Smelly or foul-smelling urine is a common symptom in women. The smell is often different than normal urine, and may be fishy or sweet-smelling. There are various potential causes of smelly urine in women, ranging from harmless to more serious underlying conditions.
Common Causes of Smelly Urine in Women
Some common causes of smelly urine in women include:
- Urinary tract infection (UTI)
- Dehydration
- Diet and food intake
- Medications
- Pregnancy
- Diabetes
- Menopause
Let’s explore each of these causes in more detail:
Urinary Tract Infection
A urinary tract infection (UTI) is one of the most common causes of smelly urine in women. A UTI occurs when bacteria, often from the digestive tract, gets into the urethra and invades the bladder. This causes an infection which can make urine take on a foul or strong odor.
Along with smelly urine, other UTI symptoms include:
- Burning with urination
- Frequency and urgency of urination
- Pelvic pain or abdominal discomfort
- Cloudy, bloody, or dark urine
- Fever or chills in some cases
UTIs are easily treatable with antibiotic medications prescribed by a doctor. Seeking prompt treatment is important to relieve symptoms and prevent the infection spreading to the kidneys.
Dehydration
Not drinking enough fluids is another cause of foul-smelling urine. When the body is dehydrated, the urine becomes more concentrated. This concentrates waste products in the urine, making it more pungent.
Other signs of dehydration include:
- Dark yellow or amber-colored urine
- Infrequent urination
- Fatigue and headache
- Dry mouth
- Dizziness
Drinking more water, around 8 cups per day, can help dilute the urine and reduce odor. Eating more fruits and veggies which have high water content can also help with hydration.
Diet and Foods
Certain foods and drinks can affect the smell of urine. Asparagus is a classic example, causing a fouler, almost cabbage-like urine odor when digested. Beets can turn urine pink or red-colored. Garlic and onions contain sulfur compounds that can make urine have a stronger, almost maple syrup-like smell.
Other foods that may influence urine odor include:
- Cruciferous vegetables like broccoli, cauliflower, cabbage
- Salmon, tuna, and other fish high in omega-3 fatty acids
- Curry, cumin, fenugreek and other spices
- Vitamin B-complex supplements
The foods are not necessarily unhealthy, but do contain compounds that can make their way into the urine. In most cases, the smelly urine is harmless. However, if the odor is very foul or accompanied by other symptoms, see your doctor.
Medications
Certain prescription and over-the-counter medications can cause smelly urine as a side effect. Examples include:
- Antibiotics – including penicillin and nitrofurantoin
- Chemotherapy drugs
- Anti-fungal medications
- Diuretics or water pills
- Anti-psychotic drugs
- Multivitamins containing B-complex or vitamin C
Check with your doctor if you notice foul urine odor after starting a new medication. Switching to an alternative medication may stop the odor.
Pregnancy
Hormonal changes during pregnancy can cause urine to take on a sweet or almost maple-like odor. This is due to increased estrogen levels and changes in acidity of the urine. The urine may also appear cloudy or murky.
As long as there are no other bothersome symptoms, smelly urine alone during pregnancy is not a cause for concern. Stay well hydrated, and discuss any urinary symptoms at prenatal checkups.
Diabetes
Uncontrolled diabetes can cause a sweet, almost fruity odor to urine. This is due to excess glucose in the blood spilling over into the urine. Other diabetes symptoms may include:
- Frequent urination
- Excessive thirst
- Weight loss
- Fatigue
- Blurred vision
- Slow healing wounds
See a doctor promptly if you notice sweet-smelling urine accompanied by other concerning symptoms. Your doctor can check blood glucose levels and help get diabetes under control.
Menopause
Changes in estrogen levels around menopause can also cause smelly or foul urine at times. This is normal, but have your urine evaluated if accompanied by symptoms like burning with urination, pelvic pain or incontinence.
When to See a Doctor
Passing smelly or foul-smelling urine now and then is usually harmless. But see a doctor if:
- The urine smells foul consistently
- The odor is accompanied by pain with urination, frequent urination, or other troubling symptoms
- You have symptoms of a UTI like pelvic pain, fatigue and chills
- You have uncontrolled diabetes
- You are pregnant and have pain, discomfort or other concerning symptoms along with smelly urine
Some more serious causes of smelly urine that require prompt medical care include:
Kidney Infection
A kidney infection, called pyelonephritis, can cause pungent, almost ammonia-smelling urine along with fever, chills, nausea and flank pain. Kidney infections need treated quickly with antibiotics to prevent permanent kidney damage.
Liver Disease
Advanced liver disease can make urine have a very strong odor, often described as “fishy”. This is due to buildup of waste products that the liver can’t filter normally. Other symptoms include jaundice, swelling, and abdominal fluid buildup. See a doctor right away if these symptoms develop.
Metabolic Disorders
Rare genetic conditions called metabolic disorders can cause smelly urine due to excess chemical compounds in the urine. Examples include maple syrup urine disease and phenyketonuria (PKU). Symptoms usually begin in infancy, causing developmental delays and neurological problems if left untreated.
Bladder Fistula
A fistula is an abnormal opening between the bladder and another organ, often caused by surgery, trauma or underlying medical conditions. A bladder fistula can allow bowel contents to leak into and mix with the urine, producing a foul fecal odor. This condition requires prompt surgical treatment.
Cervical or Vaginal Fistula
In some cases, a fistula can occur between the bladder and the vagina or cervix. This allows urine to leak through the vagina, causing foul-smelling discharge. These types of fistulas may be caused by childbirth complications, cancer, radiation or surgical injury.
