Ammonia odor in the urine

Normally, urine has a dim, specific odor, which is difficult to confuse with anything. But under certain circumstances, the smell of ammonia in the urine may appear: it is difficult not to notice it, because it is usually sharp and immediately draws attention. Such a phenomenon should be alarming, as it is quite possible that a serious pathology is present.

Causes of the ammonia odor in the urine

The odor of urine can "tell" a lot about a person's health. In normal cases, it is barely perceptible, as the aromatic components are present only in small concentrations. If the odor is pungent and unpleasant - for example, ammonia odor - you should be concerned.

The first common cause is dehydration. If there is not enough fluid in the body, the color of the urine becomes darker (up to brown), there is a sharp smell of ammonia. Often this is observed in the morning urination, because the body has lost a lot of fluid during sleep, and now its shortage needs to be replenished.

Of course, certain diseases are sometimes the cause, but certain foods can also give urine an ammonia-like flavor. Such foods and drinks include:

• Alcoholic beverages - have diuretic properties, increasing not only the volume of fluid excreted, but also the degree of its concentration, which accelerates and aggravates dehydration.
• Raw (unprocessed) onions and garlic - contain strong aromatic substances that get into not only urinary fluid, but also sweat secretion and exhaled air.
• Spices, seasonings - can strongly affect the aromatic properties of urine, give it unusual and even pungent shades.

In addition to food causes, there are other physiological factors that contribute to ammonia odor:

• A predominantly protein diet (protein is broken down to amino acids, which produce ammonia when broken down);
• the beginning of the monthly cycle in women (caused by changes in hormonal activity);
• pregnancy (due to hormonal changes, changes in the composition of microflora, changes in blood pressure, etc.);
• taking certain medications that affect metabolic processes (multivitamins, iron and calcium-containing drugs).

If the smell of ammonia in the urine is physiological in nature, it usually disappears quickly and is not accompanied by other pathological signs.

The presence of the disease can be suspected if, in addition to a systematic or strong ammonia "aroma", other symptoms begin to bother. For example, we can talk about such pathologies:

• Cystitis, urethritis are sometimes accompanied by unpleasant odors due to the development and vital activity of the infection. Associated symptomatology depends on the stage and localization of the inflammatory process.
• Pyelonephritis - often accompanied by lower back pain, fever, impaired urination and foul smelling urine.
• Diabetes mellitus - accompanied by increased levels of ketones in the body, which is exacerbated by the ever-present dehydration.
• Sexually transmitted infections, hepatitis, metabolic disorders, malignancies, tuberculosis.

In general, increased urinary excretion of ammonia occurs when:

• acidosis (non-renal);
• severe potassium and sodium deficiencies;
• primary aldosteronism;
• cystopoietitis.

Strong ammonia odor in urine can appear in almost any inflammatory processes in the genitourinary organs, as well as:

• If there are stones or sand in the bladder or urethra;
• for traumatic injuries, tumors of the urinary tract;
• for severe stress, urinary retention, endocrine disorders.

Many patients presenting for a strong ammonia odor during urination are found to have endocrine disorders - particularly hyperthyroidism and diabetes mellitus.

Risk factors

The risk group for ammonia odor in urine includes men over 40 years of age, as well as women in their 20s and 30s and obese people. With age, the risks increase and peak at 65-75 years of age. If parents or close relatives had cases of diabetes mellitus, urogenital diseases, then the probability of getting these pathologies in the patient increases.

Eliminable risk factors include:

• insufficient compliance with sanitary and hygienic rules (in particular, intimate hygiene);
• Infectious-inflammatory pathologies of the urogenital system;
• casual sex, practicing unprotected sexual intercourse;
• regular eating disorders, excess of proteins and simple carbohydrates in the diet;
• smoking, alcohol abuse;
• excessive body weight (contributes to the development of kidney disease, diabetes mellitus, pathologies of the urinary system);
• hypertension.

Patients with diabetes mellitus have a several-fold increased risk of inflammatory-infectious diseases due to neuropathy and the presence of glucose in the urine. These circumstances provide favorable conditions for the growth and reproduction of pathogenic microorganisms.

Pathogenesis

If hydrogen and nitrogen combine in the cellular structures of tissues and organs, the result is the formation of a gaseous substance that has no color but has a distinctive odor. This is ammonia, which is necessary to maintain acid-base balance, dissolution of amino acids that are formed after digestion of protein food.

The liver is the main organ with the ability to neutralize ammonia by transforming it into urea. After the liver, urea is transported through the circulatory system to the kidneys and then excreted by the kidneys during urination. In this case, the odor of ammonia in the urine should not be felt.

