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Recurrent Urinary Tract Infections

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Many children get urinary tract infections (UTIs). Common types of UTIs in children include:

  • Cystitis - a bladder infection that happens when bacteria move up the urethra (the tube where urine leaves the body) into the bladder
  • Urethritis - when bacteria infect the urethra
  • Pyelonephritis - a kidney infection that happens when bacteria from the bladder make their way into the kidneys

Some kids get UTIs repeatedly; these are called recurrent UTIs. Sometimes, recurrent UTIs in a child might mean there is a problem with the structure or function of the urinary tract. If not treated, UTIs can cause kidney damage, especially in children younger than age six. That's why it's important your child's doctor monitors and evaluates UTIs if they seem to happen often with your child.

Who gets recurrent urinary tract infections?

Many children get urinary tract infections, but they are more common in girls and uncircumcised boys. About 8% of girls have had at least one UTI by the age of five; about 2% of boys have had at least one.

What causes recurrent urinary tract infections?

Bacteria repeatedly entering and growing within a child's urinary tract cause recurrent UTIs. E. coli, a bacterium present in feces, is the most common cause of children's urinary tract infections.

Among the factors that increase the chance of recurrent UTIs in children are:

  • Constipation (when your child does not have 1-2 soft bowel movements per day).
  • Waiting too long to release the urine in the bladder. When your child holds his or her urine, this gives the bacteria a better chance to multiply in the urinary tract.
  • Not drinking enough. This prevents the bacteria from being flushed out of the urinary tract regularly.
  • Vaginitis. Irritation of the skin outside the vagina causes pain when girls urinate, which encourages them to hold their urine longer than they should, increasing the risk of UTIs.
  • Dysfunctional voiding. When children repeatedly hold their urine for too long, the bladder muscles become weak. Then the muscle that holds the bladder closed can't relax and open properly. This can lead to problems with how the bladder empties, and can allow bacteria to remain in the bladder and cause urinary tract infections.
  • Improper hygiene. If girls wipe from back to front, that brings bacteria closer to the urinary tract.

What are the symptoms of recurrent urinary tract infections?

Babies and young children can't tell you about any symptoms they may feel. So, look for:

  • A fever not caused by a known illness
  • Urine that has a strange smell
  • Vomiting
  • The child not being hungry or acting fussy

Older children are more likely to have traditional symptoms, such as:

  • Pain or burning when they urinate
  • Urinating often
  • Loss of bladder control
  • Red, pink or strange-smelling urine
  • Pain in the child's back, below the rib cage, above the waist on both sides of the back

UTIs can also cause kids to have urinary accidents, even if they've never had those problems before.

How are recurrent urinary tract infections diagnosed?

Your child's doctor performs a physical exam and may order a urinalysis and a urine culture to check for bacteria in the urine. It is best to have a urine culture with any suspected UTI to determine what specific bacteria are present. It takes a day or two for the urine culture results, but many doctors prescribe antibiotics right away to fight the infection if they think the symptoms and urinalysis strongly suggest an infection. Some doctors will wait until the final urine culture results are available to prescribe an antibiotic if symptoms are not severe.
If your child is getting recurrent UTIs, the doctor might order imaging tests of the urinary tract to see whether a structural problem with the tract might be causing the repeated infections. Those imaging tests might include:

  • An ultrasound, which uses sound waves to create an image of your child's bladder, kidneys and ureters. A small device is pressed against the skin of your child's back and stomach to create the pictures. The ultrasound is performed while your child's bladder is full and again when empty to see how well the bladder is emptying.
  • Voiding cystourethrogram, or VCUG. If the ultrasound shows there might be urine pooling inside the kidneys, your child's doctor might recommend this test. An expert in performing the test places a catheter into your child's bladder and injects a special dye. X-rays are taken while your child's bladder is filling up and then emptying. The images show any problems with the bladder or urethra.

How are recurrent urinary tract infections treated?

Recurrent UTIs are treated with antibiotics that help kill bacteria. The antibiotics may be in pill or liquid form – or given through a vein if your child is very sick.

If tests show a problem with your child's urinary tract form or function, his or her doctor might recommend surgery to fix the problem. One common surgery corrects a problem where urine backflows from the bladder into the kidney. That surgery repositions the ureters to help prevent the backflow.

Usually, surgery isn't necessary because most children outgrow the condition.

Sometimes doctors may prescribe antibiotics for months or even years to prevent recurrent infections when structural or other treatable problems are not the cause.
In addition, changing certain habits might help your child avoid UTIs. Doctors often recommend that children:

  • Drink plenty of water and non-caffeinated beverages throughout the day to help flush bacteria from the urinary tract.
  • Avoid the 4 Cs (caffeine, carbonation, citrus and chocolate).
  • Use the bathroom every two hours to prevent bacteria from growing inside the urinary tract.
  • Learn how to properly wipe his or her bottom from front to back, to move any bacteria away from the urinary tract.
  • Have 1-2 soft bowel movements per day.

What is the long-term outlook?

Recurrent urinary tract infections need to be treated promptly to avoid longer-term problems. However, effective treatment and improving children's habits often fixes the issue.

We're here to help.

If your child has been diagnosed, you probably have lots of questions. We can help. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices.

Call 682-303-0376