Friday, June 13, 2014

Is it a urinary tract infection?




Urinary tract infections are always something that need attention, but sometimes we aren't sure if we are dealing with an actual infection or just an irritation. The symptoms may overlap.

The urinary tract is the body's drainage system for removing waste and extra water. A normal body has  two kidneys, two ureters, a bladder, and a urethra. The urine should drain in only one direction-from the kidneys to the bladder and then gets peed out. Urine is usually sterile, (remember that when your baby pees in your face) but once in awhile bacteria from the surrounding skin or stool can make it's way into the urinary tract, causing an infection. If the germs make their way all the way into the kidneys it is much more serious and usually causes a much higher fever.

Holding urine for long periods of time, not drinking enough and constipation seem to make folks much more prone to infections.
In my experience, girls are much more likely to get an infection. Circumcised boys are the least likely.

UTIs will usually  come along with fever, tummy ache, back ache and maybe vomiting. You might notice your child grabbing at their crotch. Kids who are old enough to verbalize may complain that it hurts to pee. Toilet trained kids may have some accidents. Urine may have a stronger smell than usual. Young infants may simply be fussy, not feeding well and feverish. Any mystery fevers warrant a urine check to make sure that a urinary tract infection isn't the source.

Irritation around the urethra can also cause quite a bit of discomfort when peeing. This is fairly common among the newly potty trained girls. They are just not all that good at wiping.
Have you done any bubble baths lately??? Those are a very common culprit. Besides bubble baths, any harsh soaps can be irritating. Get in the habit of letting your child do their bath play without sitting in soapy water. Let them play and then when they are almost done do the gentle soap, rinse, exit the tub and towel off. If there is no fever, your child seems quite well but is complaining about pee pee hurting, check to see if you notice any redness in the area.

I am fine doing a one day watchful waiting combined with some natural treatment to see if things clear up. I would suggest:

*A nice soak in a tub with a splash of apple cider vinegar.
*After the bath apply some Vaseline or gentle ointment that can act as a moisture barrier and protect the irritated skin from the urine. 
*Increase their fluid intake; diluted urine is much less likely to sting.
*Probiotics/ less sugar in the diet will make the body less yeast prone.
*Cranberry juice.There are a lot of mixed studies out there, but most of them agree that cranberries may be useful at preventing UTIs. They have properties that prevent the bacteria from taking hold and hey, fluid is good. You may as well make it cranberry juice if they will drink it.
*Loose cotton panties; watch out for tight tights that little girls like to wear.

If your child is complaining that it hurts to pee, and there is any fever or tummy ache, they need to be seen and have their urine checked that same day.

For young babies that are not able to pee in a cup we will apply a sterile urine bag on the area and wait...and wait...and wait, to get a specimen. It is okay if the bag leaks a bit. We don't actually need much more than a teaspoon of urine. Murphy's Law loves this process - there is nothing like a good urine bag in place to make a great big messy poop come along. Sorry folks, even if it looks like the poop didn't get into the bag, we can't use that specimen. We will need to clean them off and try again.

For older kids, we will try to have them pee into a cup. Make sure they are cleaned off thoroughly before urinating. It would be great to get a mid stream specimen, but that often poses too much of a challenge and we will take whatever we can get (as long as it is clean.) If you are obtaining the specimen at home, any clean jar or tupperware that has been through the dishwasher will be fine.
If you don't relish the job of being the "cup holder" reach in with a clean ladle to collect the urine. (I learned that from my niece Molly who was a vet tech at a time when I needed to get a urine specimen from my dog. It works!) Urine poured out of a potty is NOT okay, no matter how clean you think that potty is.

Once we have the urine we will do a couple of tests. The first test, is with a dipstick that we can do in the office. The second step is a culture that takes a few days for the results. In our office we usually do a little basic culture that gives us some info the next day, but we also send the urine off to the lab where they can identify the bacteria and check which medication it will be sensitive to. That first dipstick checks for an assortment of qualities including blood, bacteria, protein, and urine concentration. This test can give us clues but is usually not conclusive. Many little girls have a bit of bacteria in the area that shows up on the test even if there is no infection. Some irritations may also cause a bit of blood and protein. I have also seen specimens that look perfectly clear on the dipstick, but still grow something  on the culture. We will have to weigh all of the symptoms and information when making the decision about whether or not we immediately treat.

If it is an infection, Your child will need antibiotics. If we aren't assured that your child is feeling MUCH better after 48 hours or so, we may also ask for some urine mid treatment to make sure they are on the right medication. We will almost always want a follow up specimen after the course of medication to make sure things have completely cleared up. If your child has a history of even one UTI, you need to be a little more suspicious whenever they don't feel well  and it is probably worth checking urine for any future fevers.

Also, kids who get  urinary tract infections usually need a follow up with the urologist to make sure that all is well with the "plumbing". With little girls, we may give them a pass until they have had more than one, but little boys usually should be checked out the first time it happens.

Be aware of something called "urinary frequency syndrome".  I see it enough that it is worth mentioning. Your young potty trained child suddenly needs to pee all the time. It doesn't actually hurt to pee. They are otherwise well. There is NO fever. There is NO irritation that you can see. Once they are asleep, they sleep quite well and don't seem to have the urgency at night. With any  sudden frequency, we do want to do a dipstick and culture just to make sure there is nothing up. If everything looks fine with the urine, it is likely this odd little syndrome. It goes away after a few weeks. Patient X was actually my daughter Alana. She often played  the "stump the doctors and nurses game". When she was four years old, she suddenly needed to pee all the time. All the workup was normal. I actually ended up driving with an inflatable potty* in my car because otherwise we couldn't go anywhere. With all the doctors mystified, we ended up at the urologist who gave us the instant diagnosis. I think with us it lasted about 2 weeks. If it was longer than that I blocked it out. It was an aggravating several weeks to say the least. Since then, I have seen it multiple times....thank you Alana as always for educating me. If this is your kid, just let them pee whenever they need. It will pass. Remember we are not going to use this diagnosis until we have a negative urine culture.

*Inflatable potty - Take an inflatable inner tube ( think pool toy) , tuck it under a kitchen size plastic garbage bag  (place the garbage bag over it as if you were placing it over a very very shallow garbage can)....voila, instant potty, the pee or poop are ready to dispose of in the bag. We subsequently used this idea for camping trips or long car rides.

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