November 25, 2012,
H.C. asks from Seattle, WA on June 24, 2009
Daughter Feels Constant Urge to Pee - Doesn't Have a Bladder Infection
My 4 yr. old daughter has been experiencing a constant urge to pee. It began last Friday, I expect due to mild constipation, which I believe was brought on from consuming cheese (she normally is dairy-free). My daughter has been experiencing constant drips in her underwear, along with the urgency. She is constantly running to the toilet, sometimes immediately after leaving the bathroom. She has sat on the toilet up to 20 times an hour! The pediatrician tested her urine - she does not have an infection. She also suggested that the urgency my daughter is feeling is being caused by her bowels pushing on her bladder/urethra. She recommended sitz baths with baking soda, drinking more fluids, for my daughter to push hard once to try to void the urine before getting off the toilet, and to give my daughter the positive message that this problem will get fixed. We have been doing all these things, plus I have given her a few doses of Mirilax to help insure that she is not backed up (her most recent bowel movements seemed quite normal.) I've also been giving her jello and popsicles and grapes and other watery fruit to increase her fluid intake - she hasn't been thrilled about drinking since she equates that to more peeing... I just wandered if anyone else has gone through this or has suggestions. I hate seeing her in such agony. I will be calling her pediatrician back, because I don't think she understood the full severity of this. We can't leave the house. She's missing school and outings. And she's miserable.
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So What Happened?™
Thank you all for your responses - I really appreciated it. The problem hasn't been solved yet. It's been 6 weeks. My daughter had some lab work done on friday - to check her kidney function. The tests came back normal. So we have an appointment with the Urology Clinic at Children's, but it isn't until September 1! Our first appointment is a "bladder seminar" with 40 - 60 other families. They are going to discuss allergies and other possible irritants, as well as bladder health and correcting behavioral issues. If after the seminar, we don't manage to fix the problem ourselves, then they will give us a private appointment. I think the pediatrician thinks her problem is behavioral. I really don't know what to think. Unfortunately, the doctors haven't given me any instruction on how to handle her in the meantime. I'd hate to make the situation worse by reinforcing the wrong behaviors. Most of the information I've found has to do with kids who never want to visit the bathroom, not ones that are trying to go to the toilet every 10 - 40 minutes. It seems scheduling potty visits would be easier if she was just to busy playing to go, but telling my child who is feeling an extremely urgent need to pee to ignore it, is very difficult. If anyone has dealt with correcting frequent urination (as a behavioral problem) I'd love to know what you did! Thanks again!
The good news is, the problem finally went away! But it took a long time. I went to a Bladder Seminar at our Children's Hospital and then had a follow up with a specialist. Here are the most useful thing that I took away from talking to the specialists: when your daughter sits on the toilet have her put her feet on a stool and have her lean forward and rest on her arms. She needs to be relaxed - legs shouldn't be dangling or straining to reach the foot stool. This eliminates some of the dripping problem. Drips (especially big ones) can be caused by pee getting pushed into the vagina, rather then streaming into the toilet. This happens especially if your daughter is not peeing with relaxed bladder muscles, but rather forcing the pee out through an unrelaxed urethra. So the foot stool and the positioning help assure that muscles are relaxed and the pee flows down, rather than into the vagina. This is called vaginal voiding, when it gets pocketed into the vagina and doesn't come out until after the child stands up.
After I made my original post, I decided to take my daughter off of wheat, because despite using Miralax we were still having problems with constipation off and on, and my daughter was always very bloated. She also had an itchy rash always on the backs of her knees. So I took her off gluten, within a few weeks her constipation problems disappeared and the rash was gone too. I was so relieved at that, but the peeing issue persisted. So, I took her to have some IgG and IgE food allergy testing. This was done with a blood test, it's validity is still questioned by some, but I was desperate for clues. It will only show allergies to foods that are currently in your diet, so I wished I'd done it before I took her off wheat. But the disappearance of the rash and constipation was enough of an answer for me regarding wheat. She was also not consuming dairy at the time, as I had suspected that that was the cause of the constipation she had suffered from since she was a toddler. The test results showed an allergy to soy, which was what I had been feeding her in place of dairy, so then I switched her to almond milk. But this didn't really solve our problem either.
