can blood in diaper be normal?

[keley]

Posted by kelley on May 18, 1999 at 11:23:02
MY SON HAS BLOOD IN HIS DIAPER ON AND OFF NOW FOR MONTHS THE DR. DID A COMPLETE
WORKUP OF TESTS ON HIM THEY SEEM TO THINK IT IS NORMAL FOR THIS I DON'T AGREE.
HIS KIDNEY AND BLADDER ALL TESTED FINE CAN IT BE SOMETHING ELSE? HE IS AN ACTIVE 2 YEAR OLD BOY THE  BLOOD IS ABOUT A QUARTER SIZE DROP SEEMS TO BE WHEN HE GETS UP IN THE MORNING USUALLY ANY HELP WOULD BE APPRECIATED. THANK YOU
ALSO HIS UA COMES BACK POSITIVE FOR BLOOD BUT NOTHING ELSE.

Posted by HFHS M.D.-AT on May 28, 1999 at 15:34:15
Dear Kelley:
Thanks for your questions and patience. Your son seems to be having blood staining of his diapers with positive UA and normal workup.
Urethral bleeding in male children is a not uncommon condition and is usually due to a benign condition.  In approximately 43% of cases it is due to infections.  A special kind in pre-pubertal  males is called as Urethrorrhagia.  It usually presents with blood spotting per urethra, microhematuria, and/or dysuria (burning during urination) in prepubertal boys. Sometimes associated with meatal stenosis (narrowing of the urethral opening), but often isolated.
It is postulated that the etiology of this condition is urethritis (urethral infection) due to a fastidious infectious organism (that is, difficult to isolate). Whatever the cause of this syndrome, recurrences tend to end after physical maturity is achieved. This may imply that the prepubertal or early pubertal hormonal interplay is important for the occurrence of the urethral inflammation. The common pathologic feature of this syndrome appears to be squamous metaplasia (change in character of urethral lining) of the urethra. The inflammation and bleeding might be due to cracking of this abnormal epithelium, with exposure of the urine to the subepithelial tissues. Increased urethral distension secondary to meatal stenosis would exacerbate this type of bleeding.
The typical patient may be treated expectantly, with diagnostic studies including ultrasound of the kidneys and bladder reserved for those with severe symptoms, or frequent and lengthy recurrences. The differential diagnosis includes infectious urethritis, calculus, tumor, or fibroepithelial polyp, all less common. Cystoscopic evaluation is usually avoided. Voiding cystourethrogram has been generally unrevealing in these patients although the inflammatory changes may be seen. Antibiotic therapy is not officialy recommended, as there is no compelling evidence that it affects the course of the symptomatic period. However, as there are unexplained strictures seen in children and they can be secondary to such inflamation (inflammation), there is some feeling that antiotic therapy with trimethoprim/sulfamethoxazole is a reasonable though unsubstantiated form of treatment.
Hope this information will help you. Best of luck.
This information is provided for general medical information purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. The Henry Ford Hospital Department of Urology has experience in the evaluation and treatments of problems as you describe. We would be most interested in helping you. You can reach us through our toll-free number 1-800-653-6568.
We can also arrange local accommodations through this number if this is your need. Please bring any x-rays (not just the reports) as well as any physicians' notes and lab test results that you may be able to obtain. These will help us greatly.
Sincerely,
HFHS M.D.-A.T.
*Keyword: Hematuria, urethrorrhagia