Urinary Tract Infections

Symptoms that suggest a urinary tract infection are:

• A frequent urge to urinate (frequency)
• Inability to hold urine very long (urgency)
• Urine that smells foul or looks cloudy
• Burning with urination (dysuria)
• Blood in urine (hematuria)
• Discomfort or pain in the lower belly
• Fever

Bacteria that live in the gastrointestinal tract (E. coli), viruses or fungi can cause some urinary tract infections. Others are related to poor bathroom habits in children or a condition at birth, such as vesicoureteral reflux (VUR). When a child has VUR, urine backflows through the urinary tract system and increases the risk of urinary tract infection. An estimated 40 percent of children who have urinary tract infections are later diagnosed with VUR.

Our doctors and nurse practitioners do more than simply treat an infection. We determine whether your child’s urinary tract infection may have a physiological or anatomical explanation or whether it could be linked to voiding habits.

Common voiding habits that increase children’s risk of urinary tract infections are:

• Not going to the bathroom often enough and waiting to pee until the last minute
• Rushing in and out of the bathroom too quickly
• Poor voiding postures, such as little girls’ failure to spread their legs enough
• Constipation
• Eating or drinking irritants to the urinary tract, including red dyes, caffeine, chocolate, citrus and acidic beverages and colored juices

If your child has a persistent problem with recurrent UTIs or underlying problems with good voiding habits, your physician may suggest additional evaluation or testing. Riley at IU Health has a Pediatric Continence Program, where nurse practitioners are expertly trained to help your child improve voiding habits related to their individual conditions.

Our specialists use methods adapted for children of all ages. We can help your child make simple behavioral changes that may prevent future infections, including:

• Setting a voiding schedule of peeing every 1 to 2 hours—regardless of their urge
• Avoiding dietary irritants
• Taking their time in the bathroom
• Double voiding to make sure the bladder is empty
• Treating constipation

These conservative steps can improve or eliminate a tendency for UTIs for most children. Children who have conditions related to anatomy or physiology may be prone to more serious infections that do not respond to behavioral changes. This includes:

• Anatomical disorders such as VUR
• Chronic kidney disease or diabetes
• Tumors or trauma
• Spina bifida, multiple sclerosis, cerebral palsy, epilepsy and other brain or spinal cord conditions that influence the way nerves interact with the bladder, urinary tract or bowel
• A loss of continence when giggling, coughing or sleeping

As one of the top-ranked pediatric hospitals in the U.S., Riley at IU Health has urologic specialists who are skilled in diagnosing and treating the underlying causes of pediatric UTIs and incontinence.

Diagnosis of Urinary Tract Infections

Diagnosis begins with urinalysis and urine culture. Our specialists will ask about your child’s history with peeing/pooping and diet. Sometimes it is necessary to insert a catheter into the bladder to collect a sterile sample for these tests. This can determine whether your child’s infection is an isolated case or related to poor voiding habits.

If initial tests suggest the infection is more than an isolated UTI, your child’s doctors may order more specialized tests to find an underlying cause. These may include:

• Kidney, ureter or bladder x-ray (KUB). KUB x-rays are taken for many reasons, but in children they often reveal constipation, which can contribute to urinary incontinence, or help locate possible kidney stones. Physicians may use KUBs to confirm an intestinal blockage or foreign objects in the stomach.
• Post-void residual (PVR). A PVR test measures the amount of urine left in the bladder after voiding.
• Renal ultrasound. A renal ultrasound is a painless, non-invasive exam, which uses high-frequency sound waves to diagnose problems with a child’s kidneys, ureters or bladder.
• Urodynamics. Urodynamic tests reveal how the lower urinary tract functions.
• Uroflow. This test uses a special toilet to measure how much and how fast urine flows.
• Voiding cystourethrogram (VCUG). A VCUG is a non-invasive x-ray examination of the bladder and urinary tract.

Some tests are more invasive than others. Our child life specialists are available to help your child through any test with minimal discomfort or pain.