Why Does My Urine Smell Strong?

You flush, and the smell lingers in the bathroom. It’s sharper than usual, more like ammonia than anything you’d call normal. You think about what you had for dinner, then you think about the word “infection,” and then you think about googling it at 6 a.m.

The usual, harmless causes

Not enough water. Cleveland Clinic¹ says when you’re low on water, the percentage of water in your pee drops and the filtered waste takes a more prominent role, so the smell gets stronger. The NHS² also says that dark or smelly urine on its own may only mean you aren’t drinking enough, and suggests drinking enough fluids to pass pale urine regularly.

Food and drink. Cleveland Clinic¹ names asparagus, Brussels sprouts, fish, onions and garlic, and says coffee, soda and alcohol may also contribute.

Supplements and medicines. Cleveland Clinic¹ says vitamin B6, supplements containing thiamin or choline, and chemotherapy drugs are known for changing urine’s smell. If it started after a new supplement, that’s worth mentioning.

When it points to something else

A urinary tract infection. The NIDDK³ lists a burning feeling when you urinate, frequent or intense urges to go even with little urine, lower abdominal discomfort, and urine that’s cloudy, bloody or strong-smelling. It says bladder infections are most often caused by bacteria. The NHS² lists pain or burning when peeing, needing to pee more often, cloudy or strong-smelling urine, lower abdominal pain and fever. See our articles on needing to pee often and interstitial cystitis.

Other conditions. Cleveland Clinic¹ lists diabetes, bladder inflammation, kidney disease and liver disease as conditions that can change urine odor. It says a smell of ammonia may indicate a UTI or kidney issues, and fruit or sweetness may signal diabetes or high blood sugar.

What to do first

Drink water through the day and see whether the smell fades within a day, as Cleveland Clinic¹ says it typically does. If you’ve had asparagus or started a supplement, note it.

The NHS² says that for UTI symptoms, a pharmacist is the first call for non-pregnant women aged 16 to 64, and suggests drinking enough fluids and avoiding bladder irritants like alcohol and coffee. It notes that cranberry products lack evidence for treating an active infection.

The play

Try this: a one-day pee check

Today, drink water steadily and note how many times you pee, the color, the smell and any burning or urgency.

Write down what you ate and took, including supplements.

If the smell is still strong tomorrow, or you have symptoms, make the call.

When to get checked

Don’t wait if

1. Urgent

   Cleveland Clinic¹ says to see a provider if the smell stays and is accompanied by other symptoms, since that deserves further investigation, and if it smells like ammonia, fruit or sweetness. The NHS² says to seek urgent care if symptoms get worse after 48 hours of self-treatment.

2. Urgent

   Get urgent care for fever and chills, nausea or vomiting, pain in your back, side or groin, or confusion. The NIDDK³ lists back pain, fever and vomiting as signs a kidney may be involved, and the NHS² lists confusion, drowsiness or difficulty speaking.

Book an appointment if any of these fit:

• The smell hasn’t gone after a day or two of drinking water
• It comes with burning, urgency or lower belly pain
• Your urine is cloudy or has blood in it
• It smells sweet or fruity
• It’s been strong ever since you started a new medicine or supplement
• You have diabetes, kidney or liver disease and notice a change

Urine odor is a message about water, food or, sometimes, health. Usually it’s the first two.