7 Causes of Strong Smelling Urine in the Elderly.

Our content is not intended nor recommended as a substitute for medical advice by your doctor. Use for informational purposes only.

Strong-smelling urine is not a cause of concern in most cases. The main causes include dietary changes, dehydration, and some medications. However, diseases such as UTI, diabetes, liver failure, and Urinary tract cancer can also cause strong urine smell.

The most common causes of strong-smelling urine in the elderly are:

• Non-disease conditions (common):
  • Severe dehydration.
  • Certain foods such as asparagus, coffee, onions, garlic, etc.
  • Certain medications and supplements, such as Vitamin B6 supplements.
• Disease conditions (less common):
  • Urinary tract infections and asymptomatic bacteriuria.
  • STDs of the urinary tract.
  • Cancer of the urinary bladder.
  • Associated vaginal infections.
  • Uncontrolled diabetes.
  • Kidney or liver failure.
  • Maple syrup urine disease (MSUD).
  • Abnormal perception of the odors or hypersensitivity to odors, as with some neurological diseases, diabetes, etc.

1. Dietary factors.

Diet is one of the most common factors associated with abnormal urine smell. Certain foods contain some compounds exerted in urine after its metabolism.

For instance, Methanethiol and other sulfur compounds in the asparagus are known to cause a strong urine smell. It also may cause bad breath and fishy-smelling stool (reference).

Always review what you ate shortly before experiencing the strong urine smell.

Common foods related to stronger urine smell:

• Asparagus.
• Coffee.
• Onions.
• Garlic
• Fish.
• Brussel sprouts.
• curry
• Alcohols.
• Pineapple.

How to know if food is the cause of strong urine smell:

• A stronger urine smell starts after consuming one or more of the above-mentioned foods.
• The smell is often temporary (it comes and goes according to your dietary habits).
• It may be associated with other abnormal odors, such as fishy-smelling stool and bad breath.
• No symptoms of urinary tract infections (no burning urination, no frequent urge to pee, no fever, and no abnormal turbidity of urine).
• No blood in the urine.
• No chronic diseases such as liver or kidney failure.

2. Dehydration.

Your kidney excretes water and waste products, and toxins through the urine. Normally, your urine is mildly smelly due to different waste products (such as ammonia).

Dehydration leads to scanty urine with higher concentrations of the smelly compounds normally found in urine.

The lack of adequate water intake or losing too much water by sweating (as with hot weather, prolonged physical activity, or sports) will make your urine concentrated (deep yellow), scanty, and scanty.

The effect of dehydration is more noticeable in the elderly, leading to stronger-smelling urine.

Always stay hydrated, especially if you live in areas with hot climates or practice sports such as workouts or marathon running.

How much water should you drink to prevent dehydration?

According to the U.S National academies of Sciences, Engineering, and Medicine, Good hydration requires you to drink about (reference):

• 3.7 liters of fluid for adult men.
• 2.7 liters for adult women.

Also, you may need to increase the amounts according to the level of exercise, etc.

3. UTI (urinary tract infection).

UTI (urinary tract infection) is common in the elderly (especially women). It is often caused by bacteria invading the urinary bladder through the urethra.

In 90% of the cases, UTI is caused by E. Coli bacteria. Strong-smelling urine is not a characteristic feature that is specific for UTI.

One study investigated the strong or foul-smelling urine odors of children perceived by their parents. The study concluded that a strong or foul urine smell is not unique to UTIs.

However, UTIs caused by organisms other than E. Coli may cause strong or foul-smelling urine. For instance, UTI caused by proteus species may lead to characteristically offensive urine odor.

Also, the urinary tract may become affected by sexually transmitted diseases (STDs) such as chlamydia trachomatis may also cause abnormal urine discharge and a strong urine smell in the elderly.

Symptoms of UTI:

• Dysuria: stabbing pain in the urethra when you pee.
• Urgency: sudden severe urgency to pee.
• Frequency: Frequent urge to pee but only a small amount of urine comes out.
• Suprapubic (lower abdominal) pain.
• Turbid (cloudy) urine may also be present.
• The symptoms may be very mild, with a strange feeling in the bladder and urethra.
• Also, UTI may become complicated (reaching the kidneys), causing high fever, flank pain, chills, etc.

