It is estimated that 20 to 50 percent of women will have at least one urinary tract infection during their lives, and many will be plagued by UTIs multiple times. [1]
Men can develop UTIs too. However, women are more prone to developing a urinary tract infection because of their anatomy. The distance between the bladder and the urethral opening is relatively short in women, and this opening is in close proximity to the vagina and rectum, which makes it easy for bacteria to move from one place to another. In men, the urethral tube is longer and its opening is further from the rectum. This results in a lower frequency of urinary tract infections.
A foul urine odor is a common symptom of urinary tract infections, and because of the frequency of urinary tract infections, it is important to know more about the nature and cause of this smell. The elevated presence of bacteria in the urine affect its smell and color. When a urinary tract infection is present, urine takes on a foul-smelling odor and may appear cloudy or may sometimes even contain blood.
What is urinary tract infection?
A urinary tract infection, or UTI for short, is any infection along the urinary tract, which includes the urethra, bladder, ureters (tubes that link your kidneys to your bladder), and kidneys.
Cystitis, an inflammation and infection of the bladder, is most common, but UTIs can spread to other portions of the urinary tract when this is left untreated. When the infection reaches the kidneys, it is also called pyelonephritis. [2]
These infections are not directly transmitted during sexual intercourse, but the chance of developing a UTI increases dramatically if you are sexually active. This increased risk of developing urinary tract infections happens because of the transfer of bacteria during sex between the vagina, rectum, and urethra.
What causes urinary tract infections?
Urinary tract infections occur because bacteria such as Escherichia coli travel into the urethra, bladder, and sometimes the kidneys. Some sexually transmitted infections such as trichomoniasis and Chlamydia can cause urinary tract infections as well.
UTIs often occur after having sexual intercourse with a new partner or with an old partner for the first time in a while; cystitis can be caught from a sexual partner who has a urinary tract infection or from friction on the opening of the urethra during intercourse. This is why urinary tract infections are famously referred as honeymoon cystitis. [3]
You are also more prone to urinary tract infections if you:
- Experience significant levels of stress,
- Have a weak immune system,
- Are eating a poor diet,
- Are pregnant,
- Have experienced a damaged urethra during childbirth or surgery,
- Are diabetic,
- Have a medical condition that requires you to use urinary catheters,
- Have a genetic predisposition to UTIs. [4]
What are the symptoms of urinary tract infections?
Common UTI symptoms seen in both men and women include:
- Pain and intense burning during urination,
- A need to urinate much more frequently, sometimes even every few minutes
- Needing to urinate with very little fluid coming out.
- Cloudy or bloody urine which signals the presence of blood in the urine
- A strong urine odor the first time you urinate in the morning. [5]
Additional symptoms of a urinary tract infection may include painful sexual intercourse, penis or vaginal pain, flank pain, vomiting, or fever and chills.
Young children with urinary tract infections may only have an elevated body temperature or even no symptoms at all. Sometimes they might deliberately hold in their pee because it stings them when they urinate. [5]
Mental changes or confusion in might be the only signs of a urinary tract infection in the elderly. [5]
In advanced infections, there may be fever, vomiting, and pain in the mid to lower back. This is a common problem as the infection reaches the kidneys. A kidney infection is serious and needs immediate medical attention and treatment.
Treatment for urinary tract infection
Once a doctor has confirmed that you have urinary tract infection, he or she will probably prescribe medication to relieve the symptoms and also an antibiotic to treat the infection itself.
Although there are also some effective herbal cures (cranberry juice, parsley tea, vitamin D, forskolin, an extract from the Indian coleus plant) you should discuss any kind of alternative treatments with your doctor. [6]
Urinary tract infections can be misleading as sometimes the symptoms go away even though the infection may be spreading to the kidneys as the further stadium of UTI.
Urinary tract infection prevention strategies are particularly important, probably even more than the treatment itself [7]:
- Drinking plenty of unsweetened fluids (water is your best choice)
- Drinking cranberry juice
- Urinating often and whenever needed. Research proved that when you hold urine for a long time, this stimulates bacteria to multiply within the urinary tract and may result in a UTI [8]
- Urinating after sexual intercourse to flush out bacteria that may have entered the urethra during intercourse
- Wiping from front to back, especially after a bowel movement
- Wearing loose-fitting underwear and clothes
- Women should avoid using spermicides (for example diaphragm with spermicide) because spermicides increase irritation and allow bacteria to grow
- Avoid using unlubricated condoms because they may also cause irritation
- Taking probiotics [9]
Urinary tract infections should ideally be avoided, but if they're already present, should be treated either at home or medically as soon as possible because of potential damage to the urinary tract, the kidneys and thus the development of possibly life-threatening problems, which may occur if a UTI is left untreated, or if the patient experiences chronic urinary tract infections. That is why, if your pain and symptoms are persistent, you must see a doctor immediately.