In some cases, patients may feel a foreign "flavor" due to non-pathological reasons - for example, after consuming too spicy food or alcohol, with insufficient water intake into the body. Pathologic causes include liver dysfunction, kidney dysfunction, and other diseases.

The normal rate of ammonia excretion with urine is 0.3-1.4 g. The odor of ammonia in the urine appears when this indicator increases.

Many aromatic changes in urinary fluid are temporary and are not associated with the development of a serious pathology, especially in the absence of other symptoms. However, if this phenomenon is observed regularly, or other painful signs begin to bother, you should definitely consult a doctor.

Epidemiology

The smell of ammonia in urine is not as rare as it may seem at first glance. According to statistics, such a symptom is detected annually in about 2% of patients. At the same time, in 7 out of 10 patients, the disorder is caused by the development of an infectious-inflammatory process in the urogenital system.

Women are somewhat more likely to experience this disorder than men. The average age range of those affected is 22-50 years, but the symptom is often detected in children and the elderly.

Medical experts emphasize that such figures are not indicative, as many people do not go to doctors, and either ignore the appearance of foreign odor in the urine, or engage in self-treatment.

Symptoms

To suspect one or another disease, manifested by the smell of ammonia in the urine, helps to carefully examine and interview the patient, detecting certain symptoms.

For example, in cystitis, in addition to an unpleasant pungent odor, it is possible to appear:

• pain in the groin and pubic area;
• urinary retching;
• frequent urge to urinate;
• fever, weakness (not in all cases).

It is important to remember that cystitis is more characteristic of women, which is due to the anatomical features of the urinary apparatus: the female urethra is wider and shorter, which favors the entry of the infectious agent.

Urethritis is more characteristic of men. With the development of the inflammatory process, an unpleasant ammonia odor appears, as well as other signs:

• swelling and redness of the outer part of the urethra;
• a burning and painful sensation every time you go to the bathroom;
• the appearance of abnormal urethral discharge.

The chronic inflammatory process can run a sterile course without definite clinical symptoms.

The smell of ammonia is also characteristic of pyelonephritis, a disease that affects both men and women equally. Additional symptoms of inflammation of the renal pelvis are often:

• Lumbar pain (especially on the side of the affected kidney);
• a rise in temperature;
• general weakness.

If the problem is caused by sexually transmitted infections, then along with a change in odor, other symptoms are detected: urinary fluid becomes dark, foreign impurities appear. Such a picture is observed in chlamydia, genital herpes, syphilis, gonorrhea, mycoplasmosis, trichomoniasis.

With insulin deficiency and impaired sugar absorption in the body there is an active utilization of proteins and lipids, resulting in the formation of non-proteinogenic amino acids that cause the appearance of ammonia aroma. This indicates a toxic effect of these products and requires medication.

In viral liver diseases, the first signs also include the typical ammonia odor. In addition, the urine becomes darker, it may be frothy when shaken. At the same time, lymph nodes increase, skin and mucous membranes turn yellow, feces become discolored, unpleasant pressure is felt in the right subcostal region.

It is noteworthy that in the chronic course of hepatitis, the smell of ammonia in the urine may be the only clear sign of pathology.

Ammonia odor in urine in women

Women and men have their own physiological peculiarities, which is reflected in some indicators of urine. In particular, in female representatives of the female sex, ammonia odor is detected much more often. This may be due to:

• hormonal changes that can affect the state of microflora and immunity, which increases the risk of infectious diseases;
• frequent bacterial infectious lesions of the urogenital sphere, which is due to the peculiarities of the anatomy of the female urogenital system;
• eating a large amount of fast carbohydrates, frequent dieting, associated with starvation and consumption of predominantly protein food, regular self-administration of multivitamin preparations and nutritional supplements not prescribed by a doctor.

In addition, the problem is often explained by a banal lack of water in the body: after establishing a water regime, the violation disappears without additional treatment.

Ammonia odor in urine in men

A change in urine odor towards ammonia is often noted in athletes who adhere to a high-protein diet - with a predominant use of eggs, meat, cottage cheese. Such products increase the acidity of urinary fluid. And the simultaneous consumption of large amounts of salt leads to an increase in the urine component concentration, which also aggravates the unpleasant odor.

The odor of ammonia is provoked by other disorders such as:

• cystourethritis, prostatitis;
• drinking small amounts of fluids, alcohol abuse;
• autoimmune diseases;
• hypovitaminosis;
• irrational and improper nutrition combined with high physical activity.

Prolonged discomfort, or the appearance of other symptoms - a reason to go to the doctor for diagnosis and treatment of the detected disease.

