Urinary Tract Infection in Children
Urinary tract infections (UTIs) in children are very important as they can cause permanent kidney damage, unlike adults. As we always say, children are not smaller versions of adults. Their anatomy, physiology and response to diseases are different. Urinary tract infection is a very good example of this situation.
“Children with urinary tract infections have an underlying surgical problem until proven otherwise.” This saying shows us the importance of this disease in children.
If there is a fever of unknown origin in children, urinary tract infection should be investigated.
What is urinary tract infection?
It is the urinary tract's response to a microbe. In general, urine is sterile (germ-free). Microbes go up from our urinary opening intermittently and reach our urinary bladder. However, we also get rid of these microbes by urinating regularly. Urinary tract infection can only be in the bladder (cystitis) or it can reach the kidney (pyleonephritis) and affect the entire system.
What is the incidence?
Every year, 1.5% of newborns (first month old) and 3.5% of children get urinary tract infection. While it is seen twice as often in boys in the neonatal period, it is 10 times more common in girls aged 1-3 years, after 6 months, after girls come forward.
What are the symptoms of UTI?
- Unrest.
- vomiting and diarrhea
- Abdominal bloating
- Prolonged jaundice in the newborn
- Anorexia and malnutrition
- slow weight gain
- Irregularity in body temperature
- Fever that rises and does not fall for no reason
It is very difficult to detect any infection, especially in newborns and infants. However, if one or more of the above symptoms are present, it should definitely come to mind.
UTIs are easier to detect as older children can describe symptoms more easily. If the UTI is only in the bladder, it may present with symptoms such as painful and frequent urination, urinary incontinence, and pain over the bladder. Acute pyelonephritis, that is, if the kidney is also involved, may present with high fever, vomiting, restlessness, and diarrhea, as well as urinary bladder symptoms.
Why is UTI so important in children?
As in developing countries, unfortunately, the most important cause of kidney failure in childhood in our country is urinary tract infections. For this reason, if the baby or child has a UTI even once, the underlying cause should be investigated.
It is very important as it can cause permanent kidney damage. Urinary tract infection should be excluded, especially in children with fever of unknown origin. Vesicoureteral reflux (VUR, reflux of urine into the kidney) (see vesicoureteral reflux disease) in children with urinary tract infection is an important cause that should not be overlooked because it can cause recurrent infections. Obstructions in the urinary tract, urinary stones, especially in older children, voiding disorders and constipation cause UTI. These children present with frequent urination, sudden urgency, urinary incontinence and urinary tract infection. Since the majority of patients with voiding disorder cannot completely empty their urine, the residual urine remaining in the bladder prepares the environment for UTI. 1/3 of these children also have backward leakage of urine. Tests such as voiding diary and uroflow (voiding flow test) are also requested in this group of children.
How is the diagnosis made, what research is done?
Urine analysis and urine culture are definitely requested from babies or children who are thought to have a urinary tract infection. Definitive diagnosis is made by culture. Culture should be taken under sterile conditions. Our preference is to take it with a catheter under sterile conditions.
If UTI is suspected, antibiotics should be started before the culture results are obtained. When the infection is certain, a bladder-kidney ultrasound should be checked to see if there is any anomaly or problem. A “voiding cystourethrogram (ISUG)” should be requested in recurrent infections or an enlarged kidney seen on ultrasound. The ISUG is the only and most important study showing us urinary reflux (VUR). If necessary, kidney damage should also be examined by scintigraphy.
What is the treatment for UTI?
The treatment of UTI is antibiotics. Antibiotics are used to treat the disease. Usually, 2 days after the drug is started, the complaints begin to decrease. The total duration of treatment is 10 days. Studies have shown that correct and timely antibiotic therapy has a positive effect on kidney damage.
Circumcision in boys has been shown to reduce UTI by 80%.
If there is a voiding disorder or constipation in children, treatment for them should definitely be started. If there is constipation, it should definitely be treated.
How do we treat children with voiding disorder or constipation who have a UTI in our centre?
We generally see urinary tract infection, voiding disorders and constipation together. Since all of these 3 problems trigger each other, they should be treated together. The vicious circle of these intertwined problems must be broken from somewhere. The most effective way to break this cycle is to treat the pelvic floor muscles. If left untreated, urine can start to back up into the kidneys.
The main problem underlying the disease of the majority of children whose urine leaks back to the kidney, which we call vesicourethral reflux, is the dysfunction of the pelvic floor muscles. Even if the child with vesicourethral reflux is operated on, the reflux will most likely recur unless the dysfunction of the pelvic floor muscles is treated.
Accordingly, we always rehabilitate the bladder and bowel together in our treatment. We do not neglect either one. At the beginning of our treatment, we primarily provide bladder-bowel education to all children and their families. In this training, there are recommendations that the child should change in his daily life. These recommendations are to prevent constipation, regulate urination-fluid hours, etc. includes goals such as
We start pelvic floor treatment for our children, whose bladder and intestines we have started to train. Our pelvic floor treatment is performed by our specialist pelvic floor physiotherapists. We rehabilitate all the surrounding muscles related to the pelvic floor and the deepest muscles of our body, including the pelvic floor, at the same time. Our treatment includes many different modalities such as manual therapy, exercises involving the spine, exercises for the thoracolumbar (chest and trunk) muscles, biofeedback, electrical stimulation, posture training, and respiratory training. In this way, we aim to solve all the problems by training the pelvic floor muscles.
Our success rate in this treatment is very high and the probability of recurrence of the complaints is very low.