Recurrent UTIs?

[DragonTail]

My 9 year old has had recurrent UTI symptoms for the last 6 years. The symptoms only go with a 10 day course of antibiotics. It has got very much worse over the last year, now its every 2 months or so.

The problem is that the urine specimens never show up an infection so we don't actually know if it is a urine infection or something else. The doctors tried not giving her antibiotics (as it never showed up) but she got really ill to the point of being sick with blood every day. She has had ultra sounds of her bladder and kidneys, all ok.

Does anyone have suggestion as to what can be wrong?

[nocoolnamesleft]

I presume you've done all the "optimising bladder health" stuff, in case they're trapped in a cycle of really nasty bladder irritation?

Roughly speaking....
Drink loads of fluids. I mean loads. At 9 yrs old, that'd be about a litre and a half of fluid (and a bit more from what they eat). The fluids need to be really spread through the day - so much easier when they're on holiday, and not trapped at school...so many seem to drink most of their fluids around teatime! Water/squash fine, milk okay, all fizzy drinks, caffeinated drinks, and fresh citrus drinks totally banned.

Watch for any signs at all of constipation, and treat thoroughly (constipation both makes the bladder not empty well, so stale urine is left behind, which is an irritant, and leaves more bugs floating around down below).

Make sure she doesn't hover, but sits on the toilet, and is certain she's finished - hovering and dashing off also lead to poor emptying. I'm sure you've stressed all the proper wiping stuff already.

You've probably already banned all bubble bath. As much as possible, just use water in the bath/shower. Where you really need to use something, use a product aimed at children with eczema, like oilatum bath: when they're caught in a vicious cycle, then the urethra gets very sensitive, and reacts to almost anything, and that both gives you cystitis symptoms, and makes it easier for bugs to get in. Don't know if you wash her hair in the bath, but if so make sure she gets out straight after: even the mildest shampoos are very irritating down below.

Hot weather can make things worse, so aim for ventilation: cotton knickers, avoid tights and leggings.

Look at her pattern of weeing when she's well. To get her bladder healthy, you want to see watery dilute urine (dilute lemonade appearance, or watery). If it's strong or yellow when she's well, it helps show she does need to drink more. Make sure she's not "hanging on" (some kids, for instance, hate school toilets), as hanging on can lead to a few drops leaking, which can again irritate things down below.

Oh, and slightly odd one - if she's been on loads of courses of antibiotics, might be worth trying probiotic yoghurts, as she might be getting an imbalance of bugs in her gut, which spread onto the perineum, and can then can cause local problems. Is she ever sore down there?

Anyway, if you've already tried all that lot, which you may well have done, then you need to ask her paediatrician (please tell me you haven't just seeen the GP!). But if not, then try giving it a whirl. Works for quite a lot of kids, and when it doesn't, then you know it's really worth pushing for more answers.

Hope that helps.

[DragonTail]

Thanks nocoolnamesleft

We do most of these things except the shampoo in the bath - will definitely try that. She is under a paediatrician but haven't seen them in 4 months after drawing a blank last time. She has since had 2 further infections and is ill a lot of the time.
She cant take probiotics - she is dairy intolerant and the health shop said not to take the powder with the other antacid medication she is on (for the sickness).
We have another appointment in a month so I'm trying to think of possibilities to suggest, or things to try before then as we are at a bit of a brick wall. We don't even know if it is a UTI as it has never shown up in a test but what else could it be? Any ideas?

[InSpaceNooneCanHearYouScream]

Well surely she should have been referred to a urologist a long time ago?? She needs further tests- standard ultrasounds don't show up many kidney or bladder problems. Immediate referral to paed and urol needed

[DragonTail]

Thanks inspace
What problems don't show up on standard ultrasounds? Is it possible to have an infection which doesn't show up in the standard tests? Its like she has a UTI and she only gets better with antibiotics but it never shows up in tests and is now coming back every 2 months (like the infection is not being properly killed off).

