Bedwetting and Urinary Tract Infections
Children with special needs often have issues with both day and nighttime wetting. This may lead to an increased risk for urinary tract infections (UTIs), and in turn, UTIs may also increase the incidence of incontinence.
"Any child with urinary continence issues is at risk for developing urinary tract infections," says Dr. Gregory E. Dean, associate professor of urology and pediatrics at Temple University.
Lucas was born with spina bifida. "I've suffered with urinary tract infections my entire life," he says. "When I get the infections, I get more incontinent. I believe it has something to do with the effect that the infection has on bladder muscle spasm strength and sphincter strength."
The urinary tract consists of the kidneys, ureters, bladder and urethra. The kidneys are responsible for filtering waste products from the bloodstream, producing urine on a continuous basis. The ureters are the tubes that carry the urine to the bladder where it is stored and then exits through the urethra.
Any abnormalities of the urinary tract, which are often found in children with spina bifida, for example, complicate the process of urination, often leading to infection.
"In children with spina bifida, the nerves that control the bladder are not connected to the brain [to varying degrees, but often there is no connection at all]," says Dr. Andy Spooner, director of the department of pediatrics in the division of general pediatrics for UT Medical Group, Inc. in Memphis, Tenn. "What that means is that most children with spina bifida cannot control when they urinate, and they routinely use catheters to get the urine out. Because of these catheters, which can introduce bacteria into the bladder, and because of urinary stasis, urinary tract infections are extremely common."
According to pediatrician Dr. Michael Erhard, chief of the division of pediatric urology at Nemours Children's Clinic in Jacksonville, Fla., many children with special needs are also unable to completely empty their bladders. Dr. Dean also says that special needs children often have a longer time span between each use of the bathroom. Both of these issues promote an increase in bacteria and cause a urinary tract infection.
Symptoms of UTIs
Fever, lower abdominal pain, new onset bedwetting or blood in the urine may be an indication that your child has a UTI; however, keep in mind that every child is unique, and symptoms may differ greatly from one child to another.
"Signs of a urinary tract infection are age specific," says Dr. Dean. "In the infant, the symptoms can be non-specific and include poor feeding, vomiting and/or fever. In the older child, symptoms may include voiding pain, frequent urination, blood in the urine and fever."
With older children, there is often an increased incidence of bedwetting if they have a urinary tract infection. "Urinary tract infections can be the cause of new onset bedwetting, and such children need to be evaluated for this," says Dr. Erhard.
Dr. Spooner points out that bedwetting does not cause UTIs. Instead, it's more likely that a urinary tract infection, due to its effect of irritating the bladder and causing spasms, might cause bedwetting in some children.
Wearing disposable absorbent underpants while working on the problem can be helpful. Special needs children may have a difficult time making it to bathroom frequently, causing embarrassment or shame. Wearing the protective underpants may help improve a child's self-esteem, since they stay dry, and save you from frequent laundering.
For children with spina bifida, developing continence is helpful in reducing their risk for UTIs. Unfortunately, this often means surgery.
"I had surgery recently to try to increase my continence, and it did, but every time I get a urinary tract infection, the effect drops to nil," says Lucas. "Self-catheterization compounds, and the passage of bacteria through that has been known to cause urinary tract infections with me, as well. I have a tethered spinal cord, which I have had all my life, and the doctors have told me that as my cord continues to tether, I will continue having infections."
His doctors have told him that the increased infections could cause more serious health problems, so he tries everything to keep them at bay. "The best way to combat [UTIs] is a regular bathroom pattern," Lucas says. "Also, ensuring that the body has enough water. Most of all – cleanliness, cleanliness, cleanliness."
Dr. Erhard explains that for those children who have a normal spinal cord, such as those with cerebral palsy, but lack the ability to have normal urinating habits, it is wise to practice timed urination to reduce bacteria accumulation in the bladder. "This requires a timed schedule, usually every two to three hours, of urinating in the hopes that this will effectively empty the bladder," he says.
Parents who have children with special needs are inherently more aware at times of the health risks their children face. If you suspect your child has a urinary tract infection, seek medical advice for treatment options. Never let a urinary tract infection go untreated.