Bacterial Vaginosis
Bacterial vaginosis is an overgrowth of bacteria in the vagina, causing a fishy odor that may affect urine when urinating. Along with foul urine, symptoms include gray, watery vaginal discharge and irritation. Bacterial vaginosis is treatable with prescription antibiotic medications.
Vesicovaginal Fistula
A vesicovaginal fistula is an abnormal opening between the bladder and the vagina that allows urine to leak into the vaginal vault. This can cause smelly discharge from the vagina, especially during urination. Fistulas are often due to complications from surgery, radiation, childbirth injuries or other trauma. Repair surgery is needed to mend the fistula.
When Smelly Urine is Normal
It’s common for urine to have some odor regularly, but it should not be an extremely foul or pungent smell. Asparagus and other foods, vitamins, spices and hydration status can cause mild changes in odor.
Occasionally foul-smelling urine is normal, like during pregnancy or with transient dehydration or dietary changes. But consistent foul odor, especially when paired with other symptoms, deserves medical evaluation.
Tips for Preventing Smelly Urine
You can help prevent smelly urine by:
- Drinking plenty of fluids daily
- Urinating when you feel the urge
- Not holding urine too long
- Wiping front to back after using the toilet
- Avoiding potential irritants like douches, sprays, scented soaps
- Peeing before and after sex
Proper hygiene and hydration can go a long way towards preventing odor. However, if foul urine persists, see your doctor for evaluation.
When to See a Urologist
If your primary doctor cannot determine the cause of smelly urine, you may be referred to a urologist. A urologist specializes in treating conditions of the urinary tract and genitals.
Reasons you may need to see a urologist for smelly urine include:
- Recurrent UTIs
- Incontinence or overactive bladder
- Signs of fistula
- Abnormal pelvic exam
- Problems passing urine
- Blood in urine
- Kidney stones
- Pelvic pain or pressure
- Neurological conditions affecting urine function
A urologist has specialized training to fully evaluate the urinary tract and diagnose conditions causing urine odor and other urinary symptoms. They can provide medications, nonsurgical treatments or surgery if needed.
Tests for Smelly Urine
To diagnose the cause of smelly urine, doctors may perform tests including:
- Urinalysis – Checks levels of protein, blood cells and bacteria
- Urine culture – Identifies any bacteria growing in the urine
- Cystoscopy – Views inside the urethra and bladder using a tiny camera
- Imaging tests – CT scan, MRI scan, ultrasound or X-ray to view structures of the urinary tract
- Post-void residual test – Measures how much urine stays in the bladder after urinating
- Urine cytology – Screens urine for cancerous cells
- Cystourethrogram – Uses X-ray images before and during urination
These tests allow the doctor to examine the urinary tract and identify any abnormalities causing foul-smelling urine.
Treatments for Smelly Urine in Women
Treatment depends on the underlying cause of the urine odor. Common treatments may include:
- Antibiotics – For UTI, kidney infections or STDs
- Medications to treat overactive bladder – Reduces accidents and urgency
- Drink more fluids – Improves hydration and dilutes urine
- Estrogen therapy – Can help some postmenopausal women
- Bladder training – Scheduled urination to stretch time between bathroom trips
- Diet changes – Avoid foods that irritate the bladder
- Surgery to repair fistula – Mends abnormal openings allowing urine leaks
Lifestyle measures like drinking adequate fluids, urinating regularly, and genital hygiene are important as well. Follow up with your doctor within 2 weeks if smelly urine persists after treatment.
When to Seek Emergency Treatment
Seek prompt emergency care if you have smelly urine along with:
- High fever
- Chills and shaking
- Confusion or fainting
- Difficulty breathing
- Back or flank pain that does not go away
These can indicate a kidney infection or other serious condition requiring hospital treatment.
Outlook for Smelly Urine
The outlook depends on the cause of smelly urine. With mild dehydration or diet changes, odor usually resolves quickly with adequate fluid intake. UTI prognosis is good with prompt antibiotic treatment.
Underlying conditions like diabetes or liver disease may require ongoing management to prevent recurrences of smelly urine. Fistulas and other anatomical defects may need corrective surgery to fully resolve odor.
Follow all treatment recommendations from your doctor. Report any worsening urine odor or new symptoms at follow up visits. With appropriate treatment guided by your physician, smelly urine can be cured or controlled in most women.
How to Prevent Smelly Urine
You can help avoid smelly urine by:
- Drinking 6-8 glasses of fluids daily, or enough to keep urine pale yellow
- Not holding urine for prolonged periods
- Urinating before and after sexual activity
- Wiping front to back after using toilet
- Avoiding potential bladder irritants
- Practicing good genital hygiene with unscented soap
- Wearing cotton underwear and loose clothing
See your doctor for regular checkups, and screenings for diabetes if at higher risk. Get prompt treatment for any suspected UTIs as well. With good hydration and urinary habits, smelly urine can often be prevented.
Conclusion
Smelly or foul-smelling urine is quite common in women due to natural body changes, foods, medications and infections. While urine odor alone is rarely dangerous, consistent foul smell with other symptoms deserves a trip to the doctor.
A simple UTI is the most common cause of smelly urine. Other possible causes include dehydration, pregnancy, menopause and diet. More concerning causes like diabetes, liver disease and fistulas may require specialized treatment.
Doctors can run tests to identify the root cause in cases of persistent smelly urine. Treatment aims to cure infection, repair anatomical defects, and control underlying conditions. With prompt medical care guided by your physician, smelly urine can be successfully managed.