damage, called kernicterus.

However, testing for this is typically done with a small blood sample, rather than a urine test.

If a doctor does require a urine sample from a baby, the lab will often supply you with urine collection bags that fit into your child’s diaper. You would place the bag over your baby’s penis or labia and put on their diaper as usual.

Use a fresh bag at each diaper change, and put the contents of each collection bag into the sample container.

The results of a rapid urine test are almost instant, but a 24-hour bilirubin urine test should be available within a few days of completing the test. Your doctor’s office will notify you about the results.

In healthy people, bilirubin isn’t present in urine. If your test confirms bilirubin is present, you may need to undergo further testing, such as blood tests or scans to measure your bilirubin levels and liver function.

You will typically have a rapid urine test to get some initial results on whether bilirubin is present in your urine.

Bilirubin is not usually detectable in urine, so you may have high bilirubin levels if the test is positive, which would usually indicate that your body is not working as expected, typically in the liver or gallbladder.

You may need further tests and treatment, but your healthcare team will be able to advise how to proceed based on your symptoms and specific medical history.