Dark urine: causes. As evidenced by the dark brown color of urine

09.09.2019

In healthy people, urine color ranges from orange to straw yellow. Coloring depends on the amount of a special pigment in the urine - urochrome. The severity of the color can change during the day. If dark urine persists for a long time, this may indicate the presence of some pathological process in the body.

Causes of darkening urine

A change in the color of urine does not always indicate a disease, therefore, the reasons can be divided into two groups: natural and pathological.

Natural causes (external or internal factors)

low fluid intake;
increased physical activity or high air temperature;
eating certain foods;
long-term treatment with certain medications.

Normally, all people have darker urine in the morning: the reason for this phenomenon is that its concentration increases during the night. A similar situation is observed with insufficient fluid intake. During hot summer days, as well as during increased physical activity, when sweating increases, urine also becomes more concentrated and darker. When a large volume of liquid is consumed, the urine brightens.

Certain medications also cause dark urine. When taking vitamins C and group B, the color of urine becomes dark yellow. The urine also darkens when taking anti-tuberculosis, antimalarial drugs, nitrofuran derivatives. Laxatives cause an increased amount of fluid to pass through the intestines, which leads to a decrease in the amount of urine excreted by the kidneys. As a result, the concentration of urochromes increases.

Certain foods can darken the urine. For example, after eating legumes, beef, rhubarb, and a lot of black tea, you should not be intimidated if the urine becomes darker. In a short time, the color of the urine will be restored.

Pathological causes

In addition to these factors, dark urine can have pathological causes:

The nature of the shade is important. If the urine is dark brown, the reason may lie in liver pathology. The kidneys begin to excrete bile pigments - bilirubin and biliverdin, the level of which in the blood is increased with liver damage. This is especially pronounced in cholestasis, when there is an obstacle in the way of the outflow of bile (stones in the cavity of the gallbladder, in the lumen of the common bile duct, cancer of the Vater's papilla).

If urine is dark yellow, the reason may be in urolithiasis, in which urine contains an increased amount of salts. With kidney disease, urine may darken due to the ingress of red blood cells or high salt content. Then there is often an admixture of blood in it, a sediment when standing, due to the settling of salts and other substances.

When to see a doctor

If the darkening of the fluid secreted by the kidneys is associated with the use of the above products, tea, insufficient fluid intake, then medical attention is not required.
But if you do not know why the urine has acquired a dark color, you should listen to your body.
It is necessary to be wary in cases where other symptoms have joined the change in the color of urine:

fever, chills, headaches, increased fatigue;
yellowing of the skin, sclera and mucous membranes;
itchy skin;
pain in the lumbar region, abdomen or right hypochondrium;
nausea, vomiting;
increased urination, accompanied by pain, cramps, or burning.

Consultation with a specialist is required if the urine contains an admixture of blood, mucus, pus, or if it has an unusual unpleasant odor. The doctor will order an examination and find out why the urine has become dark.

Important: if there are no accompanying symptoms, but the urine has a dark color for a long time, you should also visit a doctor.

Darkening of urine during pregnancy

In pregnant women, dark urine has the same causes as everyone else. But there are also some individual conditions that are inherent only in pregnant women. In the early stages, darkening of urine is often the cause of toxicosis, when a lot of fluid is lost with frequent vomiting. As a result, dehydration develops, little urine is secreted by the kidneys, and it becomes more concentrated. In severe cases of toxicosis, urine can acquire the smell of acetone.

Important: if the urine becomes dark during pregnancy, and the unusual color persists throughout the day, it is necessary to consult an obstetrician-gynecologist who will prescribe the necessary examination.

Also, during pregnancy, the load on the liver increases, which can lead to an increase in the content of bilirubin in the blood and its appearance in the urine. Another common pathology is gestational pyelonephritis. In this case, an admixture of pus, mucus may appear in the urine, it becomes unclear.

In general, if the discharge of dark urine persists for a short time, do not worry. We must first of all remember what foods were eaten the day before, and also whether enough liquid was drunk. Fluctuations in the color of urine occur in all people, and this phenomenon is far from always associated with some kind of disease.

- one of the important diagnostic indicators by which it is easy to determine the state of health. Normally, it ranges from almost transparent to rich amber. It depends mainly on the time of day and the amount of fluid you drink.

