Malodorous urine

Astrid Leitner studied veterinary medicine in Vienna. After ten years in veterinary practice and the birth of her daughter, she switched - more by chance - to medical journalism. It quickly became clear that her interest in medical topics and her love of writing were the perfect combination for her. Astrid Leitner lives with daughter, dog and cat in Vienna and Upper Austria.

More about the experts All content is checked by medical journalists.

Healthy urine is odorless and clear. Certain foods, but also illnesses, change the chemical composition of the urine and cause those affected to perceive a different odor when using the toilet. Read here about the possible causes behind the urine smelling bad and what you can do about it!

Brief overview

• Description: Healthy urine is odorless and clear. Various causes are possible triggers for the urine odor to change. Usually they are harmless, but in some cases bad-smelling urine is a sign of illness.
• Treatment: Changes in the odor of urine caused by foods such as asparagus do not require treatment. If the cause is a disease, it will be treated.
• Causes: Food such as asparagus, medication, diseases such as diabetes mellitus, ketoacidosis, cystitis, infections in the vaginal area, congenital metabolic diseases
• When to see a doctor ?: If the urine smells conspicuously over a long period of time, you should consult a doctor soon. This is especially true when there is pain or fever. The same applies if the urine changes color, is cloudy or blood can be seen.
• Diagnostics: urine examination, if necessary further examinations such as ultrasound or blood tests
• Prevention: Since bad smelling urine has various causes, prevention is only possible to a limited extent.

What does it mean if the urine smells bad?

Fresh, healthy urine (urine) has a neutral smell and a clear, slightly yellow color. The decisive factor for the odor of the urine is its chemical composition: it consists of 95 percent water, the rest of which is made up of urea, creatinine, uric acid, vitamins and salts.

In healthy people, the urine in the bladder is sterile, i.e. free from pathogens. The typical strong urine odor only arises outside the body when bacteria convert the urea into ammonia. This means that even healthy urine begins to “stink” over time, for example when the urine has been in a sample container for a long time or remains in textiles (full diaper, underwear).

Certain foods, medications, and medical conditions cause the

Change the composition and thus the smell of the urine. Most of the time, the change in smell is harmless and temporary. In other cases, however, bad smelling urine is a sign of illness. Examples of this are urinary tract infections, ketoacidosis or congenital metabolic diseases.

What can you do about it?

How bad-smelling urine is treated depends on the cause.

If foods such as asparagus or garlic are the cause of the unpleasant odor, no treatment is necessary. The odor disappears on its own after two or three visits to the toilet, but no later than 24 hours. The same applies to the odor of urine that arises after taking penicillin (antibiotic): it evaporates as soon as the intake is stopped.

If the cause of the bad smell is a disease, it will be treated. Urinary tract infections and vaginal infections are mostly bacterial. The doctor will usually prescribe an antibiotic. In the event of a fungal infection, the doctor will prescribe a so-called antifungal agent. Once the infection clears, the urine will smell normal again.

Diabetes mellitus is treated according to the instructions of the attending physician. Here it is important to always keep an eye on blood sugar in order to avoid complications such as ketoacidosis. Ketoacidosis is severe metabolic acidosis that must be treated immediately in hospital. It is caused by a lack of insulin and is particularly common in type 1 diabetes.

Metabolic diseases associated with the smell of urine are usually treated with an appropriate diet. The earlier they are diagnosed and treated, the greater the likelihood of normal physical and mental development.

causes

Causes of severe urine odor

Highly concentrated urine smells "strong". In most cases, this is caused by dehydration - the body does not get enough fluid. This is the case when those affected drink too little or when excessive amounts of fluids are given off, for example with a fever or profuse sweating during physical exertion. To prevent the body from becoming more dehydrated, it excretes less urine. The urine is darker, more concentrated than normal and smells more intense.

Morning urine may also smell more extreme. This is because the kidneys produce less urine overnight. The urine is healthy, only the amount of fluid is less than usual - the urine appears darker and smells more intense.

Sometimes babies' urine smells more intense while they are teething. The reason for this is usually that they feel uncomfortable and therefore drink less fluids.

