Urinary Tract Infections in Pediatrics

A UTI is when bacteria gets into your urine and travels up to your bladder. As many as 8 in 100 of girls and 2 in 100 of boys will get UTIs. Young children have a greater risk of kidney damage linked to UTI than older children or adults.

How Does the Urinary Tract Work?

The “urinary tract” is the organs in your body that make, store, and get rid of urine, one of the waste products of your body. Urine is made in the kidneys and travels down to the bladder through the ureters (the tubes that join them). The kidneys make about 1½ to 2 quarts of urine a day in an adult, and less in children, depending on their age. In children, the bladder can hold 1 to 1½ ounces of urine for each year of age. For example, a 4-year-old child’s bladder can hold 4 to 6 ounces—a little less than a cup.

The bladder stores the urine until it is emptied through the urethra, a tube that links the bladder to the skin, when you urinate. The urethra opens at the end of the penis in boys and in front of the vagina in girls.

The kidneys also balance the levels of many chemicals in the body (sodium, potassium, calcium, phosphorous and others) and check the blood’s acidity. Certain hormones are also made in the kidneys. These hormones help control blood pressure, boost red blood cell production and help make strong bones.

Normal urine has no bacteria in it, and the one-way flow helps prevent infections. Still, bacteria may get into the urine through the urethra and travel up into the bladder.

What is a Urinary Tract Infection (UTI) in Adults?

A UTI is when bacteria gets into your urine and travels up to your bladder. UTIs cause more than 8.1 million visits to health care providers each year. About 10 in 25 women and 3 in 25 men will have symptoms of at least 1 UTI during their lifetime.

How Does the Urinary Tract Work?

The urinary tract makes and stores urine, one of the waste products of your body. Urine is made in the kidneys and travels down the ureters to the bladder. The bladder stores the urine until it is emptied through the urethra, a tube that connects the bladder to the skin, when you urinate. The opening of the urethra is at the end of the penis in a male and in front of the vagina in a female.

The kidneys are a pair of fist-sized organs in the back that filter liquid waste from the blood and remove it from the body in the form of urine. Kidneys balance the levels of many chemicals in the body (sodium, potassium, calcium, phosphorous and others) and check the blood’s acidity. Certain hormones are also made in the kidneys. These hormones help control blood pressure, boost red blood cell production and help make strong bones.

Normal urine has no bacteria in it, and the one-way flow helps prevent infections. Still, bacteria may get into the urine from the urethra and travel up into the bladder.

What is Urinary Incontinence?

Urinary incontinence is leaking of urine that you can’t control. Many American men and women suffer from urinary incontinence. We don’t know for sure exactly how many. That’s because many people do not tell anyone about their symptoms. They may be embarrassed, or they may think nothing can be done. So they suffer in silence.

Urinary incontinence is not just a medical problem. It can affect emotional, psychological and social life. Many people who have urinary incontinence are afraid to do normal daily activities. They don’t want to be too far from a toilet. Urinary incontinence can keep people from enjoying life.

Many people think urinary incontinence is just part of getting older. But it’s not. And it can be managed or treated. Learn more here. Talk to your doctor. Find out what treatment is best for you.

Key Statistics

A quarter to a third of men and women in the U.S. suffer from urinary incontinence. That means millions of Americans. About 33 million have overactive bladder (also known as OAB) representing symptoms of urgency, frequency and with or without urge incontinence.

Studies show that many things increase risk. For example, aging is linked to urinary incontinence. Pregnancy, delivery, and number of children increase the risk in women. Women who have had a baby have higher rates of urinary incontinence. The risk increases with the number of children. This is true for cesarean section (c-section) and vaginal delivery.

Women who develop urinary incontinence while pregnant are more likely to have it afterward. Women after menopause (whose periods have stopped) may develop urinary incontinence. This may be due to the drop in estrogen (the female sex hormone). Taking estrogen, however, has not been shown to help urinary incontinence.

Men who have prostate problems are also at increased risk. Some medications are linked to urinary incontinence and some medicines make it worse. Statistics show that poor overall health also increases risk. Diabetes, stroke, high blood pressure and smoking are also linked.

Obesity increases the risk of urinary incontinence. Losing weight can improve bladder function and lessen urinary incontinence symptoms.

What happens normally?

The brain and the bladder control urinary function. The bladder stores urine until you are ready to empty it. The muscles in the lower part of the pelvis hold the bladder in place. Normally, the smooth muscle of the bladder is relaxed. This holds the urine in the bladder. The neck (end) of the bladder is closed. The sphincter muscles are closed around the urethra. The urethra is the tube that carries urine out of the body. When the sphincter muscles keep the urethra closed, urine doesn’t leak.

