Hi, I’m Steve Hodges, Associate Professor
of Pediatric Urology at Wake Forest University School of Medicine. I want to talk to you
about urinary tract infections in children- primarily little girls, because that’s who
gets most of them. Many of you may not be familiar with the urinary
tract. Blood goes through your kidneys- you have two of them which produce urine- which
flows down to the tubes called the ureters into your bladder, where you store the urine
and then evacuate it when you need to. Every urinary tract infection in a little
girl happens when bacteria from the colon comes out of the colon, travels up into the
urethra and bladder and sets up shop. And that’s what causes urinary tract infections.
They can present with varying symptoms- typically urgency and peeing very quickly- dysuria or
pain while urinating. Sometimes it can even progress to urinary frequency and sometime
fever, chills, nausea, vomiting. And those there are actual kidney infections- which
we won’t talk about right now- we’re going to focus primarily on the bladder infections.
I want to talk about how urinary tract infections happen and some of the myths about them. So
we discussed that every infection happens when bacteria travel into the bladder from
the colon. So there’s only three risk factors that girls
can have that cause infections: the primary one is constipation, if you don’t let all
of the stool out of the colon, that can lead to infections; second, is vulvitis or inflammation
of the skin between the rectum and the urethra, that allows bacteria that cause infections
to live on the skin more easily and make its way into the bladder; and the third is incomplete
or irregular emptying of the bladder, kids hold their urine too long and that is a definite
way to lead to infection. A good reminder about that is that I very
rarely see urinary tract infections in children prior to toilet training. That’s because they
have less instance of constipation, their moms usually take really good care of their
bottoms, and they never hold their urine because they don’t have a reason to.
Some common myths for infection include the way you wipe. In fact it’s never been proven
that wiping front-to-back or back-to-front has any effect on the incidence of infections.
Also, a lot of physicians will tell kids not to take baths and to take showers instead
and that really has no bearing on infections- depending on what kind of bath you take. If
you’re in irritating soaps or bubble baths sometimes it can cause inflammation which,
as we mentioned, vulvitis, is a factor in infections.
But sitting in tubs can be beneficial sometimes especially if you use non-irritating soaps.
And sometimes if you have irritation on your bottom, just using baking soda or oatmeal
or a cup of apple cider vinegar can actually soothe the irritation.
People often use cranberry juice to help treat infections. Cranberry juice- there’s rare
data that may help prevent infections, but it’s not very strong and it definitely cannot
treat infections. So the main thing for little girls to do to
help prevent infections is number one: treat the constipation; number two: make sure the
bottom is clean and dry; and number three is urinate on time. If you do those three
things, it’s impossible to get an infection. If you think your daughter has an infection
because she’s peeing frequently, peeing very urgently, or having new onset incontinence,
or pain with urinating, then you should take her to the physician where they will check
a urine study- it’s called a urinalysis. The child voids into a cup and they look at
it under a microscope and there are certain findings on that analysis that will tell them
there’s an infection. If the infection has no fever- just those
bladder symptoms we discussed- then it’s very simple to treat: you just take some antibiotics
and it gets better. If the child has fever and nausea/vomiting
and flank pain, then that could mean a kidney infection which is much more severe and you
may need some imaging studies such as a renal ultrasound or a voiding cystourethrogram to
evaluate the child’s anatomy to see why they are at risk for these worse infections.
It’s important though, if you have these new bladder symptoms, to see your pediatrician
to get this evaluated quickly.