Online Health Chat with Audrey Rhee, MD

April 19, 2017


Description

Urinary tract infections (UTIs) happen when bacteria get into the urinary system through the urethra. It’s common for UTIs in children to go untreated because often the symptoms are not obvious to the child or the parents. It’s important that pediatric UTIs be treated right away to prevent further spread of the infection and to reduce the chances of kidney damage.

The most common symptoms are painful urination (dysuria), more frequent urination and a frequent urge to urinate. Some feel as if their bladders are constantly full or experience abdominal discomfort. Other symptoms are less frequent. Urine may appear milky or cloudy. Reddish or bloody urine will be present in about 10 percent of those with a UTI. Infections that progress from the lower to the upper urinary tract and kidney may create fevers, chills and a feeling of general discomfort, distress and uneasiness.

During this free, live web chat, Audrey Rhee, MD, will answer your questions about pediatric UTIs and what the options are for their treatment. Dr. Rhee is a board-certified pediatric urologist in the Glickman Urological & Kidney Institute at Cleveland Clinic. Dr. Rhee’s specialty interests are hydronephrosis, penile disorders, undescended testicles, vesicoureteral reflux and pediatric bladder defects.


About the Speaker

Audrey Rhee, MD, earned her medical degree from Albert Einstein College of Medicine in 2004. She had previously completed her undergraduate studies at Cornell University in 1999. Dr. Rhee completed her residency at Medical College of Georgia Hospital (MCG Health) and her fellowship at Riley Hospital for Children in Indianapolis, IN.


Let’s Chat About What to Do if Your Child Has a Urinary Tract Infection

 

Discussing the Disorder

BrentByer24: What causes a urinary tract infection?

Audrey_Rhee,_MD: The causes are usually categorized into: 1. Anatomic: a structural issue that the child was born with, and  2.  Behavioral: not using the bathroom often to void urine or stool. The types of infections can be bacterial (which is the most common) or viral (rare).

BrentByer24: Can UTIs be prevented?

Audrey_Rhee,_MD: If it is a behavioral issue, then they can be prevented with voiding often and with constipation management. There is some medical literature that suggests Vitamin D and cranberry extract help to prevent UTIs.

BrentByer24: What are some common risk factors associated with UTIs?

Audrey_Rhee,_MD: Common risk factors include holding behavior (holding their urine or stool), a history of abnormal kidney or bladder ultrasound in utero (when a fetus in mother's belly), a family history of UTIs, currently potty training and sexual activity.

Daddio12: In a previous question you referred to behavioral issues. What would the process look like to correct behavioral issues?

Audrey_Rhee,_MD: Behavioral issues are challenging to address. In some, the pattern is developed over years and can take just as long to correct. Simply, we ask that you encourage the child to use the bathroom more often, specifically working on emptying their bladders and rectums better. If despite this they continue to have problems, then we refer them on to our Glickman Urologic Pediatric Incontinence (GUPI) Clinic. One of the treatment options provided is biofeedback, during which children are taught how to empty their bladder better using video games and other exercises.


Symptoms and Diagnosis

MarCy33: My daughter is 3, and I’ve noticed she’s been running to the bathroom more often today, but is having trouble getting anything to come out. Could this just be a part of her potty training, or should I be more concerned? My friend’s daughter had the same problem, and it turned out to be a urinary tract infection.

Audrey_Rhee,_MD: This depends on your daughter's history. Has she had a UTI in the past? If she is currently potty training, this could be part of the normal course. I would be concerned if there is absolutely NO urine coming out all day, or if she complains of lower belly pain or has a fever. I hope this is helpful, and good luck.

MarCy33: How are UTIs diagnosed? What does the doctor do during the examination?
 
Audrey_Rhee,_MD: UTIs are diagnosed by a urine culture. A sample is sent to the lab, and they see if any and which type of bacteria may be present. They also check for sensitivities to antibiotics. In addition to getting a complete history, the doctor does a full exam with particular focus on the abdomen and genital area. We also check the lower spine to assess for neurologic abnormalities.

Charlie96: My daughter had a test and it was negative, but she is still having issues. What can be the problem?

Audrey_Rhee,_MD: If the urine culture was negative, then the cause was not bacterial (on a very rare occasion it is viral). If she is continuing to have urgency, frequency and burning when she voids, there are other reasons, for example, constipation and not emptying her bladder enough or all the way. There are also dietary reasons. Some foods cause bladder irritation that can look like an infection. These include caffeine (soda, chocolate, tea, coffee;, artificial colors; and citrus. I hope she feels better soon.