Causes of the sweet smell of urine

Sugar in the urine causes a sweet smell. A fruity odor of urine can therefore indicate diabetes mellitus. If there is too much glucose in the blood, the body excretes the sugar with the urine.

Urine with a sweet smell is particularly common in pregnant women. In some cases the sweet smell is a sign of gestational diabetes, but it also occurs in normal pregnancies.

Gestational diabetes is easily treatable. Make sure you have a sweetish urine odor clarified during pregnancy!

Causes of acetone-like urine odor

Acetone has a sharp, sweet smell, similar to overripe fruit or nail polish remover. Acetone-like urine odor indicates that there are ketone bodies in the urine (ketonuria). This is the case, for example, with ketoacidosis - a metabolic imbalance in type 1 diabetics. It indicates a severe lack of insulin.

Ketoacidosis is a medical emergency. Diabetics who notice a sharp urine odor should call the emergency doctor immediately!

Ketone bodies are also found in urine for other reasons. They arise when the body no longer has any energy reserves (glucose) and the organism breaks down fat instead. Ketone bodies are produced as a breakdown product and are excreted in the urine. The reasons for this are long fasting or starvation. Even with excessive alcohol consumption, the body produces more ketone bodies.

Causes of ammonia odor in urine

A pungent ammonia odor in the urine is a sign of a urinary tract infection, usually a bacterial cystitis. The bacteria break down the urine, which creates the typical sweet ammonia odor. In most cases it is an infection with the E. coli bacteria found in the intestinal tract. They enter the urinary bladder through the urethra and cause inflammation there.

In the case of a bladder infection, not only is the odor of the urine changed, it is usually also cloudy, and in some cases also bloody.

Urinary tract infections occur in women and men, but because of the shorter urethra, women are affected much more frequently. Even (small) children can get cystitis. An altered urine odor is often the first sign here, especially in children who are not yet able to articulate their symptoms well.

Causes of sulphurous urine odor

Asparagus contains aspartic acid. In about half of all people, the sulfur compound is broken down by an enzyme and excreted in the urine. The typical sulfur smell forms just a few minutes after the asparagus has been consumed. In people who do not have the enzyme, the urine smells unchanged even after eating asparagus.

In addition, there are people in whom the aspartic acid is broken down by the enzyme, but who still cannot smell the sulphurous odor. They have had a (harmless) genetic change that means that they cannot smell sulfur. Doctors refer to this phenomenon as “selective non-smelling”.

Causes of other urine odors

In addition to asparagus, there are other foods whose smell passes into the urine. These include garlic, coffee, Brussels sprouts and salmon. The same applies to some spices, vitamin preparations and certain cereals; they can trigger a chocolaty urine odor.

Bad-smelling urine from congenital diseases

In rare cases, the urine has a noticeable odor even in newborns. The cause is usually a congenital metabolic disease.

These include:

Phenylketonuria: Phenylketonuria is a rare, congenital metabolic disease. Due to a genetic change, the body lacks a certain enzyme (phenylalanine hydroxylase), which typically leads to so-called failure to thrive in the second to fourth month of life: mental and motor development is delayed. The affected children suffer from severe restlessness and seizures, and the urine has a noticeable odor that is reminiscent of mouse droppings or horse stables.

Nowadays, every newborn in Germany and Austria is examined for various congenital diseases on the second or third day of life. This includes testing for phenylketonuria.

Phenylketonuria can be treated well. However, those affected must adhere to a strict diet for life!

Maple syrup disease: Maple syrup disease (branched chain disease, leucinosis) is an innate, genetic metabolic disorder in which certain amino acids (building blocks of proteins) cannot be broken down. These accumulate in the body and cause the typical symptoms such as poor drinking, vomiting, muscle weakness, breathing disorders and seizures. Affected children also develop a sweetish-spicy body and urine odor that is reminiscent of maple syrup. If the disease is diagnosed and treated early, affected children will develop largely normally.

Causes of putrid odor of urine

If the urine smell is reminiscent of rotten eggs, caution is advised. The putrid smell may indicate cell breakdown in the urinary tract, such as in bladder cancer.