Once you are ready to urinate, the brain sends a signal to the bladder. Then the bladder muscles contract. This forces the urine out through the urethra, the tube that carries urine from the body. The sphincters open up when the bladder contracts.

What are the types of urinary incontinence?

Urinary incontinence is not a disease. It is a symptom of many conditions. Causes may differ for men and women. But it is not hereditary. And it is not just a normal part of aging. These are the four types of urinary incontinence:

Stress Urinary Incontinence (SUI)

With SUI, weak pelvic muscles let urine escape. It is one of the most common types of urinary incontinence. It is common in older women. It is less common in men.

SUI happens when the pelvic floor muscles have stretched. Physical activity puts pressure on the bladder. Then the bladder leaks. Leaking my happen with exercise, walking, bending, lifting, or even sneezing and coughing. It can be a few drops of urine to a tablespoon or more. SUI can be mild, moderate or severe.

There are no FDA approved medicines to treat SUI yet, but there are things you can do. Ways to manage SUI include “Kegel” exercises to strengthen the pelvic floor. Lifestyle changes, vaginal and urethral devices, pads, and even surgery are other ways to manage SUI.

To learn more about SUI risk factors, diagnosis and treatments visit our SUI article page.

Overactive Bladder (OAB)

OAB is another common type of urinary incontinence. It is also called “urgency” incontinence. OAB affects more than 30% of men and 40% of women in the U.S. It affects people’s lives. They may restrict activities. They may fear they will suddenly have to urinate when they aren’t near a bathroom. They may not even be able to get a good night’s sleep. Some people have both SUI and OAB and this is known as mixed incontinence.

With OAB, your brain tells your bladder to empty – even when it isn’t full. Or the bladder muscles are too active. They contract (squeeze) to pass urine before your bladder is full. This causes the urge (need) to urinate.

The main symptom of OAB is the sudden urge to urinate. You can’t control or ignore this “gotta go” feeling. Another symptom is having to urinate many times during the day and night.

OAB is more likely in men with prostate problems and in women after menopause. It is caused by many things. Even diet can affect OAB. There are a number of treatments. They include life style changes, drugs that relax the bladder muscle, or surgery. Some people have both SUI and OAB.

To learn more about OAB risk factors, causes and treatments visit our OAB page.

Mixed Incontinence (SUI and OAB)

Some people leak urine with activity (SUI) and often feel the urge to urinate (OAB). This is mixed incontinence. The person has both SUI and OAB.

Overflow Incontinence

With overflow incontinence, the body makes more urine than the bladder can hold or the bladder is full and cannot empty thereby causing it to leak urine. In addition, there may be something blocking the flow or the bladder muscle may not contract (squeeze) as it should.

One symptom is frequent urinating of a small amount. Another symptom is a constant drip, called “dribbling.”

This type of urinary incontinences is rare in women. It is more common in men who have prostate problems or have had prostate surgery.

What is Urethral Cancer?

Urethral cancer is the most rare of all urological cancer. Only 1 or 2 people out of 100 patients with cancer get this type. It is more common in men than women. Some people with urethral cancer don’t have any symptoms, but most do. This information will tell you more about urethral cancer, how it’s diagnosed and treatment options.

What is the Urethra?

The urethra is a hollow tube that lets urine pass from the bladder, the organ that stores urine until ready for release, to the outside of the body. In men the urethra is about 8 inches long, and passes through the prostate to the end of the penis. In women the urethra is about 1.5 inches long, and opens to the outside just above the vaginal opening.

What is Overactive Bladder (OAB)?

Overactive bladder (OAB) is a common condition that affects millions of Americans. Overactive bladder isn’t a disease. It’s the name of a group of urinary symptoms. The most common symptom of OAB is a sudden urge to urinate that you can’t control. Some people will leak urine when they feel the urge. Leaking urine is called “incontinence.” Having to go to the bathroom many times during the day and night is another symptom of OAB.

There is another common bladder problem called stress urinary incontinence (SUI), which is different from OAB. People with SUI leak urine while sneezing, laughing or doing other physical activities. More information on SUI can be found at www.urologyhealth.org/SUI/.

Key Statistics

About 33 million Americans have overactive bladder. As many as 30% of men and 40% of women in the United States live with OAB symptoms. But the real number of people with OAB is most likely much larger. That’s because many people living with OAB don’t ask for help. Some are embarrassed. They don’t know how to talk to their health care provider about their symptoms. Other people don’t ask for help because they think there aren’t any treatments for OAB.

How OAB Can Affect Your Life

OAB can get in the way of your work, social life, exercise and sleep. Without treatment, OAB symptoms may make it hard to get through your day without lots of trips to the bathroom. You may feel nervous about going out with friends or doing everyday activities because you’re afraid you may not find a bathroom when you need one. Some people begin to shy away from social events. This can make them feel lonely and isolated.

