4 Year Old Female

[Jana Condren]

I have a daughter who is about to be 4 years old.  I have been concerned about her for some time concerning her kidneys and bladder.  She rarely urinates more than twice per day.  She takes in a great deal of liquids.  She will wait until her stomach hurts and then she will urinate.  The skin around her vagina is almost always red and irritated from the concentrated urine.  When she was born, she did not urinate for 28 hours.  We took her home from the hospital, and it was another 24 hours before she urinated again.  At the age of 4 months, she was diagnosed with congestive heart failure.  She was treated with lasix and digoxin until the age of 2.  At that time, she was diagnosed with chronic paracardial effusion.  Her heart at this time, appears to be normal.  As I look back, I wonder if her urinary habits might have had anything to do with the retention of fluid around her heart.  As a mother, I am having trouble letting go of my fears concerning her.  I have finally convinced her pediatrician to do some more tests.  At this time, the only tests they have done concerning her urine have been routine urinalysis.  So far, she does not appear to have urinary tract infections, but yet she urinates so little, that I am still concerned.  They are going to schedule her to have a renal sonogram and a VCUG.  I know that the latter is painful, and I would just like to know whether or not you think this is necessary.  Am I overreacting as a parent, or do I have some legitimate concerns?  I would appreciate any help you could give me on this.

Thank you,
Jana Condren

[HFHS M.D.-BE]

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Dear Jana,
There is such a thing as an infrequent voider. Most children urinate 4 to 5 times a day, and have bowel movements daily or every other day. Some children, primarily girls, may void (urinate) only twice a day, once in the A.M. and again at night.  These children often had normal voiding patterns as infants, but after toilet training they learned to withhold urination for long periods of time.  Their parents may have lead them to believe, however unintentionally, the idea that it is bad to wet or soil themselves.  Others may have had a bad experience such as a bladder infection along with its symptom of burning upon urination, around the time of toilet training. Other children may be excessively neat, leading them to avoid bathrooms, especially at school or other public places.  Usually they urinate enough to relieve the pressure and fail to empty their bladder completely
The infrequent urination and incomplete emptying lead to an ever-increasing bladder size and capacity.  This in turn leads to a decrease in sensation to empty the bladder.
Studies such as a VCUG and urodynamics (pressure -flow tests) are needed to study the bladder and its function.   Renal failure may ultimately develop secondary tro bladder funtion abnormalities.
Usually by changing the child's urinary habits, by keeping a rigid schedule of urination in addition to encouraging him/her to completely empty, he/she may be able to restore some good function.   Needless to say that it is going to be a challenge.  I wish you the best .

This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).

Sincerely,
HFHS M.D.-BE
*keyword: Infrequent voider