Symptoms of STDs:

• Urethritis (inflammation of the urethra, often due to STDs) can be completely asymptomatic or with only abnormal urethral discharge and a stronger urine smell.
• Urethral pain (The pain is often sharp, stepping, and continuous). The pain becomes sharper when you pee.
• Urethral discharge (the severity and nature of the discharge depending on the causative organism):
  • Gonorrhea causes plenty of pus or pus and mucus discharge from the urethra that comes out without urination.
  • Chlamydia trachomatics discharge is often scanty and watery. In females, it is often associated with vaginitis and cervicitis.
  • Mycoplasma genitalium is often asymptomatic but may cause purulent (pus) discharge from the urethra.
  • Herpes simplex urethritis intense dysuria (urethral pain) without significant discharge.
• Dysuria (painful urination).

4. Medications.

Examples include:

• Vitamin B6 supplements (the most common cause_.
• Sulfonamide antibiotics.
• Some diabetes medications.
• Rheumatoid arthritis medications.
• Multivitamins and supplements.

5. Diabetes and diabetic ketoacidosis.

Diabetes is a common disease characterized by abnormally elevated glucose (sugar) levels in your body. Uncontrolled diabetes may lead to stronger urine by several mechanisms:

• Presence of excess glucose in urine (sweet-smelling urine). The kidney starts to excrete glucose in urine when blood glucose levels exceed 180 mg/dl.
• Recurrent Urinary tract infections.
• Presence of abnormal compounds such as ketones in patients with diabetic ketoacidosis (a complication of diabetes, especially in those with type one diabetes).
• Long-lasting uncontrolled diabetes may lead to kidney function impairment (especially in the elderly), leading to chronic kidney disease and kidney failure.

Stronger-smelling urine, polyuria (frequent peeing of large amounts of urine), and thirst sensation may be the first signs of diabetes in the elderly.

Check your blood sugar if you have symptoms suggestive of diabetes, such as:

• Polydipsia: persistent thirst sensation and frequent need to drink water.
• Polyuria: Excessive urination of large amounts of urine and frequent waking up to pee at night.
• Polyphagia: persistent hunger despite eating.

Also, check for blood sugar control if you are a known diabetic and have an abnormally strong urine smell.

6. Cancer.

A bad or strong urine smell DOESN’T often mean cancer. However, it rarely produces abnormal urine smells due to associated hematuria, UTI, dehydration, or dietary changes.

Although cancer is rare as a cause of a stronger urine smell, it is especially important because almost all cancers are more common in the elderly.

Cancers of the urinary bladder, kidneys, and prostate (in males) may lead to abnormal urine smell, hematuria, and other urinary symptoms.

Elderly men are more commonly affected by cancers than women. So, it is important to be aware of the risk factors and the possible symptoms of urinary tract cancer, especially in the elderly.

Risk factors of bladder cancer (reference).

• Cigarette smoking.
• Being older (more than 50).
• Being male.
• Opium use.
• Occupation exposure to carcinogens as with metal workers, painters, rubber industry workers, leather workers, textile and electrical workers, miners, cement workers, transport operators, excavating-machine operators, and jobs that involve the manufacture of carpets, paints, plastics, and industrial chemicals.
• Genetics also plays a role.
• Schistosomiasis infection (common in north Africa and Japan).

Symptoms & diagnosis:

• Early bladder cancer may present with irritative symptoms such as painful urination (dysuria), the urgency to urinate, or frequent urination.
• Bladder cancer typically causes painless urine bleeding (intermittent attacks).
• Blood in urine or blood clots in urine.
• Abnormal or strong urine smell.
• Bladder pain or pressure in the lower abdomen.
• Dysuria or pain after the end of urination.

7. Other possible causes.

Other possible causes of stronger-smelling urine in the elderly include:

• Gastrointestinal-bladder fistula: the abnormal connection between the colon and the urinary bladder.
• Maple syrup urine disease: a rare congenital condition causing smelly urine. It often presents in early infancy and continues to older ages. It leads to persistent or intermittent attacks of stronger urine smell.
• Kidney failure.
• Liver failure.

When to worry about strong-smelling urine.

• Presence of blood in the urine.
• Blockage sensation during urination.
• Urine incontinence.
• Sudden urge to poop.
• Being older males (more than 50).
• Severe burning sensation during urination.
• Cloudy or turbid urine.
• Recent menstrual irregularities or vaginal bleeding.
• Fever.
• Unexplained weight loss.
• Extreme loss of appetite (anorexia).

• Evidence-based
• Written by a doctor.

MD, Internal Medicine and Nephrology specialist.

Dr. Esraa A. MagidAuthor

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