Treatment and Relief

BrentByer24: How is a UTI treated?

Audrey_Rhee,_MD: If it is a bacterial urinary tract infection, it is routinely treated with antibiotics.

slovoski22: What can I do at home to help my child get better? He seems so uncomfortable. Are there any remedies that you can share? I’ve heard of yogurt and cranberry juice helping, but I wasn’t sure if that was an old wives tale.

Audrey_Rhee,_MD: If your child is actively having a UTI, the best first thing to do is to start antibiotics. Make sure he is emptying his bladder regularly (kids with UTIs tend to hold their urine because it burns to void), and you can give Motrin or Tylenol. Some providers (and this depends on the child’s age) will also prescribe Pyridium, which helps to lessen bladder and urethral (the tube in which the urine comes out) discomfort. Yogurt is helpful with normalizing the gut and would not be particularly helpful during an active infection, but may be helpful for prevention. Cranberry juice has not been definitively shown to help prevention, but it does not hurt either.


After the Fact

BigMaMas: My son (age 5) has had two UTIs in the past year. Is this something I should be concerned with? How serious are UTIs?

Audrey_Rhee,_MD: Boys do not commonly get UTIs. When they do, we worry about a structural abnormality. In my office, I usually start with a renal and bladder ultrasound. Also, please make sure he is not holding his urine for too long. Kids would much prefer to play than to stop what they are doing to use the restroom.

Dancing Queen17: Are there any follow-up tests that need to take place after my daughter’s UTI has been treated?
 
Audrey_Rhee,_MD: If it has not already been done, imaging would be the next step. We would get a renal bladder ultrasound and abdominal x-ray.

Smitty45: Is it necessary to give my child antibiotics or other medications to prevent another UTI?

Audrey_Rhee,_MD: This depends on the cause of her UTI. If she has a structural abnormality, then in select patients, we will recommend a small dose of antibiotics (prophylaxis) to prevent a UTI. Also, there are a handful of patients who have behavioral issues that continue to have recurrent infections, and while we are working on correcting these behaviors, we will put them on prophylaxis. I will also recommend supplementing with daily Vitamin D.


Closing

That is all the time we have for questions today. Thank you, Dr. Rhee, for taking time to educate us about Urinary Tract Infections in Children.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at http://my.clevelandclinic.org.

For Appointments
To make an appointment with Audrey Rhee, MD, or any of the other pediatric urology specialists in Cleveland Clinic’s Glickman Urological & Kidney Institute, please call 216.444.5600, toll-free at 800.223.2273 (extension 45600) or visit us at clevelandclinic.org/urology for more information.


For More Information

To make an appointment with Audrey Rhee, MD, or any of the other pediatric urology specialists in Cleveland Clinic’s Glickman Urological & Kidney Institute, please call 216.444.5600, toll-free at 800.223.2273 (extension 45600) or visit us at clevelandclinic.org/urology for more information.

About Cleveland Clinic
Cleveland Clinic’s Glickman Urological & Kidney Institute, recognized worldwide for excellence in patient care, teaching and research, merges the urology and nephrology programs. This consolidation of disciplines allows us to better serve patients in the prevention, diagnosis and treatment of kidney disease while we continue to provide high-quality patient care and carry on innovative research in all aspects of urology. This year, U.S. News & World Report ranked both our urology program and our kidney disease program No. 2 in the nation.

Center for Pediatric Urology
Part of the Glickman Urological & Kidney Institute, our pediatric specialists manage disorders of the kidney, bladder and genitalia in children. Our team includes urologists, nephrologists, fetal medicine specialists, endocrinologists, oncologists, radiologists, neurosurgeons, nurses and social workers.

The team collaborates to offer inpatient evaluation, as well as medical or surgical intervention for acquired and congenital problems. We see patients in the Glickman Tower on the 9th floor (Q9-1) at Cleveland Clinic’s main campus, as well as at our family health centers. In collaboration with MetroHealth Medical Center, we also see patients at their main campus, 2500 MetroHealth Drive, Cleveland.

Cleveland Clinic Health Information
Learn more about symptoms, causes, diagnostic tests and treatments for Urinary Tract Infections.

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