Ammonia odor in a child's urine

Children's bodies are characterized by more intensive metabolic processes than adults. In newborn babies, the urinary fluid is practically odorless, but with the introduction of complementary foods, the situation changes, and the diapers begin to clearly perceive an additional "aroma".

Stressors that influence the appearance of ammonia odor in urine in children can be:

• low fluid intake throughout the day;
• excessive consumption of protein foods;
• Consumption of low-quality food, abundant with synthetic additives, dyes, flavorings, etc.

In food disorders, the smell of ammonia is detected only periodically, and disappears after correction of the child's diet and the associated stabilization of metabolism. If the problem was caused by a violation of the drinking regime, the condition normalizes after the restoration of water-electrolyte balance.

If the odor is present for a longer period of time, it is important not to miss the development of the following pathologies:

• hepatitis;
• allergic processes;
• infectious and inflammatory diseases;
• helminth infections.

It is necessary to observe the child, identify other associated symptoms, trace after which the unpleasant ammonia odor appeared and how long it persisted. If there are other pathological symptoms, a doctor should be consulted as soon as possible.

Diagnostics of the ammonia odor in the urine

If a long-lasting ammonia odor is detected in the urine, you should consult a urologist, nephrologist or therapist. The doctor will prescribe the necessary diagnostic tests - laboratory and instrumental.

Laboratory tests include:

• blood and urinalysis;
• biochemical examination of urine, analysis for mineral inorganic substances;
• Biochemical blood test with determination of total protein, albumin, glucose, urea, direct and total bilirubin, total cholesterol, creatinine, serum lipase, α-lipoproteins and β-lipoproteins, triglycerides, potassium, calcium, sodium, iron and magnesium levels;
• assessment of C-reactive protein levels in the blood;
• quantitative determination of CA 19-9 and REA in serum;
• study of hormone levels, namely: insulin, prolactin, thyroid hormone, cortisol, follicle-stimulating and luteinizing hormones, thyroxine and triiodothyronine, free T4 and T3, progesterone, estradiol, testosterone;
• a study of hormone concentrations in urine.

Instrumental diagnostics most often includes ultrasound, radiography, and, less often, tomography (MRI or CT).

Differential diagnosis

As part of a comprehensive examination of the body, a differential diagnosis is performed:

• kidney and urinary system diseases;
• metabolic pathologies, disorders of water-electrolyte balance;
• of gastrointestinal disease;
• infectious inflammatory diseases;
• endocrine pathologies.

In addition, the possibility of nutritional disorders, nephrotoxic medications is also considered. The differential diagnosis may involve doctors of different specialties, including therapist, pediatrician, urologist and nephrologist, gastroenterologist, cardiologist, neurologist, surgeon, gynecologist, endocrinologist and infectious disease specialist.

Treatment of the ammonia odor in the urine

In mild cases, eliminating the smell of ammonia in urine can be done in simple and affordable ways:

• Establish a drinking regimen by drinking a daily amount of water equal to 30 ml per 1 kg of body weight;
• Revise the daily intake of protein food (the norm for an adult is 1.5-2.5 g per kg of body weight;
• Stop taking medications and supplements not prescribed by your doctor.

If the foreign odor continues to be present in the urine, or if there are other suspicious symptoms, it is necessary, without delay, to visit a doctor.

When the disease is detected, treatment is directed towards its elimination. Often prescribed antibiotic therapy under the control of urine analysis (culture for flora and sensitivity to antibiotics), as well as drugs aimed at eliminating urinary stasis. Often intensive multiplication of urinary bacteria is due to impaired urine outflow from the kidneys or bladder. In such situations, antibiotic therapy is supplemented with surgery to restore normal outflow and eliminate stasis.

Medications

A competent approach in the elimination of ammonia odor in urine may include taking anti-inflammatory, antibacterial, antifungal agents, antispasmodics, depending on the main detected disease.

If there is an inflammatory process, it is appropriate to prescribe anti-inflammatory drugs such as Diclofenac, Ibuprofen.

Diclofenac	Tablets are taken twice a day (daily dosage is 100-150 mg). Rectal suppositories are used daily, at night, for one week. Possible side effects: nausea, diarrhea, abdominal pain, heartburn, skin rashes.
Ibuprofen	Tablets are prescribed 1 pc. 3 times a day, after meals. The drug is not intended for long-term use, as it may provoke gastrointestinal disorders.

Antispasmodics (Drotaverine, Spasmalgon) eliminate muscle spasms, which improves urinary fluid outflow.