OAB may affect your relationships with your spouse and your family. It can also rob you of a good night’s sleep. Too little sleep will leave you tired and depressed. In addition, if you leak urine, you may develop skin problems or infections.

You don’t have to let OAB symptoms change your life. There are treatments available to help. If you think you have OAB, see your health care provider.

The Truth About OAB

Don’t let myths about OAB prevent you from getting the help you need.

OAB is not “just part of being a woman.”
OAB is not “just having an ‘enlarged’ prostate (BPH).”
OAB is not “just a normal part of getting older.”
OAB is not caused by something you did.
Surgery is not the only treatment for OAB.
There are treatments for OAB that can help with symptoms.
There are treatments that many people with OAB find helpful.
There are treatments that can help, even if your symptoms aren’t severe or if you don’t have urine leaks.

What is Neurogenic Bladder?

Millions of Americans have neurogenic bladder. Neurogenic bladder is the name given to a number of urinary conditions in people who lack bladder control due to a brain, spinal cord or nerve problem. This nerve damage can be the result of diseases such as multiple sclerosis (MS), Parkinson’s disease or diabetes. It can also be caused by infection of the brain or spinal cord, heavy metal poisoning, stroke, spinal cord injury, or major pelvic surgery. People who are born with problems of the spinal cord, such as spina bifida, may also have this type of bladder problem.

Nerves in the body control how the bladder stores or empties urine, and problems with these nerves cause overactive bladder (OAB), incontinence, and underactive bladder (UAB) or obstructive bladder, in which the flow of urine is blocked.

What is Kidney Cancer?

Cancer is when cells in the body grow out of control. These cells can form a tumor or damaged tissue. If cancer cells grow in the kidney, it is called kidney cancer.

  • The most common kidney cancer in adults is renal cell carcinoma. It forms in the lining of very small tubes in the kidney.
  • Cancers found in the center of the kidney are known as transitional cell carcinoma.
  • Wilms tumor is a kidney cancer that very young children can get.

On average, people are diagnosed with kidney cancer at around age 64. It’s rarely found in people younger than age 45. Generally, our lifetime risk for developing cancer in the kidney is about 1 in 63 (1.6%)1. This risk is higher in men than in women.

With timely diagnosis and treatment, kidney cancer can be cured. To learn more about symptoms, diagnosis, treatment options and common questions, read on.

Basic Facts about Kidney Cancer

The terms “tumor,” “mass,” or “lesion” are used to describe an abnormal growth in the kidney. Tumors can be benign (non-cancerous) or malignant (cancerous). A fluid-filled sac, called a cyst, is the most common growth found in a kidney. Cysts are mostly not cancerous. Solid kidney tumors can be benign, but most often are found to be cancer.

Kidney cancer is one of the top 10 most common cancers diagnosed in the United States. In 2017, about 63,990 people will be diagnosed. About 14,000 people will die from this disease. Of the people who are diagnosed early (stage I or II cancer), 75-80% will survive.

What Happens Under Normal Conditions?

Healthy kidneys work around the clock to clean our blood. The kidneys look like 2 bean-shaped organs. They are found near the middle of the back below the rib cage. They are surrounded by a protective sac called the Gerota’s fascia and a layer of fat. The renal artery brings “dirty” blood into the kidney. The renal vein takes clean blood out to the heart.

Our kidneys are our body’s main filter. They clean about 150 quarts of blood daily. Every day, they remove about 1-2 quarts of water and waste from the blood in the form of urine. Urine then moves into the kidney’s collecting system, the renal pelvis. It flows from there through the ureters to the bladder to be stored. Eventually it is pushed out of our bodies through the urethra.

The adrenal glands are on top of the kidneys. The adrenal glands regulate blood sugar, potassium, body fluids and sex hormones. They control our stress response by producing a hormone called adrenaline. They create a hormone called erythropoietin that helps to produce red blood cells.

As a filter, the kidney controls many things to keep us healthy:

  • Fluid balance
  • Electrolyte levels (e.g., sodium, potassium, calcium, magnesium, acid)
  • Waste removal in the form of urine
  • The regulation of blood pressure and red blood cell counts

When the kidneys are damaged they may not work well. In most cases, some damage won’t cause too many problems. But, major damage may need more treatment, like dialysis.

1 Information cited from:

http://www.cancer.org/cancer/kidneycancer/detailedguide/kidney-cancer-adult-key-statistics

What are Kidney Stones?