If you have a putrid urine odor, get examined as soon as possible. The earlier a tumor is diagnosed, the better the chances of recovery!

Causes of fishy odor of urine

If the urine smells fishy, ​​there is usually an infection in the vaginal area (bacterial vaginosis). Menopausal women are often affected. Due to the fluctuating hormone level, the vaginal flora is unbalanced, and pathogenic bacteria multiply more easily.

In very few cases it is the so-called fish odor syndrome, a mostly congenital disease in which those affected secrete a substance (trimethylamine) that smells strongly of spoiled fish. The disease occurs only very rarely, only around 200 cases of fish odor syndrome are known worldwide.

Causes of urine that smells like yeast

Urine that smells like yeast is an indication of a fungal infection. The yeast Candida is most often responsible for this. In addition to the typical urine smell, those affected usually suffer from severe itching and whitish deposits on the genital mucous membrane.

When to the doctor

If your urine smells bad, you don't always need to see a doctor. If food such as asparagus or coffee are the reason for the changed smell, it usually disappears after two to three visits to the toilet. If the active substance penicillin is the trigger, the urine smells as long as the antibiotic is taken.

However, if the foul-smelling urine cannot be traced back to food or medication, or if the urine smells unpleasant for a long time, a doctor's visit is advisable. This is especially true when there is pain or fever. The same applies if the urine becomes discolored, cloudy or reddish (bloody).

Examination / what does the doctor do?

The first point of contact for bad-smelling urine is your family doctor or urologist. He asks about the current complaints, how long they have existed and whether there are any other complaints besides the changed urine odor. He then examines the patient and makes a first impression of his or her physical health.

The central point of diagnosis is a urine test. To do this, the patient gives a urine sample in a sterile container. To ensure that as few skin germs as possible get into the sample, it is important to note the following:

• First wash your hands.
• Men pull back the foreskin.
• Women spread their labia with their fingers.
• Now let a little urine into the toilet, only then collect the middle portion of the urine (midstream urine) in the cup.
• Make sure that the inside of the mug does not come into contact with your fingers or genitals.
• Seal the cup.

The doctor then examines the urine for changes. Deviations in the smell and color of the urine give the doctor initial clues as to possible causes. If the urine smells like ammonia and is cloudy, this is a sign of a urinary tract infection. The sweetish smell of urine indicates diabetes (diabetes mellitus).

In the next step, the doctor dips a urine test strip into the sample (urine test) and checks whether there are components in the urine that do not belong there, such as ketone bodies, protein (proteins), glucose (sugar) or blood.

The doctor then analyzes the urine under a microscope. Red and white blood cells, tissue cells, crystals, bacteria and parasites can be recognized and assessed.

If a bacterial infection is suspected, the doctor creates a so-called urine culture. This is a plastic dish (agar plate) with a kind of jelly on which the bacteria grow particularly well. The doctor uses this to identify the type of pathogen. This is important in order to be able to specifically treat the infection with an antibiotic.

Sometimes an ultrasound scan is necessary. The doctor pays attention to changes in the urinary tract that are not visible from the outside, for example constrictions, foreign bodies or tumors.

It is also possible to measure the urine concentration. To do this, the patient collects his urine in a container for 24 hours. This allows conclusions to be drawn about the filter performance of the kidneys.

After completing the urine test, the doctor is able to further narrow down the cause of the urine odor and treat it. For example, if there is a bladder infection, the patient is given a suitable antibiotic. If there are glucose or ketone bodies in the urine, the doctor will do other tests, such as a blood test. If a genetic disease is suspected, a molecular genetic test is carried out. Patients suspected of having a tumor in the urinary tract are usually referred to an oncologist by the doctor.

Prevent

The smell of urine caused by food is harmless and disappears on its own within a few hours. You can only prevent it by doing without the corresponding triggers such as asparagus, garlic or coffee.

There are no ways to prevent congenital diseases such as phenylketonuria or maple syrup disease.

It is important to prevent ketoacidosis in people with diabetes. It not only causes a urine odor similar to acetone, but is life-threatening if left untreated. Talk to your doctor about ways to prevent severe insulin deficiency.

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