Witholding urine any advice?

[GinaG3]

Not looking for medical advice here. Don't worry admin, just after a little reassurance or to see if anyone else has been through the same.

My daughter is now 3.5 she has been toilet trained for around 5 months and loved it to begin with. Infact I'm not even sure she has a problem with it now as such. She has problems with recurrent UTIs since around 6 months old. She's had 3-4 in total confirmed by laboratory testing but responds well to antibiotic treatment. Just before we started toilet training she ended up in A&E after she became very lethargic, hadn't eaten or drank hardly anything for 7 days and this particular night began foaming at the mouth. She running a temperature of 102-103. NHS direct and Seldoc advised A&E immediately where she was found to have a quite severe UTI (again!) at this point she was still in nappies. We stayed in till 6am to replace fluids and wait to be seen by the paed. She was prescribed antibiotics and it all cleared up fine. A few weeks later, with her permission and enthusiasm we started toilet training. She was brilliant, no accidents, having fun, enjoying being a big girl, huge celebrations on the toilet, the usual.

Fast forward to now, nearly 5 months later we have just tested again for another UTI. She started Antibiotics ASAP as precaution but I had to get a urine sample from her at the same time. Now this is virtually impossible. She won't wee in a pot, on a potty, we used to use u-bags but even that's abit past it now. After 15 hours witholding urine I called the doctor again, she advised to cover the toilet in cling film and get a sample that way (ingenious!!!) this worked and I was so relieved. We rushed down with the sample and sent it back to the lab. It's just come back as negative for infection. Although we are fully aware this could of happened as she had already had 3 doses of antibiotic before the sample could be produced. Any infection would of been minimal at this point. Awaiting call from GP again today.

So we have got doctors working with us to solve this issue. Possibly looking at tests on her bladder etc to rule out anything causing multiple infections.

The problem I come to you mummies with is witholding urine. She withholds urine for extreme amounts of time, her first wee after we take the nighttime nappy off doesn't happen for 8-10 hours! The least amount of time she will wait is 7 hours between each wee. She mostly only does one wee on the toilet a day and now refuses to poo on the toilet and holds that too until her nappy is put on at night. I am very reluctant to take away the nighttime nappy as I don't want to create further problems. It's a really difficult situation for me. She doesn't seem in pain, she doesn't dance around desperate. Nothing like this. She's generally happy, although has her fair share of grumps and tantrums. She's eating fine at the minute, she eats a lot of healthy and fresh stuff. She also drinks generally a 330ml bottle of water a day (I have to buy her special bottled water with Shaun the sheep on or she won't drink anything) and a few cups of cranberry juice and/or milk. To my knowledge this has all become more and more of a problem a) whilst toilet training and b) since the last infection.

Has anyone had problems with toddlers witholding urine? Recurrent UTI? And if so have you had testing done with your child to find a cause?

If you got to the bottom of this message, sorry it was a bit long! Thanks for reading.

[Saffron]

Urinary retention can definitely make this situation worse, but if the bladder/urethra has been sensitized by repeated infections then it may be difficult to overcome the retention. Would sticker charts or other rewards help to increase frequency? It may take a while to work through this stage (we're currently dealing with poo retention here!). In the meantime, what are you trying to help with the physical symptoms/prevent reinfection?

Speaking from personal experience (my own as a child and an adult), recurrent UTIs can hugely sensitize the bladder and urethra and definitely leave it vulnerable to future infections. Cranberry is very protective of the inner surfaces of the urinary system, but you don't get enough of the active compound in just the juice. You either need to take cranberry tablets, or eat fresh or tinned cranberry.

I have girl friend who swears by uva ursi ('bear berry') tincture as a urinary antiseptic. It might be worth speaking to an herbalist about what tinctures are available and safe for children.