So, the other thing the Bladder clinic doctor recommended, was to make sure our daughter consumed enough liquid every day, because she was never voiding much. This was to try to give her a sense of what a full bladder feels like and to just get things more in sync. She did suggest that her bladder may just be growing at a slower rate than the rest of her and it needed time to catch up. Also, being that she is hypersensitive, she may be more aware of sensations in general. She prescribed a bladder muscle relaxer medication (sorry I don't remember the name of the drug - I just remembered that she'd been on this after seeing one of the commenters below). We didn't notice any real improvement with this drug and discontinued using it after a few months. Also, she said to give my daughter an adult dose of Miralax everyday - two doses if needed, to "clean her out."
I was not happy with any of these explanations. The foot stool did help the drip problem, though most of kindergarten, my daughter wore a panty liner to school because it made her feel better. Also we kept a foot stool for her in the school bathroom. She went from sitting on the toilet 15 - 30 times an hour, to once every half hour or so, which was still far too disruptive at school, so I went to her pediatrician.
The pediatrician ordered x-rays of her gut. She wanted to make sure that she didn't have a tethered spinal cord (i think that was what she called it, it was a while ago) , which could lead to constipation and also she wanted to look at her intestines. What they found was that she had an excessive amount of gas. This wasn't really news to me, she was always very bloated, and found waistbands very uncomfortable much of the time. What did the pediatrician recommend? Miralax. The bladder doctor was very pushy about this to. But my daughter had been using this stuff for a few years now, and I had been giving her less and less since I took her off wheat. I wanted her off of it completely. I didn't feel good about the stuff.
So that's when I did some research on my own. On Miralax. And found people linking it to frequent urination problems! And extreme bloating. I joined a yahoo group called Miralax,so I could read more about people's negative experiences with the drug and what they used in place of it.
After reading all the horror stories, I took my daughter off of it immediately. The bloating rapidly went away. The peeing problem vanished - maybe because there wasn't all that gas pressure on her bladder, and perhaps the chemicals in the medication had also been also irritating her bladder. My daughter is still off of wheat/gluten. It's not so hard to accommodate, especially if there are no other dietary restrictions. I've reintroduced dairy (though she won't drink regular milk now, because it tastes funny to her.) And she hasn't had any constipation problems at all. If you are considering a gluten-free diet for your child, I can recommend a few staples and brands that seem to know what they are doing.
ADDITIONAL THOUGHTS 3/18/11
I want to clear up a few things, so this might be more helpful to people who stumble upon the question later. It may help them determine whether these solutions are the right thing to try.
Ultimately I believe that Mirilax was the root cause of the bladder issues - my daughter had been suffering from incredible bloat - she looked 9 months pregnant almost all the time. She was otherwise skinny. She did not like waistbands at all and would wear her pants very low due to discomfort. It wasn't until she went off Mirilax that she "deflated." And the problem went away as the bloating went away. Our daughter also had this life long rash on the back of her legs, with the elimination of wheat it went away. If she ingests wheat it returns very quickly. They are very itchy bumps. We did DNA testing with 23 And Me, and she tested positive for a gene that they believe occurs more often in Celiacs. This was from their (new) research, and differs from the gene test doctors traditionally perform.
C.S. answers from Medford on June 25, 2009
OMG! Please email me! I am having the EXACT same problem with my 4 year old daughter! We have been on a roller coaster ride of frustration since January this year!!! I have some suggestions that my doctor and I went through also...I posted a request about this a few months ago...email me and I will send you the information!
L.N. answers from Portland on June 25, 2009
I agree with the advice to call the doctor again (or a different one). I just heard about the effects of some bubble baths from a friend. Does your daughter take bubble baths? A friend just took her daughter to the doctor with a complaint that the little girl felt like she needed to pee all the time, and the doctor said, "she takes bubble baths every night, right?" And yes she did. So now she's taking baking soda baths to help. Good luck to you and your daughter!
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S.B. answers from Portland on June 25, 2009
Did the doctor culture the urine, or just look at the dipstick results? When they test for a UTI they are primarily looking for red and white blood cells and nitrates (a chemical created by some bacteria). The dipstick can give false negative results for several reasons, some white blood cells are not detected as well (mononuclear cells to be specific), the red blood cells might not be in a large enough quantity, and the nitrates can be negative if the urine hasn't been in the bladder for at least several hours. Not everyone has all three of these when they have an infection, some have one or two or none. Generally, if the dipstick results are negative the lab tech doesn't look at the urine under the microscope and it doesn't get cultured. I would suggest calling your pediatrician again and tell him/her that the symptoms are still a major problem. Ask the doc to order a culture of her urine regardless of the dipstick results. Also, make absolutely sure your daughter follows the collection directions for a "clean catch" specimen. Failure to do so can allow too many different kinds of bacteria to grow and one of the criteria for defining a UTI is that there needs to be one or maybe two predominant organisms. Then, if the culture comes back negative then I agree with the other posts that you should get a referral to a urologist.