Urine contains many dissolved minerals and salts. When your urine has high levels of these minerals and salts, you can form stones. Kidney stones can start small but can grow larger in size, even filling the inner hollow structures of the kidney. Some stones stay in the kidney, and do not cause any problems. Sometimes, the kidney stone can travel down the ureter, the tube between the kidney and the bladder. If the stone reaches the bladder, it can be passed out of the body in urine. If the stone becomes lodged in the ureter, it blocks the urine flow from that kidney and causes pain.

The Kidneys and Urinary System

The kidneys are fist-size organs that handle the body’s fluid and chemical levels. Most people have two kidneys, one on each side of the spine behind the liver, stomach, pancreas and intestines. Healthy kidneys clean waste from the blood and remove it in the urine. They control the levels of sodium, potassium and calcium in the blood.

The kidneys, ureters and bladder are part of your urinary tract. The urinary tract makes, transports, and stores urine in the body. The kidneys make urine from water and your body’s waste. The urine then travels down the ureters into the bladder, where it is stored. Urine leaves your body through the urethra.

Kidney stones form in the kidney. Some stones move from the kidney into the ureter. The ureters are tubes leading from the kidneys to the bladder. If a stone leaves the kidney and gets stuck in the ureter, it is called a ureteral stone.

What are Kidney Stones Made of?

Kidney stones come in many different types and colors. How you treat them and stop new stones from forming depends on what type of stone you have.

Calcium stones (80 percent of stones)

Calcium stones are the most common type of kidney stone. There are two types of calcium stones: calcium oxalate and calcium phosphate. Calcium oxalate is by far the most common type of calcium stone. Some people have too much calcium in their urine, raising their risk of calcium stones. Even with normal amounts of calcium in the urine, calcium stones may form for other reasons.

Uric acid stones (5-10 percent of stones)

Uric acid is a waste product that comes from chemical changes in the body. Uric acid crystals do not dissolve well in acidic urine and instead will form a uric acid stone. Having acidic urine may come from:

  • Being overweight
  • Chronic diarrhea
  • Type 2 diabetes (high blood sugar)
  • Gout
  • A diet that is high in animal protein and low in fruits and vegetables

Struvite/infection stones (10 percent of stones)

Struvite stones are not a common type of stone. These stones are related to chronic urinary tract infections (UTIs). Some bacteria make the urine less acidic and more basic or alkaline. Magnesium ammonium phosphate (struvite) stones form in alkaline urine. These stones are often large, with branches, and they often grow very fast.

People who get chronic UTIs, such as those with long-term tubes in their kidneys or bladders, or people with poor bladder emptying due to neurologic disorders (paralysis, multiple sclerosis, and spina bifida) are at the highest risk for developing these stones.

Cystine stones (less than 1 percent of stones)

Cystine is an amino acid that is in certain foods; it is one of the building blocks of protein. Cystinuria (too much cystine in the urine) is a rare, inherited metabolic disorder. It is when the kidneys do not reabsorb cystine from the urine. When high amounts of cystine are in the urine, it causes stones to form. Cystine stones often start to form in childhood.

What is Interstitial Cystitis/Bladder Pain Syndrome?

Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a chronic bladder health issue. It is a feeling of pain and pressure in the bladder area. Along with this pain are lower urinary tract symptoms which have lasted for more than 6 weeks, without having an infection or other clear causes.

Symptoms range from mild to severe. For some patients the symptoms may come and go, and for others they don’t go away. IC/BPS is not an infection, but it may feel like a bladder infection. Women with IC/BPS may feel pain when having sex.  The more severe cases of IC/BPS can affect your life and your loved ones.  Some people with IC/BPS have other health issues such as irritable bowel syndrome, fibromyalgia, and other pain syndromes.

The bladder and kidneys are part of the urinary system, the organs in our bodies that make, store, and pass urine. You have 2 kidneys that make urine.  Then urine is stored in the bladder.  The muscles in the lower part of your abdomen hold your bladder in place.

How the Urinary System Works 

When it is not full of urine, the bladder is relaxed.  When nerve signals in your brain let you know that your bladder is getting full, you feel the need to pass urine.  If your bladder is working normally, you can put off urination for some time.    Once you are ready to pass urine, the brain sends a signal to the bladder.  Then the bladder muscles squeeze (or “contract”).  This forces the urine out through the urethra, the tube that carries urine from your body.  The urethra has muscles called sphincters.  They help keep the urethra closed so urine doesn’t leak before you’re ready to go to the bathroom.  These sphincters relax when the bladder contracts.

What is Hematuria?

During routine visits to your health care provider, you are often asked to give a urine sample for testing. Many tests are done routinely, like checking for sugar (diabetes), bacteria (infection) and blood. Blood in the urine that you do not see is called “microscopic hematuria.” This blood is only visible under a microscope. There are many causes and most are not serious, but may call for care by your health care provider.