Drotaverine	The drug is prescribed for spasms of smooth muscles of urinary and gastrointestinal tract 120-240 mg per day (divided into 2-3 doses). For children dosages are set individually (the drug is contraindicated before 6 years of age).
Spasmalgon	Take orally after meals, drinking water. The recommended daily dosage is 1-2 tablets. The duration of intake is not more than 3 days. Possible side effects: dry mouth, decreased blood pressure, exacerbation of gastritis and peptic ulcer disease.

Antibacterial agents (Monural, Abactal, Rulid) stop the multiplication of bacterial flora and thus eliminate the cause of the inflammatory reaction.

Monural	It is used for the treatment of uncomplicated infections of the lower urinary tract. The drug is taken on an empty stomach, at night. Possible side effects: diarrhea, nausea, heartburn, allergic reactions.
Abactal	It is used for urogenital infections, gonorrhea, as well as other infectious lesions caused by sensitive microorganisms. Orally administered 1 tablet per day (every 12 hours), usually for 3 days. The drug is usually well tolerated by patients.

Antifungal agents (Fluconazole, Diflucan) are used in case of fungal (or mixed) origin of the inflammatory process.

Fluconazole	Prescribed in individual dosages, depending on the specifics of the pathological process. Possible side effects: taste disturbances, headache, nausea.
Diflucan	The dosage depends on the type and severity of the fungal infection. Treatment may be accompanied by some side effects such as headache, stomach pain, diarrhea, skin rash.

Mild antimicrobial action has some phytopreparations, such as Kanefron, Fitolizin. Their use is appropriate for cystitis.

Kanefron	Natural diuretic, antispasmodic and antimicrobial agent. Take 2 dragees three times a day.
Phytolysin	Plant antispasmodic and analgesic drug with diuretic activity. Strengthens the effect of antibiotics. Dilute 1 tbsp. Of paste in 50 ml of water, take the resulting suspension three times a day.

The effectiveness of treatment depends not only on a timely correct diagnosis, but also on a competently designed treatment regimen. As a rule, such a scheme contains a complex of drugs that eliminate the cause of pathology and alleviate the symptoms. In addition to drug therapy, one should not forget about the correction of diet and drinking regimen, as well as compliance with hygienic rules.

Physiotherapy treatment

Many symptoms of urological pathologies, including the smell of ammonia in the urine, disappear faster if the drug treatment is supplemented with physical therapy. In particular, the doctor may prescribe such procedures:

• laser and magnetotherapy;
• laser therapy and short-pulse electroanalgesia;
• UHF;
• UHF;
• sinusoidal modulated currents;
• endovesical phonophoresis.

The treatment may combine electrophoresis with sinusoidal modulated currents. CMT-electrophoresis is indicated in patients with chronic inflammatory processes, a marked disorder of urinary fluid outflow and detrusor hypertonus. At the recovery stage, laser therapy, UHF, ultrasound may be prescribed.

The use of heat treatments is in most cases inappropriate and even contraindicated.

Herbal treatment

It is not recommended to treat the disorder on your own, even if you know the exact diagnosis. Using folk remedies without consulting a doctor is quite dangerous, because you can aggravate the situation and harm your health. Optimally, if herbal treatment is combined with drug therapy and approved by the attending doctor.

With the appearance of ammonia odor in the urine, it is possible to use such folk recipes:

• Take 500 g of fresh parsley (leaves, rhizomes) and pour 1 liter of boiling water, insist under a lid for 1 hour, then filtered. Take the remedy by one sip up to eight times a day.
• Take 1 tbsp. Aspen leaves, pour 200 ml of boiling water, insist for 1-1.5 hours. Filter and take the infusion of 1 tbsp. 4 times a day, between meals.
• Prepare a tea of cowberry leaves. Drink one glass three times a day. Duration of treatment - at least one week.
• Take one tablespoon of rosehip root, brew 500 ml of boiling water, insist for 2 hours. Filter and take 100 ml half an hour before meals, three times a day. Duration of therapy - 4 weeks.

It is recommended to drink instead of regular tea during the day infusion of chamomile, St. John's wort, marigolds. It is useful to add cranberries to the diet: from berries you can make compotes, morsels, desserts, add them to salads and second courses.

Surgical treatment

Surgical treatment may involve minimally invasive interventions or complex (often cavitary) operations. Surgical interventions are often indicated for ammonia odor in urine and urological diseases, such as urethral narrowing, removal of malignant and benign lesions, and urolithiasis.

Today, laser and radio wave surgery techniques are used to perform these and some other operations. Thanks to these methods, it is possible to significantly reduce traumatization during the intervention, facilitate postoperative recovery of patients and reduce the time of their stay in hospital.