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K.M. answers from Richland on June 25, 2009
She needs to see a pediatric urologist. My daughter is 10, has suffered with exactly what you are listing for YEARS, & we recently figured out her problem...It is an allergy/body reaction to a medicine she was on.
We learned, from the pediatric urologist, that trying to push the pee out actually pinches the urethra closed & causes more pain & frustration. My daughter was given relaxation exercises for when she sits on the potty. (give her a pin wheel, put her fee up on a stool, & take her mind off trying to pee by blowing on the pinwheel. This will relax her and she will pee.)
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W.C. answers from Seattle on June 25, 2009
definitely call your doc. She is way too uncomfortable. How would you feel if you would her? I would reduce the extra liquids. Also have the doc consider a bacterial infection as well as a viral infection.
No little girl should go through this.
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K.O. answers from Portland on June 25, 2009
Take her to a pediatric urologist. I have one I can refer if you are interested. Both myself and my youngest son suffered from kidney, urological issues. When I was young my mom took me to the doctor with 'peeing' issues roughly a million times. They kept telling her I was fine, she was certain I wasn't. Guess who was right?! I ended up with a bunch of bladder infections shortly after, and was ultimately treated with adult medicine they got so bad. Follow your instincts.
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C.B. answers from Anchorage on June 25, 2009
Does your daughter take bubble baths? My 4 year old son had the same problem. He would go all the time and only pee a little tiny bit, but then have to go again just a few minutes later. When I took him to the pediatrician, the first thing he asked me was does my son like to take bubble baths. Of course he does. He took one everyday and could spend hours in there if I’d let him. He told me if it wasn’t a bladder infection then bubble bath soap could be irritating him. I had no idea that this could happen. He told me to try his suggestions for a couple of weeks and if he didn’t improve, then we would go in for some more tests. Honestly, I didn’t think it was the soap, but it turns out, he was right. Here’s what he recommended. Take a bath with no bubble bath. Bathe with water only. Keep all shampoos and soaps out of reach because they’ll get a hold of it and make their own bubble bath. Let her play in the water until she’s ready to get out. Once she’s ready to get out. Shampoo her hair and wash her body. Rinse immediately and get her out of the tub. Even shampoo and body wash can irritate her, so you have to get her out of the tub quickly after rinsing her off. After 3 or 4 days I saw improvement. My son now takes showers and hasn’t had any problems with frequent bathroom trips. Good luck to you and your daughter. I know how frustrating it can get.
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S.S. answers from Seattle on June 25, 2009
My name is S., I am 62 years old and I have 5 children, 20 grandchildren and 4 great grandchildren. I live in Auburn, WA.
I know from personal experience that some UTI-type infections really do not show up on tests until they get pretty serious. They may be too low level to grab the attention of a doctor but they are excruciatingly uncomfortable for the patient.
I would suggest looking up some natural, healthy approaches to treating &/or preventing UTI's and try them out. Yogurt and cranberry juice are the most well known and even my doctors have said they are beneficial.
All of my natural health books are packed right now because I am moving soon, or I would look a few others up for you.
Since your child is young, be very wary of vitamins/food supplements and herbal stuff even herbal teas (Always check these out with your doctor).
Try to stick with the nutritional stuff you can achieve with healthy food products.
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I.S. answers from Portland on June 25, 2009
Hi H., you should call the doctor back. Perhaps there is something more they can do to help her get through it.
I know from personal experience what your little girl is going through and your right she is miserable. When I eat fatty foods like cheese, my digestive system gets very irritated. My colon stops contracting and feces gets backed up causing constipation/diarrhea. The pressure pushes on my bladder not allowing it to expand to hold urine. Which causes the urges to go often. If urine gets blocked or backed up it can cause an infection.
Another thing to consider is how much fiber is in her diet. If she is already having trouble at 4 she will most likely have trouble for the rest of her life. You want to talk to her DR about fiber powder/supplements. Picky eaters have more challenges and its even more difficult to get enough dietary fiber from foods.
Once bowel movements are restored to normal it can still take a few days for the colon to settle down.
My doctor tells me to avoid trigger foods and increase fiber intake. I do use a mild laxative (for constipation), pain reliever (for spasm/cramping),anti-oxidants cranberry, bilberry, blueberry juice or capsules (prevent infection). It can take any number of days before the symptoms all clear.
Small pantie liners to line her panties until it passes may help her feel more confident. She will not have to change her panties all day long.
Hope this helps,
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