If the color is significantly different from normal, this is a reason to carefully consider your health. Why does it occur in women and men dark or almost black urine, we will find out further.

Unlike many other indicators of the state of the body, a person can observe the color of urine every day and quickly respond to any alarming changes. Therefore, this should not be neglected.

Natural reasons

Very dark urine does not necessarily indicate a disease... There may be many more conventional explanations for this. The color of urine is due to urochrome, and it is its increased content that leads to color changes.

Several factors that affect color:

Often the urine turns darker during pregnancy... This is due to the increased stress on the woman's body during the period of gestation, including on the liver and kidneys. In addition, as the fetus grows, the uterus presses more and more on the surrounding tissues, temporarily provoking difficulties with the outflow of bile. All this can entail.

For the prevention of pregnant women, make sure to drink enough water (about 2-2.5 liters per day).

Pathological causes

There are many diseases of the liver, kidneys and other organs, which can be indicated by darkened or blackened urine. Its appearance cannot give an unambiguous indication of a specific disease.

Therefore, it is very important to immediately pass urine for analysis and go to the doctor in order to start treatment as soon as possible.

Black urine may indicate the following diseases:

cirrhosis of the liver;
hepatitis;
copper poisoning;
oncological diseases of the kidneys, liver, pancreas;
diseases that provoke metabolic disorders.

The color itself can tell a lot about which organ is out of order.

Often, if the shade of the darkened urine is brown, this means that the reason lies in the liver and a violation of the outflow of bile. At the same time, liver pigments are released into the urine - biliverdin and bilirubin, which paint it in an unusual color.

If the color is closer to yellow, the problem may be lurking in the kidneys. Urolithiasis, for example, leads to a sharp increase in salt concentration. Only analysis can tell for sure. urine color is a serious signal. It is caused by the presence of red blood cells in urine. This means inflammation or kidney damage.

Associated symptoms

It is important to remember that if there is a disease that caused the formation of black urine, there will be other symptoms.

For example, such as:

What to do?

If you find your urine has a strange black color, you do not need to be afraid. Should analyze your behavior in recent days to rule out dehydration, unusual circumstances, or eating disorders.

If you can't remember anything like that, you drink enough water, but your health worsens or your urine looks or smells completely abnormal, you need to take it for analysis and see a doctor. This can be done quickly and easily at any diagnostic center, this procedure will not bring harm, but early detection is very important in the treatment of many diseases.

How to correctly pass urine for analysis, read our article.

In general, donating urine for a preventive test a couple of times a year is a very good idea, which will help to avoid a huge number of health problems in the future. The possibilities of detecting diseases in the early stages are very wide, and this will significantly simplify the task of treatment, help avoid expensive operations and procedures, and save the body's strength for other things.

Do not self-medicate in any case.

A change in the color of urine can indicate a huge range of a wide variety of diseases, and it is simply impossible to understand them without a competent specialist. Here, as elsewhere, an attentive and careful attitude to health - a guarantee of a long productive life.

What the color of urine can tell you about - watch the video:

When you are sent for testing, everyone, even without a medical education, tries to diagnose himself by external indicators of urine. Dark urine is most alarming. And not yet receiving the results, we wind ourselves up that such a color indicates kidney problems or other diseases. How to be?

There are many reasons for this shade, and they do not always consist in the presence of diseases. Let's try to dot the "and", revealing all the causes of urine darkening - both natural and pathological. You will also find out for which diseases dark urine acts as a concomitant symptom.

1. If dark urine is a deviation, then what color is the norm
2. Dark urine: examining natural causes
3. What reasons will indicate pathology in the presence of dark urine
4. Dark urine - details according to different shades

If dark urine is a deviation, then what color is the norm

The color of urine depends on the amount of urochrome pigment content in it. Its concentration increases if a person has consumed little liquid. So, if at night you do not get up to drink water, then in the morning you get more dark urine... If we talk about the norm, then ideally it is a light yellow color of urine.

The pigment dissolves easily with the drinks you drink, especially with ordinary drinking water. You can notice: if you had to drink a lot of water in a day, then the urine also acquired a light shade.

But not all drinks reduce the concentration of urochrome - if you decide to drink a dark carbonated drink, then get ready for the darkening of urine.

