Dr. Bhavin Desai

Urinary Tract Infections are a group of diseases that affect one’s urinary system such as the urethra, bladder, ureters or kidneys. Women are more prone to contracting UTIs than men. They may be accompanied by symptoms such as a constant urge to urinate frequently along with a burning sensation in the concerned parts and pelvic pain. The urine may have traces of blood in it. These infections are usually treated with antibiotics.

Causes behind Urinary Tract Infection:

Urinary Tract infection generally occurs when the bacteria enter the urinary tract via the urethra and begin to proliferate in the bladder. Although the urinary system is structured to ward off such invaders, at times, the defense mechanism fails. In that case, the bacteria may evolve into a full-blown infection in the urinary tract.

Few risk factors are:

1. Female anatomy: A woman’s urethra is shorter as compared to a man’s, thus lessening the distance the bacteria need to travel to the bladder. This increases the chances of UTIs in women.

2. Using diaphragms and spermicidal agents for birth controls

3. A dip in the levels of estrogen post menopause

4. Abnormalities in the urinary tract that hinder the discharge of urine or cause the urine to travel back into the urethra.

5. Enlarged prostate or kidney stones that cause the urine to be trapped in the bladder.

6. An impaired immune system because of diabetes and other ailments

7. Using catheters (tube) to urinate is one of the common risk factors because of the chances of infections.

Many children all over the world are affected by urinary tract infections or UTIs that can be resolved with simple antibiotics, but might also lead to complications at times. Most often, kids under 2 years of age are affected by it, and either the bladder or the kidney might be infected leading to cystitis or pyelonephritis , in smaller children kidneys are presumed to be infected unless proved otherwise.

Causes of UTIs

Though bacterial infections are the most common cause, viral or fungal infections might occur in some cases as well. Most UTI in infants are caused by structural abnormalities of urinary tract. Uncircumcised male infants or children with poor toilet habits, or female children with poor toilet hygiene are susceptible to this disease. Children suffering from a weak immune system might also be at a risk.

Symptoms and signs

Symptoms of UTI are very difficult to differentiate from any other illness in small kids under 2 years of age, symptoms include high fever, diarrhea vomiting, and dehydration. Basically any fever for which no cause is apparent must be evaluated for UTI. UTIs in older children beyond 5 years of age come with different signs including pain during urinating (dysuria), frequent urination, abnormal urge for urination, or bedwetting. Sometimes, fever, abdominal pain, blood in urine or vomiting might be signs as well.

Which doctor to consult?

In most cases, UTIs in children are treated by pediatricians, but if kidney function is troubled then a pediatric nephrologist needs to be contacted immediately. Pediatric Nephrologist to be consulted once the fever is over to look for cause of UTI.

1. Tests carried out: To understand the underlying cause of the infection and any anatomical or functional risk factors, several examinations or tests are carried out. Vital signs like blood pressure, body temperature, and breathing rate are checked. The abdomen is palpated to find tenderness near the kidneys. Genital areas are also examined for signs of trauma, redness, discharge and such. Urine cultures are essential for diagnosing UTIs finally and this helps in assessing the antibiotic sensitivity profile too.
2. Good to know: Right after an antibiotic is administered, UTI in children starts getting resolved. But recurrent UTIs might lead to urinary tract abnormalities like kidney malformation. Also note that UTI is not contagious, and cannot be passed on if children share a bath or if you sit on an infected toilet seat.

Treatment

In most cases, UTIs respond well to oral antibiotics, though Pyelonephritis may require hospitalization and intravenous drip. Some studies are also carried out to check if the child is susceptible to renal scarring or kidney failure. These are as below:

1. Renal ultrasound: Defines the location of the kidneys and their size and shape clearly.
2. Voiding cysto-urethrogram: The bladder is filled with a dye through a catheter in this method. Then the catheter is removed to study if the bladder is getting emptied without any reflux or obstruction.
3. Renal scan: To test the functioning of the kidneys and the risk of renal scarring, a bit of radioactive material is used.
4. Intravenous pyelogram: Though rarely used, in this method, a dye is injected into the bloodstream and X-ray images are obtained.

Prevention

1. Maintaining proper hygiene: Girls should wipe from front to back and uncircumcised boys should be able to gently retract the foreskin to reveal the urethral opening.
2. Complete voiding of bladder: Encourage kids to urinate every two to three hours, since they often ignore a full bladder to carry on playing.
3. Consumption of fluids: Drink plenty of fluids and avoid constipation. If you wish to discuss about any specific problem, you can consult a Pediatrician.