It does seem some people are just more prone to UTIs, like other people are more prone to stomach upset or nasal congestion. Hope it's better soon. xx

[Fuschia]

It does look like testing for a cause of repeat infections would be essential - my daughter had ultrasounds and a nuclear medicine scan. Whether she is holding on because of fear of pain, or because of some physical cause, that needs to be checked out.

[duchessofdulwich]

Have you spoken to a GP/ specialist regarding her not passing urine for long periods of time? That's something that needs to addressed.

[Ruth_Baldock]

"It does seem some people are just more prone to UTIs, like other people are more prone to stomach upset or nasal congestion. Hope it's better soon. xx"

This is so true. Both me, my Mum and all my sister (and now Seb and probably Lex...) always had recurrent UTIs (and thrush, since we're on the subject). In my case, it's due to a very short urethra, so not much could be done on that front, so it's all about preventative measures, really, which I'm sure you know about. I had to have lots of tests, scans of my kidneys and such to rule out anything more serious.

I withheld urine whenever, as a child, I was constipated too. Not sure why. Could this also be a factor? xx

[GinaG3]

Spoke to GP again today. We are going to get another urine sample now antibiotics finished to see if that shows anything. Will drop in on Monday. Then book appointment to get results and make a plan with GP. As I understand it's standard practice to have further tests done on a child that has had more than 3 infections and especially more than 2 in 6-12 months. I don't quite know what preventative measures we can try, bar trying to get her to keep her fluids up. She seems to get one every 9 months or so. Stress is probably a contributing factor, as much as I hate to say it. I'm under a lot of stress with health problems since she was born and no doubt she picks up on this. I try my hardest to keep this away from her but it's virtually impossible when we are couped up all day with me in pain or on the unlikely day of not being in pain having nothing to do anyway. She doesn't know any children her age and is desperate for friends, which I'm sure she finds stressful too. Although she is starting preschool in September all this makes me feel like a terrible mother.

On the other hand, whether this has anything to do with it, I don't know. All this stress has been very full on since she was about 6 months old, it's never seemed to bother her before.

Ruth, I too had severe problems with constipation when I was a child. I put this down to falling onto a radiator tap when I was a child and getting internal bruising but my mum is certain is wasn't. I found it very difficult to use the toilet as a child but neither me or my mum remember problems passing urine. I do remember from the age of around 10 though never weeing during the day and only going once on waking and once before bed. Before pregnancy my bladder could hold a lot of urine.

I'm happy for her to have tests, so long as no invasive. Obviously. I'm dreading the future with her already, I'm riddled with chronic gynae problems and hate to think this could be the very first signs of her following in my footsteps.

Thanks for all replies so far!

[Fuschia]

My daughter was on prophylactic antibiotics for almost a year, it is an option I think?

[GinaG3]

Will ask doctor about preventative measures medical and non-medical we can try when I see them next week. Come up with a plan of attack.

[Saffron]

GinaG3 Wrote:

-------------------------------------------------------

> I don't quite know

> what preventative measures we can try, bar trying

> to get her to keep her fluids up.

Cranberry is definitely worth a try not only as a treatment, but as a preventative measure too. More specifically, cranberry contains "antiadherence" compounds which prevent common bacteria from sticking to the inside of the urinary bladder. You can do a Google Scholar or similar search for information. Here's one example: http://www.cranmaxinfo.com/CDNJournal.pdf . Study concluded tablets were more effective than juice. My personal experience is also in support of this... sorry TMI warning... I've once awakened on a Sunday with an infection so bad that I was unrinating blood. Cranberry had me pain-free and blood-free in <12 hours without antibiotics (then I went to the drs the next morning obviously).

I don't have any personal experience with uva ursi, but my girl friend does swear by this. She has had problems with both bladder and kidney infections. Uva ursi is thought to have an antiseptic effect in the bladder. This looks interesting from the abstract: http://www.ncbi.nlm.nih.gov/pubmed/18950249 .

I would also say that in the future (again from personal experience), your daughter might find that use of some types of hormonal birth control is associated with increased UTIs and candidiasis (thrush). Incredibly my GPs did not pick up immediately on this, and I was suffering for years!

[GinaG3]

Agree 100% saffron. I know about cranberry and I'm fully aware there is almost no benefit in the juice but I can't get her to eat actually cranberries (funny though, as she does like bitter fruits and juices). She's not allowed orange juice as this did seem to cause the UTIs in the first place, but now I'm probably thinking it didn't. It seemed so likely at the time. Will look into options and take ideas to doctor for a chat. Thanks.

[Saffron]

What about cranberry tablets crushed in something sweet, like yogurt or a smoothie? Not sure what uva ursi tea tastes like, try sweetening with stevia? There are other unrinary antiseptics too. Not sure how well-researched any of them are. Off the top of my head, maybe mallow (which tastes ok)?

Re orange juice, there is a lot of anecdotal evidence relating orange juice to UTIs. I think there is beginning to be some research to support this as well, though the causal relationship is not clear. (I had lots of OJ as a child, and lots of UTIs, so of course I'm biased!)

You're daughter is a bit young for it, but I think cognitive-behavioural therapy could be a good avenue for the future for trying to encourage good habits. I don't think we should (and I'm sure you don't!) underestimate how upsetting really bad UTIs can be for children. If anyone is looking for gentle, age-appropriate therapy for very young children I can highly recommend Hannah Ferry, who is a qualified art therapist with an interest in women's and children's issues. PM me for more info.

[GinaG3]

Definitely very young for CBT, I've been through it myself and probably couldn't imagine a child doing it until at least 7 or 8. Although mine was very high intensity. Will look into cranberry tablets and use in children her age etc. Thanks for the info. See if I can maybe get some this week.

[GinaG3]

Another urine result back normal but still witholding. As urine output is not normal doctor is ordering bladder and kidney scans and wants me to take her into kings to have bloods done to check her kidney function, fluoride levels and something else too.

Anyone offer any advice about helping a 3.5 years old prepare for blood tests?

[Gidget]

No advice about preparing for blood tests, but can you get her to pee in the bath when it has water in it? Was told to do this myself when I had bladder infections. More comfortable that way.

Can you give her live bio yogurt? That should help with her flora and fauna.

I didn't have bladder infections until I was 16 but know how painful they can be. Good luck.

[Gidget]

Forgot to say - what do you use in her bath? If bubble bath then you should stop doing that as it can cause problems like thrush in females.

[Saffron]

Oxford Paeds Ctr-

Tips to help your child with blood tests:

1. Tell your child they are going to have a blood test.

2. Put on EMLA ?magic? cream. This is of course optional, but we strongly recommend it in

children eight years old or under. It is a local anaesthetic cream put on the site of the test for

40 minutes. It numbs the skin for over half an hour after its removal, so children feel no or

reduced pain during the test.

3. Stay with your child during the test. Be calm, but don?t offer them an option out of having

it. If you have negotiated a reward, don?t make the stakes too high (it can mount up if they

need further procedures another day!)

4. The doctor will explain to your child what will happen. He or she will put a tourniquet (tight

band) around the arm, or ask another team member to hold the arm tightly. This is to help

with the blood test, not to hold the child still.

5. Cold spray can be used as an additional or alternative local anaesthetic at this point. It

briefly freezes the skin and numbs it just before the needle is put in. It can be helpful for older

children, who have grown out of waiting for magic cream to work, but still need a bit of help.

5. Distract your child during the test by reading, counting, singing, chatting or by finding Wally

in Pauline?s book.

6. Nobody will mind if your child is noisy during the test, but it is really important they keep

still.

7. When it?s all over congratulate your child on having the test and we can put on a bravery

sticker.

Ask your pharmacist for EMLA. They may not stock it, but they can order it. You can also order it from online pharmacies. It takes about 45 min to mumb the area and lasts <1 hr once the skin is numbed IME. So you need to time it right. I've used this with my daughter for jabs, and it wasn't 100% but was better than nothing (works better on some people than others). I presume you can buy cold spray from a pharmacy as well, not sure. Worth asking.

Just to clarify, is it really the case that your daughter is not having urinary pain at any time? Just that she is witholding urine, and also prone to infections? (I'm not doubting you, I'm just making sure I've understood your post correctly.) xx

[GinaG3]

She wee's in the bath if she wants to, I dont discourage. Although she is never in pain when she passes urine, infection or no infection, she just withholds to excess. She won't eat live yogurt either, unless I can possibly get her to have it in the 'yogurt drink' variety.

We don't use bubble bath as she has eczema and is really sensitive to stuff in her bath. So no harm there.

Doctor says last positive urine from A&E only showed white blood cells, although they told me and my partner she had a severe infection. They found traces of a lot of things in the sample. So confused with all the contradiction. She seems fine in herself, really praying all goes well with all the bloods and tests and comes back clear.

[GinaG3]

Saffron, I've heard EMLA shouldn't be used for blood test in children as it can draw the vein away from the surface making it harder for the Phlebotomist to get a sample leading to probing. I've researched into using this already. So I'm unsure about using.

Hoping it will be fine with just distraction and thought of sweetie shop on a weekday! Unless there is any other ingenious method?!

She doesn't seem to have any urinary pain, a vaguely remember she used to cry passing urine as at around 14 months. At 16 months she bluntly told me 'no wee, hurty' but not much since, that I can recall. Although I struggle with my memory a lot due to medication. Doesn't help! She has always let out crys falling asleep and stretched her body out as far as possible with her tummy in the air, and pulled legs up even now. Bouts of unconsolable crying during the night and not being able to put her back to sleep for a few hours, quite obviously in pain, doing all the stretching. Doctors know all this, partly why he feels tests are necessary.

[shaunag]

My daughter (19 months) had bloods done at kings last week in the outpatients on fourth floor hambleden wing.if having it there can reassure you the nurses are excellent.they were very calming and the room,though small has stickers all over the wall.the lion king was playing on the wall.they used the cold spray and heaped praise on her after.lo was so distracted by all to see she didn't even cry.the nurses do it all day every day and are brilliant with kids. we got in and out of the room so fast I didn't have time to get anxious about it.i would wait to explain to your daughter what is going to happen until just before so she does not get worried about it but when you do explain it, try not to give away that you think it is a big deal/is scary. If you are going to a and e i would insist a nurse does it as they are far more experienced at it and as a result tend to be quicker and cause less pain/minimal bruising (or none as has always been case for my lo). Have done it quite a few times so know what to expect-if lo agrees i would sit her on your knee and let nurse tell you which way she should face. The nurses will guide you on what you need to do. The lo's are tougher than us really with all their scraped knees etc.it is also such a tiny amount of blood that they take-they use teeny tiny vials.so,rambling, but in summary,try not to worry and keep a brave face on-it will be fine!

[Saffron]

I've also heard anecdotally that EMLA causes vasoconstriction, but what I've witnessed using it is vasodilation. I think vasoconstriction occurs initially, followed by vasodilation. So if that's the case, you just need to leave it on the recommended time. The quote from the Oxford Paeds dept was specifically from the Paeds Rheumatology dept, where children need frequent blood tests... I will look for the link... I've just clicked away from it while searching for something for work.

Can you find out what the possible sites are for the blood tests, eg inner elbow or wrist? You could put EMLA on one site, and leave the other uncovered. Then if the tech thinks that vein is difficult, you still have the other site. You lose nothing with this approach, and you can still use cold spray on either site.

Make sure that you are getting someone who is really experienced at paediatric blood samples. This is not a case for a student or new phlebotomist. Also, just to say, that even a contracted vein is not impossible to hit for someone who is really good. I've seen people hit the tail vein on a mouse and make it look easy!

