12 year old with recurrent UTI's

[azoremama]

Since 2, our daughter has had many UTI's with many different bacteria at times.  We have lived overseas on an island without a pediatric urologist and have come to a point where we need another opionion and what they are not sure to do here.  In the past 6 months our daughter recently confessed to having had constant pain (nothing that brings tears) after urinating and dribbling all along for the past year and a half.  Here we thought she was doing well, although I made her take cranberry pills and acidophilus to help prevent things.  I did not know at that time that mild infections could come and go without antibiotics.  She drinks lots of water as well.  Well, after this confession in which she looked normal I took her in the next day and she did have an infection.  They put her back on an antibiotic which cleared it with the follow-up check and then again on Bactrim for the once a day preventative.  We did an ultrasound of kidneys and abdominal area and was good.  Now they just want to put her on an anti-depressant again which they did when she was young and that one didn't work for her.  Made her nuts.   She has a chronic stomach problem as well (which as a mom I have always been more concerned with since it has always bothered her more).  She was tested not to have lactose problem, but she has admitted milk and juices and some other things bother her, but never butter, or cheeses.  She also does not move her bowels on a normal basis.  Sometimes goes a week and more often lately better with every 3 days.   I made her mark it.  We have done a 3 day diary bladder and that seems good.  We had a Reflux test done when young and she didn't have that.  I can't remember what else, but I know only the one catheter that has freaked her out ever since as they were not child friendly and she always used to do well with blood tests and all until they just came at her and didn't even say hi or normal calming talk.  I want to get to the problem of this and not just keep her on anti-depressants for dribbling and antibiotics for long term.  She has had 10 in a year before when she was going in and many different bacteria and at that time (until about 8yrs.) I always wiped her so that wouldn't be a reason.  (We homeschool).  The pain is about every day but not bad and she says it burns when she stops in the middle of going, and then she goes more and it usually goes away.  Dribbles several times a week, but tiny leaks from coughing, laughing, walking on stairs sometimes.  She had a thickening of the bladder wall when littler that they pointed out, but didn't know why that was.   Should IVP be done next? and what else?  Please help.  A urologist does come sometimes from other island and they could send me off island to the mainland for better testing.  Should I push them?  I have always thought the bowels and bladder were associated somehow since it has always been both which could cause stomach cramps and nausea too.  Thank you for you help.

[Kevin Pho, MD]

I would retest for vesicoureteral reflux.  This can be done a VCUG (voiding cystourethrogram) or RNC (radionuclide cystogram) to detect the presence and severity of VUR.

If negative, I would also consider an IVP or cystoscopy to examine the anatomy of the urinary tract.  Any anatomical abnormality can lead to an increased incidence of UTIs.  

I would certainly consider another opinion to discuss further testing.  If everything is negative, then chronic, preventative antibiotics may be considered - the choice of antibiotics should be made by your urologist.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

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