The antibiotics that are commonly used to treat the urinary tract infections include [10]:
- Nitrofurantoin,
- Cephalosporins,
- Sulfa drugs,
- Amoxicillin,
- Trimethoprim-sulfamethoxazole,
- Doxycycline, or
- Quinolones.
Most non-elderly adult women and men only need 3-14 days of antibiotic treatment, but if the infection has spread to one of the kidneys, you may need hospitalization to receive hydration and antibiotics through the vein. Treatment of a chronic or recurrent UTI must be thorough because of the chance of a kidney infection. Sometimes the antibiotics must be taken repeatedly for as long as 6 months, or more. In some cases, stronger antibiotics are used even for a single, uncomplicated episode of cystitis.
What is urine odor?
Urine odor relates to the volume and concentration of a variety of chemicals excreted by the kidneys. Normally, urine does not have a strong odor, but if you are dehydrated and your urine becomes highly concentrated, it can have a strong ammonia smell. Many foods and medications, such as asparagus or vitamins can also affect the odor of urine.
Most changes in urine odor are temporary and do not indicate serious illness. However, sometimes an unusual urine odor can be associated with an underlying medical condition. That is why you should talk to your doctor if you are concerned about the odor of your urine.
- A strong ammonia smell might mean there is not enough fluid or point to the presence of dehydration
- Foul smelling urine often indicates a bacterial infection of the kidneys or bladder.
- Sweet smelling urine might be caused by uncontrolled diabetes.
- Musty smelling urine might be caused by liver disease or phenylketonuria which is a rare and inherited metabolic condition.
- A maple syrup smell indicates maple syrup urine disease, which is rare inherited metabolic disorder.
Maple syrup urine disease is referred to as MSUD. There are several forms of this disease. The classic form is quite serious and kids with this disease get very sick in the first week of life with vomiting and worsening symptoms over a few days. Babies that suffer from the mild form of maple syrup disease have the sugary smell at first and then gradually develop other symptoms.
These kids should have a special diet. There is also a form of maple syrup disease which responds well to the vitamin thiamine. All of the forms of MSUD are a result of missing enzymes that normally help process proteins in our body. In some cases, the odor of the urine may be fine, but it is something you will want to be sure your doctor knows about.
Test for urine odor
Doctors usually need to test the urine to find the cause of the unusual urine odor. To obtain a clean-catch urine sample, males should wipe the head of the penis clean and females should wipe between the labia with soapy water and rinse well. Sometimes a patient should use a special clean-catch kit with a cleansing solution and sterile wipes.
At the beginning, the patient should let a small amount of urine into the toilet bowl to clear the urethra of contaminants. Then he or she needs to collect a sample of urine in a clean or sterile container. Doctors need about 1 to 2 ounces of urine for a urine test. Try to remove the container from the urine stream without stopping the flow. You may finish voiding into the toilet bowl, so after this, take the sample to the lab.
Taking a urine sample from an infant
The infant’s genital area should be clean and dry. When you attach a collection device to collect the urine, you have to be sure that you have done it carefully, to prevent leakage. After the baby has urinated, you should transfer the urine to a sterile container for transport back to the health care provider.
Then, the health care provider will smell the specimen in a laboratory to determine its odor. No special preparation is necessary for this test, but if you took the collection from an infant, a couple of extra collection bags may be necessary. The test for urine odor involves only normal urination, and there is no discomfort. The normal odor of urine is aromatic. An abnormal urine odor may indicate liver failure, ketonuria, maple sugar urine disease, phenylketonuria, rectal fistula, or urinary tract infection.
When urine sits at room temperature, some of the chemicals in it may break down and cause an ammonia-like odor in some cases. It is important to remember that asparagus produces a characteristic odor in the urine.
Risk factors that increase the chances of getting a urinary tract infection
- Pregnancy and menopause,
- Kidney stones,
- Sexual intercourse, especially if you have multiple partners or use a diaphragm for birth control,
are risk factors for getting a UTI [12].
If you had
- Prostate inflammation or enlargement,
- A narrowed urethra,
- Or have been immobile for a long time, for example, during recovery from a hip fracture,
you also have an increased risk of developing UTIs.
Persons who are
- Not drinking enough fluids,
- Who have bowel incontinence or catheterization
also have an increased risk of developing urinary tract infections.
Children, circumcision and the risk of urinary tract infections
Some children develop UTIs, most commonly boys before their first birthday. UTIs are more common among uncircumcised boys. In young girls, UTIs are most common around age three, overlapping with the toilet training period.
A few of the studies that have evaluated the association between UTIs in male infants and circumcision status have looked at potential confounders. [13, 14] Those are, for example, prematurity, breastfeeding, and method of urine collection. For example, because premature infants appear to be at increased risk for UTI, the inclusion of hospitalized premature infants in a study population may act as a confounder. It is commonly suggested that uncircumcised infants have an increased risk of UTIs. Premature infants usually did not have a circumcision because of their fragile health status. In another example, breastfeeding has a threefold protective effect on the incidence of urinary tract infections in a sample of uncircumcised infants.