Doc, why does my urine stink?

Dr Flo, I drink at least two litres of water daily and my urine is clear, but after going to the toilet the urine drips on my undies and it stinks.

I have tried wearing two boxers and bikers but that hasn’t contained the smell. I have resorted to squatting to relieve myself, but whenever I stand, walk or sit, I feel urine dripping. I even shake my male organ after passing urine but I still feel like there is urine left.

I eat the normal food, and I don’t drink or take drugs. I am not on medication and I don’t have sexually transmitted infections. Is the problem the fabric of my underwear or my body? Please help me. ADN

Dear ADN,

Urine usually has the smell of ammonia, which is stronger or weaker depending on how well hydrated you are.

The smell of urine can be affected by food and drink (e.g. onions, garlic, asparagus, brussel sprouts, salmon, spices, alcohol, and coffee), medication and vitamin supplements.

Diabetes can also cause urine to have a sweet smell. Genetic diseases such as maple syrup urine disease and phenylketonuria can also affect the smell of urine, but these are rare, very serious diseases that are usually diagnosed in infants.

 Keep taking a lot of water and avoid any food or drink that may be affecting the smell of urine.

The dripping of urine after urinating is called post-micturition dribble. It happens in many men, because the urethra is not straight; it has a small curve, and some urine may remain in it and drip down later due to gravity.

 The only way to manage this is to take your time when passing urine, allowing time for the dripping afterwards. Also, do pelvic floor exercises to strengthen the pelvic floor muscles so that they are better able to push the urine out.

To do this, contract the pelvic muscles as though you are stopping the flow of urine. You can identify the specific muscles by stopping the urine mid-flow when you are urinating. Contract these muscles for about 10 seconds, 10 times in one set, and six to 10 sets in a day.

Dr Flo, I am 30 years old and I have three kids. The youngest was born in 2016 and my periods resumed a year after his birth. However, two weeks before my periods resumed, my left knee got uncomfortably warm. I have had the feeling on and off for nine months. It usually comes two weeks before my periods, lasts about three days, then disappears. I walk a lot and I don’t eat lunch most of the time. My diet consists of tea and chapati in the mornings and ugali with sukuma wiki in the evenings. I weigh 52 kilogrammes and I am still breastfeeding. What might be the problem? CBN

Dear CBN,

Three out of four women develop some symptoms every month before, during or after their periods. This is called premenstrual syndrome.

The symptoms vary from person to person, and may change from month to month, and disappear when you are pregnant or after menopause. The symptoms may also change over time, and may be altered after a pregnancy.

The symptoms may be mild or severe and may include physical symptoms, emotional symptoms and behaviour changes. Joint inflammation is one of the possible symptoms, which is why your knee feels warm. The fact that it comes at a particular time in the cycle then disappears, suggests that it is affected by the monthly hormonal changes.

Excessive walking and low calcium may worsen the symptoms when they occur. You need to add proteins to your diet and foods rich in calcium, especially because you are breastfeeding. You can use a cold or ice pack to cool down and rest the knee whenever it feels inflammed.

Dr Flo, I have suffered from stomatitis since birth and efforts to get effective treatment in the 52 years I have been alive have proved futile. What can I do to resolve the issue once and for all? NM

Dear NM,

Stomatitis is inflammation of the mouth or lips, with or without developing wounds, sores or ulcers. It can affect the lips, the inside of the cheeks, the gums, the tongue or the palate (the roof of the mouth).

It may be an apthous ulcer (usually white in the centre with a red border), or cold sores (blisters that form on the lips every time you have a cold) or it may be due to biting yourself, or injury caused by a sharp tooth or by braces, or by chewing tobacco, or from hot food or drinks.

 Food or drug allergy can cause stomatitis, as can some autoimmune diseases like lupus, Crohn’s disease or Behcet’s disease. Some treatments like chemotherapy, radiotherapy, epilepsy medication, antibiotics and some immune modulating medicines can also cause stomatitis.

Since your condition has been recurrent over 52 years, it may be due to cold sores, which are caused by the herpes simplex virus. Most people get infected in childhood. The virus never goes away, it hides in the body and is reactivated when you are stressed, when you have a cold or when there are hormonal changes in the body.

You may also be getting aphthous ulcers, otherwise known as canker sores. In most cases, there is no known cause for aphthous ulcers. They may appear when you bite yourself, when you are stressed, if you don’t sleep or eat well, if you lose weight too fast, if you take acidic foods or drinks, if your immunity is lower like when you have a cold, or when there are hormonal changes, or even from bacterial, fungal or viral infection.

It may also be from vitamin B12 or folate deficiency. Some people are genetically predisposed to having the sores, and this may be a result of an auto-immune disease. In an auto-immune illness, the body’s immune system forms antibodies against some tissues in your own body, in this case, against your mucus membranes. You may, therefore, benefit from screening for vitamin B12 and folate deficiency and for auto-immune illnesses like Behcet’s, Crohn’s disease and lupus.

You cannot completely eradicate the sores. To manage the stomatitis, gargle with some salty water or mouth wash, use topical creams to relieve the pain and inflammation, and use anti-viral medication for the cold sores.

 Avoid very hot food or drinks, and avoid very salty, spicy or acidic foods. Take a lot of water and maintain good dental hygiene.  You may also benefit from vitamin B and folic acid supplements. If a sore lasts for more than two weeks without healing, you need to be reviewed by a doctor.

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