When the bladder hurts
Lisa has been running to the toilet again and again since the early morning. As soon as she sits down, only a few drops come out, but they hurt like hell. Every trip to the toilet is torture. It hurts so much that Lisa can hardly sit still at school. In the last lesson, she feels ill and has pain in her abdomen. At home, she suddenly sees blood in the toilet. Her
mum takes her to the doctor. After a urine test, it is clear that Lisa has a bladder infection. She is 16 years old and has recently been intimate with her boyfriend.
«Bladder infections are common in the practice,» says paediatrician Stephan Rupp from Einsiedeln. Around one in ten girls, but only one in a hundred boys, has experienced cystitis into adulthood. Boys are more frequently affected in infancy,
then mainly girls. According to paediatrician Rupp, there are three age phases in which children fall ill with cystitis:
- Säuglinge und Kleinkinder unter zwei Jahren, bei denen oft ein anatomisches Problem wie eine Fehlbildung zugrunde liegt.
- Mädchen im Kindergarten- und jungen Schulalter, bei denen es um die Hygienethemen geht.
- Pubertierende Mädchen, die sexuell schon aktiv sind.
«Urinary tract infections are mainly a problem for girls - and later also for women,» confirms paediatric gynaecologist Irene Dingeldein. This is because their urethra is very short - only one to two centimetres in little girls. Bacteria therefore get into the bladder more quickly. The anus, vagina and urethra are also very close together in girls.
very close together.
Correct hygiene
Cystitis usually occurs when bacteria are carried over from the intestines, says Maya Horst, urologist at Zurich Children's Hospital. These are predominantly
Escherichia coli bacteria. This is why the genital area should always be cleaned from front to back. «When little girls learn to take care of their own hygiene, this can be the cause of repeated urinary tract infections,» says Stephan Rupp. But in such cases, you also have to think about inflammation of the labia, because not everything that burns is a bladder infection. In paediatric medicine, an old household remedy is used to treat inflammation of the external genital organs: Sitz baths with baking soda. «Girls before puberty don't yet have oestrogen, so the common remedies with lactobacilli don't work for them,» explains Rupp. And Dingeldein adds that other irritations of the mucous membranes are also possible. Instead of baking powder baths, she recommends baths with almond oil. Sometimes too much hygiene can also cause problems because it destroys the body's natural flora. Other causes of urinary tract infections
can be drinking behaviour, constipation or urination problems. There are girls who never empty their bladder completely, for example, or others whose urinary tract does not drain properly.
drain properly. This leaves behind so-called residual urine, which can be a reservoir for bacteria.
Antibiotics only with clear findings
Bladder infections are very annoying, but not actually dangerous. Nevertheless, they must be treated. All three experts are in favour of a correct diagnosis before treatment with antibiotics, not least because of the risk of resistance developing. Irene Dingeldein
calls for this especially for pubescent girls. «Every sexually active girl with a urinary tract infection must be tested for chlamydia,» she emphasises, «because of the risk of infection for partners and the consequences: possible infertility.» If the test is positive, the partner must also be treated and followed up after three months. «The diagnosis of a urinary tract infection is made with a urine test,» says Stephan Rupp. «The treatment is chosen based on the symptoms.» The aim is to prevent complications caused by the spread of the infection.
The specialists warn that pyelonephritis can leave scars, which can lead to a loss of kidney function. Cystitis in children is usually treated with antibiotics for three to five days. The treatment lasts up to two weeks if the renal pelvis is also affected. Maya Horst emphasises: «Children with a feverish urinary tract infection should also have an ultrasound scan of the kidneys and urinary tract.»
Plenty to drink and a little patience
The diagnosis and treatment of cystitis is usually carried out by the paediatrician or family doctor. A referral to a paediatric urologist or paediatric nephrologist
is recommended for very small babies, in the case of repeated febrile urinary tract infections
or if malformations are suspected. Pubescent girls with recurring urinary tract
urinary tract infections or unclear symptoms should see a gynaecological specialist.
Repeated bladder infections are common. «It is therefore essential to look for the cause and treat it instead of repeatedly administering antibiotics,» says Maya Horst. The problems are often persistent and require patience on the part of the parents, the affected person
affected, but also on the part of those treating them.
Tight clothing is not to blame
Bladder infections can be prevented by drinking plenty of fluids, emptying the bladder regularly and maintaining good hygiene. Young girls in particular should always empty their bladder before and after sex to flush the urethra. Although there are alternative products for
products such as cranberries or bearberry, but there is no scientific data on their effectiveness in children. With this clinical picture
Stephan Rupp says: «Warm pants and vests don't prevent cystitis any more than tight jeans, loose-fitting T-shirts and airy dresses are to blame for a urinary tract infection.»
Typical symptoms of a urinary tract infection
Infants and toddlers under two years of age:
- Fieber
- Erbrechen, Durchfall
- Unwohlsein
- Trinkschwäche, Gewichtsverlust
Mädchen über zwei Jahre und Pubertierende:
- Schmerzen oder Brennen beim Wasserlösen
- häufiges Wasserlösen
- Unterbauch- oder Flankenschmerzen
- Übelkeit, Erbrechen
- Fieber
Causes of urinary tract infections Urinary tract malformations
Contamination of urine in normal urinary tract due to:
- einer Blasenfunktionsstörung
- nicht vollständig entleerter Blase
- zu geringer Trinkmenge, zu selten aufs WC
- einer Verstopfung
- mangelnder Hygiene oder übertriebener
- Hygiene
- sexuellen Kontakts (vor allem bei Mädchen)
Literature
Diagnosis and treatment of urinary tract infections in children.
Recommendations of the Swiss Working Group for Paediatric Nephrology, the
Paediatric Infectiology Group Switzerland and the Swiss Society for Paediatric Urology
Paediatric Urology, Paediatrica, Vol. 24, No. 4, 2013.
www.swiss-paediatrics.org > Paediatrica >Volume 24