Dark urine: examining natural causes

If the mustard hue of urine in the morning can be taken as the norm, then the same situation throughout the day may indicate deviations. Although it is quite possible that it is not worth sinning on diseases, but on your way of life.

Natural causes that change the shade to a darker one depend on the following indicators:

You do not drink much fluids throughout the day, in particular drinking water;

You are experiencing increased sweating, for example, on a hot day or during physical exertion;

You have been taking certain medications for a long time ( vitamins C, B, laxatives, etc.);

Your diet is dominated by foods such as beef, dark teas, rhubarb and legumes.

Having changed the diet or lifestyle, the color of urine will return to normal, and if this has not happened, then it is time to move on to identifying pathological causes.

What reasons will indicate pathology in the presence of dark urine

Having found that urine is darker than normal, you should not ring all the bells. Discard natural causes first. If your drinking regime is 1.5-2 liters per day, you are not physically overworked and do not take medications, only then think about pathology.

It is not worth making a diagnosis on your own, the best option is to consult a doctor. He will prescribe laboratory tests and then you can judge the presence of a problem.

Most often, a dark shade indicates diseases of the kidneys or genitourinary system. But in any case, only a doctor can refute or confirm the situation.

Dark urine - details according to different shades

Dark urine- This is a generalized concept, because it can vary in shades, which may indicate different deviations. So, here's what the shade will tell you:

dark brown color suggests that it is time to pay attention to the liver and gallbladder, the development of an ailment is possible when bile pigments are excreted into the urine by the kidneys;

dark yellow tint- a symptom of bladder or kidney problems, maybe a symptom of pyonephrosis;

presence of blood impurities(reddish tint) signals trauma to the tissues of the organs of the urinary system.

Separately, it is worth paying attention to the dark shade during pregnancy, when everyone needs changes in a woman's body is extremely attentive.

Then this symptom may indicate several problems:

dehydration of the body;

Wrong distribution of substances in the body.

Dark urine has pathological and natural causes. If natural ones depend on the amount of fluid consumed, lifestyle and other factors, then pathological ones indicate the presence of a different type of disease.

So, you should not immediately panic when you notice dark urine. First, exclude natural causes, and then you should think about a possible pathology and diagnose.

Drinking regimen and nutrition play an important role in the shade of urine, so if you drank a glass of water during the day, then do not rush to disturb the doctor.

A dark color for 1-2 days is not a deviation, but when the shade does not change for a long time, regardless of the diet, then go to the hospital.

The article only helped you figure out when the color is far from the norm and what may cause it, and how to act, decide for yourself.

Please note: it is extremely life-threatening to diagnose yourself, and even more so to select treatment with medications. estet-portal.com

P.S. And remember, just by changing your consciousness - together we are changing the world! © econet

Urine analysis is one of the most revealing in medicine. And not in vain - any deviations from the norm may indicate the course of the pathological process.

Even the color and transparency are important. Is it possible to somehow suspect the presence of a disease without tests?

One of the symptoms will be dark urine in a woman, the causes of which can be both harmless and quite serious.

Dark urine in women - causes

Pigments that color it can give color to urine.

There are also pigments produced by certain organs of the human body.

If these organs are disrupted, the excess amount of pigments is excreted in the urine and gives it the appropriate color.

Dark urine in women may indicate abnormalities in the liver.

The reasons for the change in the color of urine can also be inflammatory processes in the female genital organs.

You should not guess why the urine has become dark in color, it is better to do an analysis. It will take very little time and can tell a lot about your body.

Dark urine during pregnancy

The main indicators of urine in a pregnant woman should be the same as in a healthy one. But pregnancy still brings its own characteristics. This period is most often characterized by toxicosis and vomiting, which lead to dehydration.

With dehydration, the urine becomes more concentrated and the content of urinary salts in it increases. This gives the urine a dark color.

In such a situation, there are no pathological and infectious processes in the body, but the very state of dehydration can be very dangerous not only for the pregnant woman, but also for the fetus.

Therefore, women in this position regularly pass urine for analysis, where the doctor monitors not only its laboratory parameters, but also its physical properties - color and transparency.

A feature of the pregnancy period is also the physical compression of the internal organs due to the enlarging uterus. The liver is no exception.

When the liver is squeezed and the load on it increases due to the metabolism of not only the mother, but also the child, the content of bilirubin in the blood increases - a brown bile pigment. When excreted in urine, it gives it a brown color.

