Illnesses & Symptoms
Urine: Painful Urination, Infections, Accidents and More
Many children have trouble with urination. Sudden accidents in a previously potty-trained child could be a behavior problem, or sign of illness — such as infection or diabetes. Painful urination can be from infection or rashes or trauma to the area.
Also ask your child about bowel movements (hard, watery, painful, frequency, etc.) if you notice urine problems. Constipation is associated with both accidents and infrequent urination. Diarrhea can irritate the skin and cause pain with both urination and bowel movements. Teach proper wiping techniques ... many girls wipe front to back, leading to problems with the urinary tract.
If you are uncertain about the cause of problems with urination, call our office for an appointment.
Urinary Tract Infections
Symptoms of infections of the urinary tract might include fever, vomiting, abdominal pain, frequent urination, accidents, foul smell to the urine, and pain with urination. Not all symptoms need to be present. It is diagnosed with a urine sample. If a child is not able to provide a sample, our nurses can put a catheter in the urethra (the part of the body urine passes through when we urinate) and collect a sample. Our office can do a quick urinalysis, which can help with proper diagnosis. A sample with blood cells, proteins or nitrates can help us determine the cause. If an infection is suspected, the sample will be cultured at a local laboratory. Results of this culture are available in 2-3 days. Antibiotics are used to treat infections of the urinary tract. Children with multiple urinary tract infections, or young infants with their first infection, undergo further testing to determine their risk for future serious infections. For more information on this testing read the below section titled VCUG — What is it and why does my child need it?
Other Painful Urination
Not all painful urination is an infection. We commonly see skin irritation as a cause for pain. Improper wiping in newly potty trained girls is a common cause of painful irritation. Soaps and bubble baths also irritate the sensitive genital skin in girls. If the skin is red and irritated and there are no other symptoms of infection, home treatment is recommended. You can have your child sit in a bath with warm water and 1 cup of baking soda. No soaps should be used during this bath, as soaps can irritate the sensitive genital skin. If hair washing is required, this can be done at the end of the bath, followed by rinsing of the genitals with fresh water. This procedure can be repeated for all baths if it is a recurrent problem. Applying petrolatum jelly or diaper rash ointment is also helpful. See also our page on vaginal irritation. If this treatment fails or symptoms worsen, an appointment is indicated.
Frequent urination can be a sign of diabetes. It can also be due to constipation or infection with certain viruses (such as adenovirus). Many children with constipation don't initially seem to be constipated, so a trial of Miralax is often recommended if the urinary frequency persists without identified cause. This treats the constipation if it exists, and is part of the diagnostic evaluation.
Children with signs of increased thirst, increased hunger, weight loss, frequent urination (especially if there are other signs of dehydration, such as dry mouth, loss of tears or lethargy) need to be seen immediately. A urinalysis in our office might show sugar, and a confirmatory blood test can help with diagnosis. This is often a medical emergency and should be addressed as soon as symptoms are noticed. Children with new diabetes are referred to an endocrinologist, a specialist in diabetes. They often spend a few days in the hospital for stabilization of medical issues and teaching of how to manage at home.
Increased frequency of urination, also called pollakiuria, is common and benign. Other terms that have been used to describe this condition include extraordinary daytime urinary frequency, and increased frequency of childhood. The cause is unknown. It involves frequent urination during the day, but most children do not change their nighttime urinary pattern. If they previously wet the bed, they still will, but if they previously stayed dry all night, they will continue to stay dry at night. Pollakiuria appears to be seen somewhat more often in boys and is most common between 4 and 10 years. It generally lasts 1-6 months and can be quite problematic due to the frequent bathroom trips needed (often every 30-90 minutes), but it is not a serious illness and it self resolves. To diagnose this, a child should be seen to discuss the symptoms and to do a physical exam. Often constipation aggravates this issue, so close attention to stool patterns and the abdominal exam are important. A urinalysis should be done to rule out diabetes or urinary tract infection. If no other source of frequent urination is found, we apply the "wait it out" approach. This problem typically starts suddenly and ends suddenly, though can last for months. Dietary changes can help, especially avoiding all caffeine and limiting acidic beverages (such as juice). Contrary to what many would intuitively think, drinking plenty of water might be beneficial, so don't limit water! Medications have been found to be ineffective. Be sure the teacher knows what is going on so if your child needs to go to the bathroom every 30 minutes he will be allowed.
Foods to avoid if your child has frequent urination, at least for 2 weeks and then slowly re-introduce to see if they lead to increased urination:
- Highly acidic foods (salsa, sodas, teas, coffee, cranberry juice, orange juice
- Caffeine (it acts as a diuretic and increases urine, found in coffee, tea, chocolate, sometimes ice cream or other treats)
- Spicy foods (chili peppers, jalapeno peppers, horse radish, curry, salsa)
- Artificial colors
- Carbonated beverages
We refer many children who have urinary tract infections for special testing to see if they are at risk for future serious infections. For more information on VCUG's please visit the following resources from Children's Mercy:
Videos and booklets that help kids understand the procedure: