How to Identify Urinary Reflux in Children

Vesicoureteral reflux (VUR), commonly known as urinary reflux, is the abnormal backwards flow of urine from the bladder toward the kidneys. Urinary reflux is most commonly diagnosed in babies and children, and if left untreated it can lead to kidney damage caused by urinary tract infections that involve the kidneys. Learn to spot urinary infections and VUR so you can get your child treatment.

Part 1 - Looking For Symptoms

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→ Watch for symptoms of urinary tract infections (UTIs). UTIs are a common sign of urinary reflux, so if your child has one or several UTIs, you should consider having him tested for VUR.

→ In infants and toddlers with urinary reflux, symptoms of UTIs include an unexplained fever, diarrhea, vomiting, lack of appetite, and irritability. You may also notice frequent urinating in small amounts, blood in the urine (hematuria), or cloudy, strong-smelling urine.

→ If your child is younger than 3 months old and has a rectal temperature of 100.4 F (38 C) or higher, contact your doctor. If your child is three months or older and has a fever of 102 °F (38.9 °C) or higher, contact your doctor.

→ Older children might experience similar signs, but can also communicate several others. These include a strong, persistent urge to urinate, a burning sensation when urinating, and being hesitant to urinate or holding urine to avoid that burning sensation.

→ Listen for other, less specific complaints from older children. These can include going to the bathroom more often, saying, "It burns," or, "It hurts," when urinating, or complaining of a stomachache.

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→ Identify any kidney pain in older children. Older kids with urinary reflux (as well as other UTIs) may also experience kidney pain. Kidney pain is felt as a pain on either side of the back, just beneath the lower ribs.

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→ Look for dysfunctional urination. Dysfunctional urination is a symptom of more serious urinary reflux. This can be an overactive bladder, a tendency to "hold in" urine, or the inability to release anything but a very weak stream of urine (particularly in boys). Your child may also be suffering from severe constipation (holding in stool).

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→ Look for other symptoms of bladder/bowel dysfunction (BBD). These may include having to urinate often or suddenly, long periods of time between bathroom visits, daytime wetting, and posturing to prevent wetting. Your child may also have pain in the penis or perineum (the area between the anus and genitals), constipation (fewer than two bowel movements in a week, and painful, large, or hard when they happen), bedwetting, or incontinence (the inability to hold stool in the colon and rectum).

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→ Be aware of birth defects. One type of VUR is caused by an obstruction in the bladder. In some cases this is the result of surgery or injury. It is also common in children with spinal cord birth defects like spina bifida.

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→ Check your family history for the presence of urinary reflux. VUR can be a genetic disease, so if the parents had it in the past, their children could develop it. If the mother had VUR in the past, as many as half of her children could have VUR.. Similarly, if one child has it, their siblings might, especially younger siblings. About 32% of siblings will develop the disease, and nearly 100% of identical twins.

→ Some doctors will advise against the testing of siblings. They believe it is unnecessary to test kids who have not experienced UTI's or any other negative symptoms.

Part 2 - Receiving a Medical Diagnosis

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→ Make an appointment with a doctor. If you suspect VUR, or just have evidence for a UTI, you will want to go to a doctor to get a diagnostic test and the best treatment options. When you visit the doctor, you should have information ready that will help him or her understand the situation better. It is a good practice to write this information down before going to the doctor. Information you should have includes:

→ Any signs or symptoms your child has, and for how long.

→ Your child's medical history, including recent health problems and general information.

→ Your family medical history, especially whether any of the child's close relatives (parents and siblings) have had VUR.

→ Any medications your child is currently taking, both prescription and over-the-counter, and how much they have taken.

→ Any other questions you might have for the doctor.

→ When you are at the appointment, don't be afraid to ask questions that occur to you. You want to find the right treatment for your child, so do everything you can to learn your child's condition, and what your options are.

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→ Do a sonogram study of the kidneys and bladder. A sonogram uses very high frequency sound (ultrasound) to generate images, which avoids radiation exposure. The sonogram will not be able to identify the presence of urinary reflux in itself; however, it will reveal any damage to the bladder and kidneys caused by more severe reflux or any anatomical problems that may be associated with reflux.

→ This procedure is painless and safe, but it can be difficult to perform well if your child is uncooperative.

→ In children with urinary reflux, an ultrasound may reveal swollen, scarred or unusually small kidneys.

→ If the doctor wants to look at the bladder, it is important for it to be as full as possible. This can be difficult with babies and very young children. Let the technicians know the last time your child urinated. If it has been awhile, the doctor can try to do the bladder part of the study first before your child urinates. Older children often will be asked to urinate after the first part of the study, and take additional images after.

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→ Have a catheter inserted for a bladder reflux test. The two most common and reliable tests for reflux require using a catheter, a thin flexible tube the doctor inserts into the bladder. Your child will be lying on her back on an examination table. The doctor will gently clean the area around the urethral opening with a special soap to minimize bacteria. Following this, a thin tube is slowly passed through the urethra into the bladder. When the tube is fully in the bladder, urine will begin to drain. The tube is secured with tape and the selected procedure is done.

→ Since the tube is inserted into the opening of the urethra (where the urine exits the body), your child may be anxious or embarrassed. It can be reassuring if a parent is present during the procedure. A Child Life specialist may also be present to distract and help relax your child.

→ When having a bladder catheter inserted, there are several things that your child can do (if old enough) to help the tube pass as easily and comfortably as possible. Girls should place their legs in a frog leg or butterfly position with knees bent and feet touching. Boys should lie with their legs straight.

→ As the tube is passed, have your child slowly blow air out of the mouth with pursed lips like blowing bubbles or a pinwheel. This helps to relax the muscles that can tighten around the urethra, making it more difficult to pass the tube.

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→ Do a voiding cystourethrogram (VCUG). After the bladder catheter has been inserted, you doctor may choose to test for the presence of urinary reflux using a VCUG. The doctor will fill the bladder with a solution that appears clear (like water) but can be seen using an x-ray. Once the bladder is full, the child is asked to urinate (while still lying down on the examination table) and the tube is pulled out. During the filling and emptying of the bladder, multiple x-ray images are taken. These images will be used to determine whether fluid in the bladder flows back towards the kidney.

→ When each picture is taken, you child must remain still for a few moments.

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→ Use a radionuclide cystogram (RNC). Alternatively, your doctor may choose to do test for the presence of urinary reflux using an RNC. The doctor will fill the bladder with a solution containing a very small amount of a radioactive substance. Rather than an x-ray machine, the procedure uses a camera that detects tiny amounts of radiation. At the conclusion of the test, the bladder is emptied, the catheter removed, and a final picture taken. The location of the radiation will help your doctor to determine whether fluid from the bladder is flowing back towards the kidneys.

→ The camera is pretty big and is suspended over the child, close to, but not touching, the abdomen. Your child will need to hold still for a number of minutes while the camera detects the emitted radiation.

TIPS

→ Girls develop complications caused by urinary reflux more often than boys because they are more prone to urinary tract infections.

→ White children are also far more likely to contract urinary reflux than children of other races.