Management and prevention of UTIs

What to do when you have cloudy and/or smelly urine:

1. How to tell if the urine is cloudy

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  Catch fresh urine in a clear plastic cup or glass, don’t let it sit.

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  Hold the cup against a bright light or a window and observe

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  Clear urine allows the light through, whilst cloudy urine looks milky or foggy

2.  How to tell if the urine is smelly

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  Catch fresh urine in a container, don’t let it sit.

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  Sniff over the open end of the container and compare the smell to your baseline

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  If it has a sharp pungent smell, then it is smelly urine.

3.  Why does urine sometimes get cloudy or smelly in the neurogenic bladder?

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  Missed a CIC (didn’t do 5 times in 24 hours)

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  Inadequate intake of water

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  Could be a sign of poor hygiene when performing CIC

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  Could be a sign of UTI

4.  What to do when you have cloudy  and/or smelly urine

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  Cloudy and/or smelly urine is common in neurogenic bladder

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  Cloudy and/or smelly urine may indicate that you have a urinary tract infection (UTI). This will need assessment by a doctor to confirm. If a UTI is confirmed, treatment is guided by your doctor.

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  In the meantime at home, the following steps may help as you arrange to see a doctor

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  Increase your intake of water- this helps to flush out your bladder. If you have been diagnosed with kidney disease or failure, it is important to consult your doctor to know how much fluid you can take

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  Perform CIC more than 5 times a day- this means urine is emptied from your bladder more frequently. The longer the urine stays in the bladder, the more bacterial growth occurs in the bladder. When frequency of CIC increases along with increased water intake, this can help to flush out the bladder and reduce bacterial growth in the bladder.

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  Pay close attention to hygiene when performing CIC- wash hands thoroughly before the procedure, wipe the genital area well before inserting the catheter and ensure thorough washing of the catheter after CIC and storage on a clean and ironed piece of cloth. 

5.  What can I expect will happen?

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  If the smelly urine was caused by dehydration or urine stagnation, with extra fluid intake and extra CICs, the odour and cloudiness should improve and clear within 24 to 48hours

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  When cloudiness and odour clears, continue your routine 5 times a day CIC, ensure you are taking an adequate amount of water daily and maintain hygiene when performing CIC.

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  If the cloudiness and odour do not clear within 24- 48 hours, or if you develop systemic symptoms (described in the section below), arrange to be seen by a doctor promptly.

6.  When to see a doctor promptly

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  Cloudy or smelly urine is common with neurogenic bladder and does not always mean you have a dangerous infection.

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  However, when you have any of the following symptoms make sure you see a doctor promptly: fever, pain in the lower abdomen, flank pain, lower back pain, lethargy, irritability, nausea and vomiting, blood in the urine. ( Note that in spina bifida, because of reduced or absent sensation, and depending on the spinal level of the lesion, one may not feel pain at all or may not be able to tell where the pain is coming from).