DEAR MAYO CLINIC: What could be causing my husband's urine to have a very strong odor? Is it cause for concern? He is 74 years old.

ANSWER: Strong-smelling urine has several possible causes. One possibility, diabetes, is a serious medical concern. Other reasons can range from diet -- specifically asparagus -- to a urinary tract infection, which requires treatment.

Causes for strong urine odor include:

Urine concentration:

It's normal for urine to have a stronger odor first thing in the morning. After a night's sleep, urine is more concentrated and odorous as well as brighter yellow in color.

Dehydration:

This also increases urine concentration, causing stronger smelling urine. Have your husband try drinking more water to see if the odor lessens. Hot weather or intense physical activities can contribute to dehydration, too. Concentrated urine, without any other symptoms, generally isn't harmful.

Diet:

For some people, eating asparagus causes urine to produce a sulfur-like smell. There are no health concerns associated with this odor.

Urinary tract infection:

Foul-smelling urine is a symptom of a urinary tract infection. Other symptoms are cloudy urine, an urgent need to urinate, or a burning sensation while urinating. The foul smell may be the only symptom of a urinary tract infection. With a persistent foul smell from the urine, your husband should see a physician for a urinalysis and diagnosis. A urinary tract infection needs to be treated with antibiotics to prevent kidney infection and kidney damage.

Diabetes:

Strong sweet-smelling urine is a sign of advanced diabetes, which can be diagnosed with urinalysis. With advanced diabetes, sugar and ketones, which are normally absent, can accumulate in the urine and create a strong odor. According to the American Diabetes Association, an estimated 5.7 million people have undiagnosed diabetes. If the odor in your husband's urine persists, I'd suggest he see a physician for a simple urine test.

One other consideration is urine leakage/incontinence.

When this occurs, the smell may seem stronger than usual because it clings to clothing. Temporary or chronic incontinence has many possible causes.

Temporary causes can be too much fluid in the bladder.

Coffee and alcohol especially can cause a sudden need to urinate and urine leakage. Dehydration and other sources of bladder irritation -- carbonated drinks and spicy, sugary or acid foods -- can irritate the bladder and cause leakage of urine.

Causes of chronic incontinence can involve prostate and bladder disorders, including enlargement of the prostate and a weakened bladder. If incontinence is contributing to the smell, your husband should talk with his primary care doctor to determine the cause and develop a treatment plan.

-- Amy Krambeck, M.D., Urology, Mayo Clinic, Rochester, Minn.

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