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Incontinence

20 November 2019

Why you should pay special attention to urinary tract infections in children

We tend to associate UTIs and bladder infections with adult women, but they affect young children and babies too… and there could be complications if left untreated.

Urinary tract infections (UTIs) occur when there is inflammation in the pelvic region, including the bladder and urethra.

UTIs commonly happen when bacteria from the rectal region come into contact with the skin around the opening of the urethra, which leads to the bladder.

UTIs are especially common among girls (because of a shorter urethra) and uncircumcised boys.

Recurrent UTIs

Some kids get UTIs frequently – this is known as recurrent UTI and can cause significant kidney damage, especially in children younger than six.

The signs and symptoms of UTI

Signs and symptoms of UTI often go unnoticed, so it is suggested that parents be on the lookout for the following symptoms:

  • Complaining of pain, burning or stinging when urinating
  • Urinating more or less than usual
  • Darker coloured or strong smelling urine
  • Fever
  • A loss of appetite, listlessness and general malaise
  • Pain in the lower abdomen or back
  • Sudden bed wetting

Are there underlying reasons for UTIs?

When a UTI is diagnosed, it can often be treated successfully with a course of antibiotics. But when a UTI is recurring, it could be because of an underlying condition that may cause serious complications if not treated.

One of these is vesicoureteral reflux (VUR). This condition happens when the urine flows back from the bladder into the kidneys and the ureters. When this happens, urine can pool in the kidneys and, in rare cases, lead to infection of the kidneys. VUR is common and occurs in 30%–50% of children diagnosed with UTI.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) in the US, most children who have underlying VUR responsible for a UTI recover fully. The situation can, however, lead to other problems such as urinary incontinence and bed wetting, or bowel problems like fecal incontinence.

Another condition that may cause a UTI is enlargement of the kidneys (hydronephrosis) caused by blockage of the urine flow.

Other more complicated reasons

Sometimes, recurring UTIs occur for other reasons that are not easily diagnosed. Children may be suffering from something called dysfunctional voiding – where they don’t relax the muscles properly and can’t completely void the bladder. Not urinating often enough or trying to hold in urine can also cause a UTI.

A child should therefore be encouraged to properly empty their bladder and make a habit of going to the toilet as soon as they feel the urge – not holding it in.

Other than these, children can also suffer from recurring UTIs if there is an abnormality in the immune system.

Treating UTIs

Treatment depends on what is causing the UTI in the first place. Antibiotics and simply teaching your child to completely empty their bladder or wipe from front to back will help. In cases such as VUR, the condition can be outgrown, but the child needs to be constantly monitored for kidney infection.

According to Dr George Flesh, director of urogynaecology and pelvic reconstructive surgery for Harvard Vanguard Medical Associates, a UTI should be thoroughly diagnosed, no matter how many symptoms there are or how insignificant the symptoms may appear. 

Prevent and manage UTIs

These tips may help to prevent UTIs or catch them early:

  • Encourage your child to drink enough water during the day.
  • Encourage them to talk to you if there is any discomfort or pain when they go to the loo.
  • Avoid bubble baths and fragranced soaps.
  • Teach your young daughter to wipe from front to back to avoid bacteria spreading to the urethra.
  • Teach your child not to hold in urine.

Image credit: iStock

 

Ask the Expert

Incontinence Expert

Dr Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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