She is under a paediatrician but has never seen a urologist... I think I will request this when we see the paed next month.

[Pancakeflipper]

Poor thing, horrid things are UTI's.

I agree with the probiotic, personally I'd avoid the yoghurt variety and go for a tablet or powder one. Not cheap but they can really lift the immune system. My child uses an Optibac one that I put in their juice but there's others around. I used them after several kidney infections and I found they helped me as I felt my entire body was beginning to struggle.

Lemon barley water can help, apparently it flushes out your system. I drink a glass or 2 each day. Someone (a colleague and he'd been plagued with UTI's) told me to do it after a serial bout of kidney infections and I've not had one for years.

Hope things improve

[Pancakeflipper]

I know this sounds silly but could it be anxiety - I know a young teen whose persistent uti's were actually tied in with stress and anxiety.

[InSpaceNooneCanHearYouScream]

Kidney reflux doesn't show up on ultrasound- normally children with recurrent uti's are sent by a urologist for specific kidney function scans- DMSA,MAG3 and MCUG.

[DragonTail]

Thanks for the responses. I feel like I'm at my wits end with this so any suggestions are great. Will definitely ask to be referred to a urologist at our next appointment with the paediatrician.

I don't think that its anxiety related as I'm assuming that the antibiotics wouldn't have an effect then. If she doesn't get a 10 day course of antibiotics, she gets worse and worse. The paediatrician tried not giving her antibiotics at the start of the year, as nothing showed up on tests but she got so ill she was vomiting blood.

Have tried daily cranberry juice, will try lemon barley water. Cant try the probiotic as the health food shop said not to take it with the antacid tablets she is on for the sickness and she cant have the yoghurt as she is dairy intolerant.

[ovenchips]

Hi DragonTrail. This sounds really rough for her and you. You have my sympathies.

Can you just explain a bit more - if she doesn't have a course of ABs she vomits - is that right? Is that a normal symptom of a UTI?

And the antacid she is on - is that prescribed by a GP and if so for what? Is she on this daily? My understanding (I may be wrong here) was antacids were for indigestion caused by excess stomach acid production. I don't fully understand the link between that and the UTI.

Apols for all the questioning

[InSpaceNooneCanHearYouScream]

What are her exact symptoms when she gets an episode? What does her wee look like? Does it smell? Vomiting blood is not normally associated with uti. Sounds all very difficult

[DragonTail]

Thanks for the replies, I'll try to explain what is happening.

The symptoms of the UTI are hot urine, needs to go all the time, difficulty controlling her bladder (particularly when asleep), bad stomach aches. She also gets very white, and ill looking and has no energy.

It doesn't show up as an infection, so late last year the paediatrician (who we were referred to a year ago) said no more antibiotics as she had had 14 lots since she was 3 year old. She got the symptoms of another UTI at the start of the year and without antibiotics over the next 4 months she got more and more unwell, the stomach aches got more severe until she started vomiting everyday and then being sick every day with blood. She was prescribed omeprazole to combat that and still needs it. They did blood tests and stool tests but everything came back negative.
After 4 months we got her on a 10 day course of antibiotics and the symptoms disappeared. Since then the symptoms have come back every 2 months but go with antibiotics. Its like the antibiotics don't properly get rid of the infection and certainly she does look pale and catches everything so her school attendance is terrible. Also if its not a UTI then where could the infection be?

Any suggestions as to what could be the matter and what we could suggest to the paediatrician would be great. Thanks

[DragonTail]

Forgot a couple of things. She has tried medication for an overactive bladder but it made no difference at all. Also she had a head MRI scan which was clear .

[InSpaceNooneCanHearYouScream]

Well- the urinary symptoms definitely need investigating further- I'm sure a urologist would be able to review the whole thing properly- I also think i'd be inclined to ask for a second opinion from a different paediatrician to review her- her care sounds a bit mixed up and disjointed. Does she have constipation issues at all?