An unfavorable cause of darkening of urine can be the development of gestational inflammation of the kidneys, in which, in addition to the dark color of urine, mucus and pus are found in it.

The main difference between a dangerous and safe urinary clouding is the duration of this symptom. If the cloudiness is temporary, there is no cause for concern. If the dark color of urine is permanent and does not depend on the time of day, this is a signal for an urgent visit to the doctor.

If you are pregnant and notice unusual changes in your body, be sure to tell your doctor about them. Many conditions can be easily corrected in the early stages, and a neglected process can harm the fetus.

Non-hazardous causes of dark urine

eating aloe, rhubarb, legumes, beef, black tea;
taking certain medications (vitamins, anti-tuberculosis, antimalarial, antibiotics, laxatives);
a higher concentration of morning urine;
increased physical activity, profuse sweating or temporary dehydration.

Clouding of urine due to these reasons is absolutely understandable to a person and does not raise doubts in him. To do this, you just need to remember your last meal and read the instructions from the drug you are taking. The dark color of urine, which occurs for pathological reasons, a person most often cannot associate with any of his actions.

You may have encountered some of these situations earlier in your life. For example, many people notice a darkening of the color of urine in the morning. In such cases, you should not worry.

SARS and urinary tract infections are the most common diseases in children. In this article, you will find out why the risk of developing infectious processes in the genitourinary system is increased in childhood.

Pathological causes of clouding of urine

Dark urine that results from a medical condition is usually not the only symptom of concern. In addition, lethargy, fever, yellowness of the skin, additional inclusions in the urine, a strong unpleasant odor, urge to urinate, pain in the abdomen may appear. Diseases causing clouding of urine:

dehydration;
liver disease (cirrhosis, cancer, hepatitis);
cholelithiasis;
glomerulonephritis;
kidney tumors;
diseases of the pancreas;
hemolytic anemia;
heavy metal poisoning;
internal injuries.

If the darkening of urine happened unexpectedly for you and you cannot explain it by the peculiarities of your lifestyle, it is better to get tested and go to the doctor's office.

Causes of dark brown urine in women

Features of the structure of the genital organs, namely, their close location to the urethra and urinary tract, promotes the penetration of infection from the genitals into the kidneys. Therefore, additional factors that can cause clouding of urine may be female diseases, for example:

fibroids, tumors of the uterus;
venereal diseases;
inflammatory processes.

At the same time, in addition to cloudy urine, women may notice an unpleasant odor or changes in discharge.

Regular examination by a gynecologist is a must for every woman. However, even if the reason is in gynecology, then urinalysis will show the course of the inflammatory process.

Learning to read urine analysis

When analyzing urine, its physicochemical parameters are diagnosed and the sediment is examined in order to highlight those inclusions that the kidneys have filtered and excreted along with urine.

When studying physical and chemical properties, the following is assessed:

Transparency. Normally, it should be transparent.
Acidity. The environment should be acidic.
Specific gravity. Indicators - 1010-1025 are considered the norm.
Colour. Shades of yellow are considered the norm.
Protein. Ideally, it should be absent. The maximum allowable value is 0.033 g / l.
Glucose. Should be absent. The maximum possible value is 0.8 mmol / l.
Bilirubin. Content is not allowed.
Ketone bodies. Should be absent.
Urobilinogen. 5-10mg / l is allowed.
Hemoglobin. Should be absent.
Epithelial cells. Allowed 0-10.
Bacteria. Not allowed.
Red blood cells. Allowed 0-1. (0-3 for women).
Leukocytes. Allowed 0-3 (0-6 for women).
Cylinders. Not allowed.
Salt. Not allowed.

Any deviations from the norm may indicate the presence of pathologies. By what specific indicator exceeds the norm, one can judge the nature and localization of the disease. Therefore, urine analysis is one of the fastest and most informative diagnostic methods and should not be neglected.

The norms of indicators for the analysis of urine should be known to everyone, but you can never decipher it as well as a doctor. Therefore, it is best to go to an appointment with a doctor who will explain to you what each overestimated indicator in the analysis indicates.

Our body will always let us know that something is bothering it - the properties of urine will change, the temperature will rise, pallor will appear, or something else. One has only to be attentive to your health and pay attention to the problems that have arisen in time.

