Definition of UTI
An urinary tract infection, UTI, is basically an infection affecting different parts of the urinary tract, predominantly the bladder, urethra and kidneys. The infection is usually bacterial in origin, affecting people of all ages, both genders, even though women are slightly more affected compared to men.
As far as children are concerned, it is estimated that they account for approximately 3% of all cases of UTI in the United States every single year. Moreover, a million visits to pediatricians' offices every year are related to urinary tract infections. Even at this age, girls are more affected than boys.
In small children UTI does not have to be accompanied by symptoms and signs that typically affect adult patients. However, most children develop fever with chills, they lose appetite, they may vomit or are sometimes completely asymptomatic. Fortunately, most cases of UTI in children affect only the bladder, rarely spreading further to the kidneys.
Once the amount of bacteria reaches certain number, the urine of the affected child changes its color, becomes cloudy, there is blood in urine and it starts to emit foul/strong odor. Frequent/urgent need to urinate, malaise, pain and burning with urination occur as well. Children who have been toilet trained may start to experience wetting problems. If the infection affects the kidneys, the child develops fever, chills, nausea and vomiting, pain in the flank area or severe pain in the belly.
Causes and Diagnosis
The urine is under normal circumstances sterile, i.e. does not contain any microorganism. Bacteria may enter the urethra and spread to the bladder and upper parts of the urinary tract from the skin around the rectum and genital area. As a matter of fact, the majority of bacteria responsible for UTI actually originate from the colon and are normally located around the rectum.
Since girls are prone to urinary tract infections more compared to boys, they need to adopt healthy and hygienic behavior when cleaning the anal and vaginal area after urination and defecation. Namely, the girl must learn to wipe from the front to the back this way avoiding the transmission of the bacteria around the rectum near the vagina and the urethra.
It is a well known fact that certain underlying conditions make the onset of UTI much easier. For instance, vesicoureteral reflux disease is a common reason behind repeated urinary tract infections. It requires prompt treatment and sometimes even surgical correction because recurrent entrance of the urine into the kidneys (especially if it is contaminated with bacteria) leads to irreversible damage and may even cause complete loss of kidney function.
UTIs are also frequent in patients suffering from some nervous system illnesses like myelomeningocele, spinal cord injuries and hydrocephalus.
Finally, since children are prone to delay a trip to the bathroom, urine accumulates inside the bladder which increases the risk of infections. What is more, holding urine has negative impact on the sphincter muscle of the bladder. If the muscle cannot relax completely, there is always remnant urine in the bladder which additionally increases the chance of UTIs.
Diagnosis of UTIs in children is not so difficult. All doctors need is a sample of urine which is tested in a lab. The presence of bacteria is easily confirmed. Symptoms and signs only help doctor suspect UTI and definitive confirmation is achieved with specific tests.
In children UTIs require prompt treatment with antibiotics. Only this way, kidneys are protected from further spread of harmful microorganisms.
Infants are most commonly hospitalized and they are administered antibiotics intravenously. Older children may or may not need to be hospitalized but they cooperate and are easily treated with oral antibiotics i.e. do not have to receive these drugs intravenously. The entire treatment additionally includes plenty of water and other fluids. The excess of fluids in the body increases urination and allows the body to get rid of bacteria quickly.
Children with repeated UTIs as well as those suffering from vesicoureteral reflux disease may need to take antibiotics for several months. The prognosis is better in children in whom there are no abnormalities of the urinary tract and those with healthy immune system.
It is estimated that around 3% of American children develop UTI each year. There may be no symptoms and signs of the infection, these can be mild or moderate or become unbearable requiring hospitalization. Each and every case of UTI must be reported and treated adequately. If left untreated, infections spreads to kidneys and may cause irreversible damage to the organ.
Furthermore, 10% of all children suffer from at least one episode of UTI until they enter puberty. The highest incidence is in low-birth weight infants (10%) while infants of normal birth weight are affected in 1% of all cases.
Amazingly, in the first year of life boys seem to be affected more. The incidence then changes and remains higher in girls and women of all ages.
And finally, 40% of children suffering from UTI have some underlying problems with their urinary tract. These include malposition of certain organs, duplications, mega-ureter and hydronephrosis.