In order to find out whether and to what extent surgery is required, you should consult a doctor who will perform the necessary diagnostic measures and assess the need for such treatment.

Complications and consequences

The likelihood of developing complications depends on what disease caused the ammonia odor in the urine.

• Complications of cystitis can include pyelonephritis, kidney infections, stone formation, urinary incontinence (overactive bladder), and sphincter dyssynergia.
• Urethritis can be complicated by cystitis and other inflammations of the urinary tract, violation of the vaginal microflora, renal failure, reproductive disorders.
• Pyelonephritis can cause the development of complications, both from the kidneys and the whole body. Among the most common adverse effects are renal abscess, renal failure, and sepsis - the entry of pathogens into the circulatory system.
• Venereal diseases, which are accompanied by the appearance of ammonia odor in the urine, are often complicated by numerous inflammatory pathologies - cystitis, endometritis, prostatitis, epididymitis, adnexitis, orchitis. The risk of developing neoplasms in the genital system, adhesions, strictures, and infertility increases - both in women and men.
• In diabetes mellitus, the most common deteriorations are hypoglycemia (hypoglycemic coma) and ketoacidotic coma.
• Complications of viral hepatitis are considered functional and inflammatory pathologies of the biliary tract, as well as hepatic coma.

Prevention

• Eat right, adjust your diet: increase the daily proportion of fruits and vegetables, complex carbohydrates, seafood, do not abuse sugar and animal fats, protein food.
• Observe the rules of personal and intimate hygiene, take regular showers, wear clean and quality lingerie, matched to the size.
• Seek medical attention in a timely manner, even with seemingly minor symptoms.
• Ensure adequate physical activity, avoid both hypodynamia and overloading the body.
• Get rid of bad habits (smoking, drinking alcohol).
• Normalize your body weight by consulting an experienced nutritionist beforehand.
• Be responsible about sexual contacts, avoid casual liaisons, practice protected sex.
• Be attentive to your health, especially if you have chronic pathologies, as well as in pregnancy.

Forecast

In order for the treatment of the disease to be successful, it is important to strictly follow the recommendations of the attending doctor. If there is pain or other signs of deterioration, it is necessary to immediately notify the doctor. You should not independently take medications, use heating procedures, limit yourself in the use of fluids. But it is better to exclude coffee, alcohol, salt and spicy spices: this will improve the outcome of the underlying pathology.

It is equally important to pay attention to the quality of hygiene procedures: take a daily shower, using hypoallergenic hygiene products. At the same time, it is better to avoid going to the bath or sauna.

Fresh urine is normally free of foreign odor. The smell of ammonia in the urine appears in stagnation of urinary fluid, or in diseases such as cystitis, pyelitis, pyelonephritis. In this case, the prognosis depends entirely on the prognosis for the underlying disease. Often it can be considered favorable, provided persistent long-term treatment with compliance with all medical recommendations.

List of authoritative books and studies related to the study of ammonia odor in urine

1. "Clinical Chemistry: Principles, Techniques, and Correlations" - by Michael L. Bishop, Edward P. Fody, Larry E. Schoeff (Year: 2021)
2. "Tietz Textbook of Clinical Chemistry and Molecular Diagnostics" - by Nader Rifai, Andrea Rita Horvath, Carl T. Wittwer (Year: 2020)
3. "Urinalysis and Body Fluids" - by Susan King Strasinger (Year: 2015)
4. "Interpretation of Diagnostic Tests" - by Jacques Wallach (Year: 2014)
5. "Henry's Clinical Diagnosis and Management by Laboratory Methods" - by Richard A. McPherson, Matthew R. Pincus (Year: 2016)
6. "Clinical Chemistry: Techniques, Principles, Correlations" - by Michael L. Bishop (Year: 2018)
7. "Urinalysis: A Clinical Guide to Compassionate Patient Care" - by Nancy A. Brunzel (Year: 2021)
8. "Chemistry and Diagnostic Errors" - by Gregory J. Tsongalis (Year: 2017)
9. "Clinical Chemistry: Concepts and Applications" - by Henry, Naomi H.; Tiedeman, James S. (Year: 2021)
10. "Laboratory Medicine: The Diagnosis of Disease in the Clinical Laboratory" - by Michael Laposata, Paul L. Knechtges (Year: 2019)

Literature

• Lopatkin, N. A. Urology: National Guide. Brief edition / Edited by N. A. Lopatkin - Moscow : GEOTAR-Media, 2013.
• Mukhin, N. A. Nephrology: National Guide. Brief edition / ed. By N. A. Mukhin. - Moscow : GEOTAR-Media, 2016.