Video on the topic

The most effective way to eliminate this phenomenon can be called the consumption of a significant amount of fluid in order to avoid its deficiency in the body.

Dark brown urine in most people causes an attack of panic, because it is often a sign of serious pathology. But there are a great many reasons why brown urine appears, and there are completely harmless explanations for this symptom. Therefore, it is appropriate to consider in more detail the reasons due to which brown urine appears, as well as methods for diagnosing and treating this condition.

Causes of the phenomenon

It is worth noting that brown urine sometimes appears under the influence of non-hazardous factors, but it can also serve as a signal of serious disorders in the body. So, non-dangerous reasons include the consumption of food or drinks with an abundance of coloring pigments:

beef;
legumes;
rhubarb;
blackberry;
Coca Cola;
Black tea.

Certain medications can also cause dark urine. Its brown tint of urine can be caused by such groups of drugs:

medicines with carbolic acid (Naphthol, Salol, Creosote, Phenol);
antimicrobial (Furadonin, Rifampicin, Metronidazole);
quinine drugs (Delagil, Primaquine, Chloroquine);
laxatives based on senna and cascara;
ascorbic acid and B vitamins;
medicines containing aloe.

In addition, it is worth noting that if there is dark brown urine when urinating in the morning, then this often indicates an increase in the level of urochrome. For the same reason, it may appear. Also, orange urine occurs with a high concentration of urobilinogen. Since orange urine is just as troubling as brown urine, it is useful to consider the causes of this phenomenon.

As a rule, they are harmless and are explained by taking certain medications, adding products to the menu that are rich in natural or chemical pigments. And yet, orange urine can also signal pathologies. This is often a reason to pay attention to the condition of the kidneys and urinary tract.

But back to brown urine and the pathologies that provoke it:

jaundice;
diseases of the prostate;
inflammation in the kidneys, liver;
oncology of the liver, pancreas;
ailments of the urinary, reproductive system.

Jaundice provokes changes in the shade of urine due to a failure in the synthesis or in the excretion of bile enzymes. For example, due to violations of the liver in parenchymal jaundice, due to difficulties with bile outflow in mechanical (obstructive) jaundice, and also against the background of the breakdown of erythrocytes in hemolytic jaundice. With kidney pathologies, urine takes on a brown color due to impurities of pus or blood, but acute intestinal ailments usually cause a significant loss of fluid, which often causes a change in the color of urine.

Types of brown urine

Often, a certain shade of urine indicates a specific ailment. It has already been mentioned what the orange urine indicates, but with brown the situation is somewhat more complicated, since a gradation of its shades is possible. So, sometimes light brown or dark brown urine appears, its clouding, mucus or flakes may be observed.

Light brown urine

Often, the appearance of light brown urine occurs due to an increase in the concentration of urochrome against a background of dehydration or due to intense sweating caused by physical exertion or climate change. In such situations, there is no particular cause for concern, as the color of the urine will return to its usual color upon returning to a normal drinking regime. If this did not happen, then it makes sense to visit a doctor and perform a set of laboratory tests.

Cloudy brown urine

When the brownish urine also becomes cloudy, then in all situations this signals a pathology that cannot be left without medical attention. As a rule, if this biological fluid has become cloudy, then the reasons lie in such deviations:

pyuria;
phosphaturia;
alkaptonuria;
increased concentration of bile pigments.

But often, dark brown urine indicates kidney ailments. Deviations in the function of these organs entail their inability to remove toxins or excess fluid, due to which the urine darkens and becomes cloudy. In parallel with this, impurities of blood may be noted in it, a pungent odor appears. Often, kidney pathologies are accompanied by other symptoms that are difficult to miss. This is pain in the lower back, muscles, pain when urinating and fever. In such circumstances, it is impossible to delay the visit to the doctor and it is imperative to conduct urine and blood tests.

Dark brown urine

Often it appears as a reaction to the use of certain products or medicines, but if we consider pathologies, then it signals hepatitis and. So, an intense dark brown color of urine acquires due to the progression of hemolytic anemia, but the color of dark beer is more typical for parenchymal jaundice, hepatitis and inflammation of the hepatic tissue of a viral nature. Obstructive jaundice is characterized by the discharge of dark urine with a greenish tint and completely colorless feces.

