As we age, our bodies go through many changes. One common change that older adults may notice is a stronger or more pungent urine odor. A strong urine smell can be worrying, but in most cases it is not a cause for concern. There are several reasons why elderly people may have strongly scented urine. In this article, we will explore the most common causes and when to see a doctor about this symptom.
What is normal urine odor?
Urine typically has a mild, non-offensive scent. The smell comes from waste products that are filtered out of the blood by the kidneys. Normal urine odor ranges from almost odorless to a faintly sweet, ammonia-like smell.
The scent is influenced by what you eat and drink. For example, eating asparagus can make urine have a stronger, almost skunk-like odor. Drinking coffee can also darken urine color and increase odor.
A slightly stronger smell can also occur when you are dehydrated and not urinating frequently. The longer urine sits in the bladder, the more concentrated the waste products become.
When urine odor is abnormal
While a mild urine scent is normal, an elderly person should talk to their doctor if the odor becomes very strong, foul or unusual.
Abnormal urine odors to look out for include:
- Fishy smelling urine
- Urine that smells like ammonia
- Sweet smelling urine
- Urine that smells like rotten eggs or sulfur
- Foul-smelling urine
A major change in urine odor can signify an underlying medical condition that needs treatment.
Common causes of strong urine odor in the elderly
Here are some of the most common reasons for elderly people to notice a stronger urine smell:
Dehydration
Dehydration is one of the most frequent causes of strong-smelling urine in the elderly. As the body becomes dehydrated, the kidneys conserve water by producing more concentrated urine. Higher waste product concentration equals a stronger ammonia odor.
Seniors are at increased risk of dehydration for several reasons:
- The thirst reflex diminishes with age, so they feel less urge to drink
- Some medications have dehydrating side effects
- Illnesses like diarrhea and vomiting lead to fluid losses
- Cognitive issues can make them forget to drink enough
- Reduced mobility makes it harder to get water independently
Drinking at least six to eight cups of fluids daily can help prevent dehydration and reduce urine odor. Water is best, but juice, milk, tea and soup also count towards daily fluid intake. Your doctor may recommend more if you are at high dehydration risk.
Urinary tract infections
Urinary tract infections (UTIs) are another prevalent cause of foul-smelling urine in the elderly. UTIs happen when bacteria enter the urinary tract and multiply. Common UTI symptoms include:
- Cloudy, bloody or strong-smelling urine
- Needing to urinate more frequently than usual
- Burning sensation when urinating
- Pelvic pain or pressure
- Low grade fever and chills
Elderly individuals are prone to UTIs due to weaker immune systems and certain physical changes. About 20% of women and 10% of men over 70 have a UTI each year. Prompt antibiotic treatment clears up the infection and foul odor. Cranberry juice may help prevent recurrent UTIs.
Bladder or kidney infections
While UTIs affect the urethra and bladder, more serious kidney and bladder infections can also cause smelly urine.
Bladder infection (cystitis)
Bladder infection, or cystitis, results from bacterial overgrowth in the bladder itself. Symptoms are similar to a UTI. Urine may be cloudy, bloody or strong smelling. There is pelvic discomfort and frequent, urgent urination. Mild bladder infections will clear up with a course of antibiotics.
Kidney infection (pyelonephritis)
A kidney infection, called pyelonephritis, is a more systemic illness. Bacteria ascend from the bladder into one or both kidneys. In addition to urinary symptoms, an individual will experience:
- High fever
- Chills and shaking
- Flank or back pain
- Nausea and vomiting
Kidney infections require hospitalization for intravenous antibiotics and fluids. The urine odor resolves as the infection clears.
Enlarged prostate
In elderly men, an enlarged prostate is a common cause of more noticeable urine odor. The prostate naturally increases in size with age. As the gland grows bigger, it can obstruct urine flow out of the bladder. Urine then sits stagnant in the bladder, becoming more concentrated and smelly.
Other enlarged prostate symptoms include:
- Weak urine stream
- Straining or pushing to urinate
- Dribbling urine
- Frequent urination, especially at night
- Sudden urges to urinate
Medications like alpha blockers can improve urine flow by relaxing prostate muscles. Prostate reduction procedures are options if medications are not effective.
Bladder or urinary retention
Bladder retention refers to incomplete emptying of the bladder during urination. Similar to an enlarged prostate, retention causes urine to pool in the bladder longer. The urine becomes more concentrated and foul-smelling.
In seniors, common causes of bladder retention include:
- Nerve damage from diabetes or stroke
- Side effect of medications
- Pelvic organ prolapse in women
- Neurological disorders like Parkinson’s
Seeing a doctor for the underlying cause is important to resolve retention and odor. They may prescribe medications to relax the bladder and promote complete emptying. For severe cases, intermittent self-catheterization may be needed to empty the bladder.
Kidney or liver problems
The kidneys and liver help filter waste products from blood. If these organs are damaged, more waste products can be expelled into the urine. This can lead to a stronger urine odor.
Kidney disorders linked to urine odor include:
- Chronic kidney disease
- Kidney stones
- Glomerulonephritis inflammation
Liver conditions associated with smelly urine include:
- Cirrhosis
- Hepatitis infections
- Liver cancer
Treating the underlying kidney or liver disease may help reduce odor. But some residual smell may persist due to permanent damage.
Metabolic disorders
Some examples of metabolic conditions that can cause smelly urine include:
- Diabetes: Uncontrolled diabetes leads to glucose in the urine. Bacteria thrive on this glucose and create foul-smelling compounds.
- Maple syrup urine disease: This rare genetic disorder causes urine to smell like maple syrup.
- Phenylketonuria (PKU): Inability to break down phenylalanine amino acid leads to musty-smelling urine.
Controlling diabetes and adhering to special diets can minimize the urine odor from these metabolic diseases.