[Saffron]

Topical Anesthetics for Intravenous Insertion in Children: A Randomized Equivalency Study

Charmaine Kleiber, RN, PhD*,

Mark Sorenson, RPh?,

Kathy Whiteside, CCLS?,

B. Ann Gronstal, RN, MSN*,

Raymond Tannous, MD‖

(2002)

There is a new formulation that causes less vasocontriction: http://pediatrics.aappublications.org/content/110/4/758.short

"Children view needle sticks as the worst source of pain and fear in the hospital setting. In an effort to minimize the pain of needle sticks, the use of eutectic mixture of lidocaine and prilocaine (EMLA) has become standard practice in many children?s hospitals. Unfortunately, EMLA requires at least 60 minutes to be fully effective and reportedly may cause vasoconstriction, leading to difficult vein cannulation. A newly available local anesthetic (ELA-Max) may require less time and cause less vasoconstriction. The purpose of this randomized crossover study was to investigate the anesthetic equivalence of EMLA and ELA-Max."

However, perceived vasoconstriction did not effect the ability to successfully cannulate:

"Conclusion... There were no differences between hands that were treated with EMLA or with ELA-Max for success of IV insertion."

[lala_anbu]

Is is possible for you to force your little girl (by showing cartoons or characters which she like) of eating fruits with lots of water content like melons? She definitely has some fear (due to previous UTI - fear of pain while passing urine, in previous instances) and that forces her to hold her bladder as long as possible. Do speak to her that nothing is wrong with her and that she is fine (as with frequent visits to doctors and tests give an impression that something is wrong with her).

My daughter is 3.4 yrs old and even when bruised to a great extent, when told that its a minor thing and brushed aside, she gets off it. So please do try.

[buggie]

Blood tests for children are done in children's out pt's (might need to confirm with GP & call out pts to arrange time) by trained children's phlebotomist's who know all the tricks in how to reduce stress & am sure would use ametop (similar to emla). The best thing you can do is to be relaxed & confident about going in for the procedure - otherwise she'll pick up on your stress & be stressed herself.

Maybe talk about plans for afterwards (so that she knows it won't last long) or a treat for afterwards.

Hope this helps & that all is sorted soon x

[GinaG3]

Re; fruit etc. She eats a lot of things that have a high water content. She regularly carries round cucumber just eating the whole thing. And eats it with every meal. She eats ALOT of fruit, far more fruit in her diet than anything else, but not acidic fruits as I don't think these help the situation. She drinks a 330ml bottle of water a day, a juice with breakfast, milk before bed, and a few other drinks throughout the day. Her fluid intake is fine, so her urine output should be aswell. Yet another reason doctor is concerned. She isn't dehydrated and shows no signs even the slightest.

Re; fear. We always tell her nothing is wrong and that she is fine, the doctor just wants to make rainbows with her wee and various other silly things. She is never scared, and shows no signs of fear. These will be first actual tests besides urine specimens. She's not scared to use the toilet. She doesn't physically hold in urine, dance around desperate but won't go. None of this, it's just like she physically isn't producing it, or isn't feeling that she needs a wee. She never has accidents. Ever!

I just don't understand it, she is happy, looks healthy, barely ever complains (sometimes shows signs of pain, but won't make a fuss), she just doesn't wee as you would expect her to and of course has had problems in the past with infections.

Thanks Buggie. I know it's in the children's outpatient department and done by specialists. I'm feeling confident about her having it done. Hoping she doesn't have any problems like me, I've been known to have sat for 2 hours while having blood drawn. No suitable sites. 10 different sites tried for IV drips to prepare for surgery etc. Really hope it's easy for her. Not mentioning anything until we go on Friday, then I will explain it to her and tell her on the way home she can pick a treat and a magazine from the shop. Her favourite treat! Then we will probably pop in and see nanny and she wont stop telling her all about it for the next year. Usually how it goes.