In addition, calculi in the kidneys or bladder (ICD), prostate adenoma and infectious diseases can affect the color of urine. Dark urine can be a consequence of a recent viral or bacterial infection, or poisoning with chemicals, in particular, copper compounds, can appear. But whatever the reasons for the phenomenon, you need to immediately go through the appropriate studies (primarily urine and blood tests).

Brown flakes in urine

This symptom often indicates an inflammatory process in the kidneys. A similar phenomenon is considered as an independent or as a complication against the background of hyperplasia, prostate cancer, renal failure, ICD and pathologies of the female reproductive system. But the same urine is characteristic of cystitis, pyelonephritis, sexually transmitted diseases and appears due to the high concentration of protein. In such circumstances, it is impossible to establish the exact cause of the phenomenon without preliminary analyzes.

Brownish mucus in urine

The release of a small amount of mucus in the urine is quite normal, but a significant amount of it indicates stagnation of biological fluid or an infection of the excretory system. As a rule, this problem is more common in women and often indicates urolithiasis, pyelonephritis, gynecological diseases, and even pregnancy. In the latter case, mucus indicates inflammation that can cause miscarriage, and in the later stages, provoke premature birth.

Brownish urine in men

In men, it is noted against the background of physiological and pathological reasons. Darkening of urine often occurs due to dehydration or serious functional abnormalities of internal organs (for example, the genitourinary system). If these metamorphoses in men are caused by pathology, then they are often accompanied by other symptoms, which facilitate the diagnostic process. These include nausea, pain in the abdomen and when urinating, and an unpleasant smell of urine.

Common pathological causes of dark urine in men include:

inflammatory process in the epididymis;
bacterial infection and cancer of the urinary system;
diseases of the prostate, testicles, vas deferens, or trauma to the scrotum;
an overdose of vitamins B, C or a high concentration of red blood cells.

Often, brown urine indicates progression of prostate involvement or inflammation in the vas deferens or testicles. The phenomenon is associated with the fact that in addition to urine through the urethra in men, semen is also excreted, which includes the secretion of the prostate gland. Trauma to the genitals leads to the same symptom.

When it comes to liver ailments, the color of urine is often affected by disturbances in the outflow of bile, which is why the urine takes on the shade of dark beer. In the case of neoplasms, bacterial lesions or inflammatory processes in the internal organs, the shade of urine, as a rule, is due to the presence of blood or pus in the biological fluid.

Brownish urine in women

Changes in the color of urine in women are often observed in diseases of an inflammatory nature, but they can also signal other pathologies (sexually transmitted diseases, cervical oncology, uterine fibroids at the stage of decay). In such circumstances, in addition to a change in the shade of urine, there is a repulsive odor of discharge and pain during urination. Often, brown urine in women is noted in such situations:

vasculitis;
pregnancy;
infections of the genitourinary system, fibroids, cervical cancer in the stage of decay.

Brown urine in children

Any child can also develop such an anomaly, which often terrifies parents. But in babies, the color of urine is mainly influenced by the foods they eat, dehydration, and certain medications.

Parents should be wary only when accompanied by an increase in temperature, abdominal pain, as well as painful urination. In such circumstances, you should not ignore the symptoms - you should rather call a doctor. Only after receiving the results of the examinations, the pediatrician will be able to say with accuracy what the problem was.

Diagnostics and therapy

To identify the reasons why the urine has become brownish, you need to be tested. A study of urine, its physical and chemical characteristics is immediately carried out, but other studies may also be required:

a complete blood count to determine the level of creatine, nitrogen, urea and liver enzymes;
urinalysis to determine the concentration and content of protein.

A complex of additional studies is also possible when a high level of erythrocytes is detected. Particular attention should be paid to the collection of material, since the accuracy of the analysis directly depends on this. It is worth taking care of the correct storage of the samples (it is optimal to keep them in the refrigerator before delivery).

Based on the results of the research, the doctor prescribes the necessary treatment. If diseases of the kidneys, female or male reproductive system are diagnosed, then a course of drug treatment is prescribed.

The most effective way to eliminate this phenomenon can be called the consumption of a significant amount of fluid in order to avoid its deficiency in the body.

Due attention should be paid to the hygiene of the genitals, especially for men, because it is the ingress of microbes into the prostate that stains urine brown. But whatever the reasons provoked the phenomenon, a timely visit to a medical facility will help maintain health.