Peeing is a mundane but important part of life.
“The kidneys are the scrubbers of the body, and they filter out all the toxins and waste that we don’t want in our blood,” says UNC Health urologist Mary Beth Westerman, MD. “That waste is diluted with water and comes out as urine.”
The specifics of your urine—much like the specifics of your bowel movements—aren’t typically considered topics for polite conversation, but that can leave you wondering if you’re having a problem. We asked Dr. Westerman what’s normal and what symptoms you shouldn’t ignore.
Color
Healthy urine can range between a pale, almost transparent yellow to a darker yellow, and it will likely change in appearance throughout the day.
“The color is very much dependent on how much water you’re drinking,” Dr. Westerman says. “In the morning, it’s likely to be a darker yellow because you’ve gone the night without drinking water.”
You’re getting enough water when your pee is more on the clear, see-through side than a darker shade.
Cloudy urine, with a milky or hazy tint, can be a sign of a urinary tract infection, but if you’re not having any other symptoms, such as pain while urinating or fever, you might just need more water.
Some medications can make your urine turn a different color, as can some foods (as anyone who has ever eaten beets knows), but if your urine is any color other than yellow and you’re not taking one of those medications, talk to your doctor.
Smell
Because urine contains the waste products urea and uric acid, it will produce an odor like ammonia. How perceptible that odor is can vary by time of day and your hydration levels.
“A lot of people notice a strong odor in the morning, when they’ve had less water and the waste is more concentrated,” Dr. Westerman says.
Your diet also plays a big role; asparagus, onions, garlic and coffee are notorious for changing the smell of pee.
If you’re concerned about the smell of your urine, start by drinking more water. If you notice a strong, bad smell that lasts for a few days, talk to your doctor. It could be the sign of an infection, especially if you’re having other symptoms, such as fever or pain.
Urine that persistently smells sweet and fruity can be a symptom of diabetes.
Frequency and Urge
How often you go to the bathroom will vary.
“There’s really no such thing as normal or abnormal with frequency,” Dr. Westerman says. “It depends how much you’re drinking and how much water you’re losing through other parts of your body. When it’s really hot and you’re sweating, you’re not going to pee as often.”
If you’re only going a few times a day, take note of your urine’s color—if it’s dark yellow, you’re probably not getting enough water.
You probably have an idea of how often you go per day when you’re well-hydrated, and if there are sudden changes to that—you suddenly feel like you have to pee every 30 minutes and you’re not drinking more water—talk to your doctor. It could be a urinary tract infection, pelvic floor dysfunction or a prostate issue; more frequent urination can also be a symptom of diabetes.
The number of times you pee—frequency—is different than how often you feel the need to pee, which is urgency. If you’re having sudden urgency and can’t get to the bathroom in time, or you rush to the bathroom only for nothing to come out, talk to your doctor.
Urgency issues can signal a wide variety of issues, including infections or inflammation in the urinary tract, bladder or prostate, overactive bladder, pelvic organ prolapse and menopause. You may have an issue with the nerves that run from the bladder to the brain.
People with urgency issues often benefit from pelvic floor physical therapy.
“Some people carry stress in their back and shoulders, but some people carry it in their pelvic floor,” Dr. Westerman says. “When those muscles get tight, it can be hard to pee, so pelvic floor physical therapy can teach you how to relax those muscles.”
If issues with either frequency or urgency are affecting your quality of life, talk to your doctor.
Urination Changes As You Age
As you get older, you may notice changes with frequency and urgency.
The transition to menopause, when estrogen drops, can cause changes to the vaginal lining and bladder-related symptoms, Dr. Westerman says.
“Women might feel like they have more burning with urination, more frequent UTIs or have to go more frequently. We have a great treatment for that: vaginal estrogen.”
Vaginal estrogen, typically a cream or a tablet, is applied directly to the vagina and directly impacts vaginal and urinary symptoms, as opposed to systemic menopause hormone therapy, which is usually a patch that circulates estrogen throughout your entire body to help with a wider variety of symptoms.
Men also may experience increased urgency as they age because of enlarged prostate, making it harder to empty the bladder all the way. Talk to your doctor if symptoms are affecting your quality of life.
You may notice that you get up in the middle of the night more often to pee, but it’s not always your bladder’s fault.
“Sometimes, it’s other medical issues, like sleep apnea, that are waking you up, and then once you’re up, you think you might as well go to the bathroom,” Dr. Westerman says.
Tell Your Doctor About These Urinary Symptoms
If you see blood in your urine or in the toilet, tell your doctor.
“It may just be an infection, but in about 10 percent of people who see blood, it’s due to bladder cancer,” Dr. Westerman says. “It may be your only symptom, but we still strongly push for an evaluation.”
Blood in the urine also could be a sign of kidney cancer or prostate cancer, but this symptom may happen only once and then go away, so don’t wait once you’ve noticed it. You could miss out on a timely diagnosis and months of treatment if you wait for a second instance.
If you’re having any changes to your urinary habits or you notice strong and persistent odors, and you’re having other symptoms, such as fever, lower back pain or burning during urination, talk to your doctor. Most likely, it’s a urinary tract infection, which can be confirmed with a urine test, but if you finish a course of antibiotics and symptoms don’t resolve, you may require additional evaluation.
“Women are the minority of bladder cancer patients, but they tend to be treated with more rounds of antibiotics for UTIs before they get a diagnosis, while men are referred for an evaluation much sooner,” Dr. Westerman says. “If symptoms come right back after treatment, it needs more investigation.”
Healthy lifestyle habits such as eating a balanced diet, regular exercise and adequate hydration will help keep your urine normal.
“Diabetes and high blood pressure are toxic to the kidneys, so keep your blood sugar and blood pressure controlled,” Dr. Westerman says. “Eat foods that aren’t ultraprocessed and drink plenty of water. If your kidneys are healthy, your urine is healthy.”
Concerned about urinary symptoms? Talk to your doctor or find one near you.