Foods and vitamins
Certain foods and vitamins can impart a strong scent to urine after digestion and processing by the kidneys. Common examples include:
- Asparagus
- Fish
- Garlic
- Onions
- Some spices like curry
- Vitamin B6 supplements
These types of diet-related odors are harmless as long as they go away after the food is eliminated from your system. Make a note if any particular foods provoke a stronger or more prolonged urine smell for you.
Incontinence issues
Loss of bladder control is a prevalent problem among the elderly. Urine that sits in undergarments or absorbent pads can breed bacteria and take on an offensive odor.
Incontinence-related causes of smelly urine include:
- Urinary incontinence
- Urinary urgency and frequency
- Overactive bladder
- Nocturia causing nighttime accidents
- Side effects of medications
- Restricted mobility preventing bathroom access
Improving bladder control and hygiene practices can help mitigate embarrassing odors. This may include prompted bathroom trips, prescription medications, absorbent pads, gentle cleansing after accidents and drinking adequate fluids.
When to see a doctor
Here are some guidelines on when to seek medical advice for strong urine odor:
- Odor persists for several days or keeps returning
- Odor is distinctly foul, strange or strong
- It is accompanied by other urinary symptoms
- You have other troubling symptoms like fever or flank pain
- You have risk factors like diabetes or enlarged prostate
- Odor coincides with starting a new medication
A doctor can test your urine and assess if an infection, metabolic problem or other disorder is causing smelly urine. They can prescribe treatments to clear up the odor and address any underlying problem.
Seeking early treatment is especially important for the elderly, who are prone to dehydration, UTIs and kidney issues.
When to go to the Emergency Room
Most causes of smelly urine in the elderly do not require emergency care. However, go to the ER promptly if you experience:
- Pain or burning when urinating
- Inability to urinate
- High fever with shaking chills
- Nausea and vomiting
- Lower back pain or abdominal pain
- Blood in urine
These symptoms indicate a possible kidney infection, bladder obstruction or other serious condition requiring urgent treatment.
Diagnosing the cause
To identify what is causing elderly smelly urine, the doctor will typically:
- Get a urine sample for urinalysis and culture
- Test for signs of infection
- Look for excess protein, glucose or blood
- Check urine pH
- Assess urine concentration
They will also do a physical exam, asking about associated symptoms. Your medical history provides clues – like past UTIs, prostate enlargement, diabetes, mobility issues or neurological disease.
Other diagnostic tests sometimes needed include:
- Blood work to check kidney function
- CT scan to visualize kidneys and bladder
- Cystoscopy to see inside the bladder with a camera
- Post-void residual test to look for urine retention
Preventing smelly urine
You can reduce the chances of having strong urine odor by:
- Drinking 6-8 glasses of fluids daily
- Urinate as soon as you feel the need
- Take showers rather than baths
- Wipe front to back after using the toilet
- Avoid products that irritate the urethra
- Treat constipation promptly
- Practice good hygiene of genital area
- Have any urinary conditions treated
These healthy bladder habits lower the risk of urine retention, dehydration and infections – common causes of smelly elderly urine.
Treating smelly urine
The right treatments for strong urine odor depend on the underlying cause, such as:
- Dehydration: Drink more fluids daily and eat foods with high water content.
- UTI: Take a course of prescribed antibiotics to kill the infection.
- Enlarged prostate: Alpha blocker medications relax the prostate to improve urine flow.
- Bladder retention: Try medications to relax the bladder and urinate on a timed schedule.
- Incontinence: Use pads, prompted bathroom trips, prescription medications and gentle hygiene practices.
Lifestyle measures like drinking more fluids, urinating frequently and wiping thoroughly also help. Cranberry products may prevent recurrent UTIs.
When to seek follow up care
It is important to follow up with your healthcare provider if:
- Urine odor does not improve with treatment
- Infections keep recurring
- New symptoms develop
- Odor returns shortly after finishing antibiotics
- You have complications from kidney disorders
- Incontinence is not adequately controlled
Persistent or recurrent smelly urine may require additional tests and treatments. Follow up care ensures the underlying problem is properly addressed.
Coping tips for smelly urine
Here are some tips to help cope if you have ongoing issues with smelly urine:
- Drink cranberry or lemon water to help deodorize urine
- Eat yogurt with active cultures to prevent UTIs
- Take urine odor removers or vitamins like B6 and vitamin C
- Use unscented, gentle soap to clean genital area
- Change pads and undergarments frequently
- Opt for pad styles with odor control
- Treat incontinence if it worsens odor
- Stay well hydrated to dilute urine
Let your doctor know if these methods are not keeping odor under control. You do not have to be embarrassed about discussing this common problem.
When to consider seeing a urologist
For ongoing bothersome urine odor, you may benefit from seeing a urologist. A urologist specializes in treating urinary conditions. They have advanced training in conditions like:
- Recurrent UTIs
- Chronic kidney disease
- Enlarged prostate
- Bladder retention issues
- Urinary incontinence
- Bladder and prostate cancer
A urologist has access to specialized tests and advanced treatments. They can perform further evaluation to pinpoint causes of smelly urine not responding to usual therapies.
Conclusion
It can be alarming for elderly individuals to notice a sudden onset of strong or foul smelling urine. However, in most cases it is not a cause for serious concern. Paying attention to accompanying symptoms can help determine if a simple issue like dehydration or UTI is to blame. Or if a more complex problem requires urological care.
Addressing smelly urine quickly improves quality of life and prevents progression of minor conditions into chronic kidney, bladder or urinary tract infections. Simple preventive steps like drinking more fluids, urinating frequently and proper hygiene make a big difference. Being attentive to changes and seeking care for new or worsening odor promotes healthy aging.