Updated 17 August 2015

Answer: What's your diagnosis? – Case 23

Mr O suspects that his 5-year-old daughter has a urinary tract infection. However, a common cause of frequent urination in young children is faecal overloading, which is the most likely diagnosis in this case.


Mr O read that frequent urination is one of the symptoms of bladder infections in young girls. These are not uncommon in young children and may cause significant problems like kidney failure if left untreated.

We do not have enough information to exclude urinary tract infection as the cause of the young girl's urinary frequency, but usually, with urinary tract infections, pain on urination, burning, itch or foul smelling urine, are usually also present. Unexplained fevers may also suggest urinary tract infections.

Vital clues

The fact that the young girl does not follow an optimal diet is cause for concern. Children can easily become constipated as their toilet habits are not yet well established. A clear diet history is always important when dealing with young children.

Read: What is constipation?

Before doing any special investigations, clinical examination may provide some vital clues to making a proper diagnosis. In young children a full examination is required at all times. An examination should never jump straight to vaginal examination to exclude local causes. Systemic examination may highlight probable causes like constipation.

Doing sideroom urine testing is important. A urinary tract infection may show up on simple urine dipsticks, but it is important to send a urine sample to a laboratory for microscopy and culturing when faced with a possible urinary tract infection. If urine testing is clear, a plain abdominal X-ray may reveal faecal overloading, which will explain the urinary frequency with the colon pressing on the bladder. This is of particular importance in otherwise asymptomatic children.

Besides ensuring a proper diet, parents should be aware of the toilet habits of young children. Noticing when a child passes stool is important.

Another important cause of frequency and urinary tract infections that should always be considered is sexual abuse. This possibility should always be investigated – especially in children with recurrent urinary tract infections.

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? -  Case 1: vomiting and weight loss

What's your diagnosis? -  Case 2: eye pain

What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

What's your diagnosis? - Case 6: runner with seizures

What's your diagnosis? - Case 7: swollen knee

What's your diagnosis? - Case 8: bloody semen

What's your diagnosis? - Case 9: confusing neurological signs

What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis? - Case 11: bruising with no apparent reason

What's your diagnosis? - Case 12: severe tummy pain

What's your diagnosis? - Case 13: severe sore throat

What's your diagnosis? - Case 14: abdominal pain and swelling

What's your diagnosis? - Case 15: the world is spinning

What's your diagnosis? - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? - Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

What's your diagnosis? – Case 20: chest pain next to breastbone

What's your diagnosis? – Case 21: burning sensation in vagina

What's your diagnosis? – Case 22: vomiting and headaches

What's your diagnosis? – Case 23: frequent urination

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