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I would say sanitation was more of a problem than "pollution" in the modern sense. The causes of disease were poorly understood. and in urban areas drinking water sources might not be well protected from contamination. Diseases like cholera were a problem in Europe well past the middle ages, and was often spread by contaminated drinking water sources. Sanitation issues my have contributed to the the ubiquitous consumption of ale. Medieval ale was fairly low in alcohol, and because the liquid was cooked in the brewing process it was much safer to drink than water (although medieval people may not have clearly understood this, and certainly did not understand why).

Trash and refuse are issues in any urban environment, As urban populations grew over the middle ages cities developed methods to deal with them. Many cities had regular trash cart services, and we have many examples of cities passing ordinances about keeping streets free from clutter and garbage. Sewer systems were very rare in medieval Europe, outhouses were the common solution. These were periodically mucked out and the contents taken to dump sites outside of the cities, where the material could be used as fertilizer.

People often used chamber pots inside their houses to go to the bathroom. They would throw these contents out into the street. The contents would mix with manure from horses and oxen. People with money would often wear high heels to walk in the streets, even men.

Diseases like the Black Death were common at these times and the sanitation problems help spread it. People did not understand that about microbes at all as they could not see them.

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