Early in my career, I was preparing to see a patient whose complaint was “strong urine.” What could it mean, I wondered as I stood outside the exam room? Smelly? Dark? Painful? Able to leap tall buildings in a single bound? Strong urine and I have since done battle many times. While primary care providers hear a number of common urinary complaints – pain, weird color and frequency, to name but a few – in my experience, “strong” combined with some variation of “urine” almost always means stinky pee.
What does stinky pee mean? Often nothing major. Let’s start with the benign causes:
- Foods like asparagus can make urine smell. People who eat mostly vegetables can have a grassy odor to their urine.
- Vitamins in general can make urine a little stinky (and colorful). B vitamins especially can impart a peculiar odor.
- Dehydration can make urine smell more strongly of ammonia.
- Certain medications can give urine a different odor and, like vitamins can cause a change in color. Many commonly used antibiotics change the odor of urine as well.
Certain persistent stinky pee issues might be more serious and require the attention of your primary care provider.
- Foul-smelling urine, especially when it is associated with pain, frequency, urgency, fever, back pain, or an odd color (rusty, red, pink, purple) should be evaluated. All of these things suggest a bacterial infection somewhere in the upper or lower urinary tract.
- Musty-smelling urine is quite unusual and can be associated with metabolic and liver diseases.
- Sweet-smelling urine is sometimes associated with diabetes.
- Urine with a scent of maple syrup can be associated with a serious metabolic disease with a yummy-sounding name: Maple Syrup Disease. Pancakes anyone?
- Urine that smells like feces could mean that there’s a connection (called a “fistula”) between the rectum and the bladder or urethra.
- Some vaginal infections have an odd odor that women tend to notice when they urinate.
Many of these more serious issues have symptoms besides stinky pee, but if you have any questions or concerns, make a “pit stop” at Student Health Services!
John A. Vaughn, MD
Student Health Services
The Ohio State University