Dr. Hive - 4yo DD - urinary issues

[UncleEJ]

My DD is having some weird urinary issues and I need help!

 

Background:

She is 4 years old, 5 in July.

She was a late potty trainer, probably for about a year now.

She has yet to make it through the night dry.

She had weird constipation issues as an exclusively breastfed infant that are mild now. She goes poop on her own so I don't know the exact frequency. She says she goes every other day or so.

She eats and drinks normally. I don't feel that she is dehydrated. She drinks plenty of water throughout the day.

 

The issues:

The biggest issue in my opinion is that her urine smells incredibly strong and foul. A very fishy smell.

She seems to have trouble staying dry. She never fully wets her pants but "dribbles" all the time. I have tried everything I can think of. Reminding her, talking to her, ect. She says she can't make it in time. But that doesn't make sense, she will go in the potty and then a few minutes later will pee in her pants.

Sometimes she urinates very frequently. Like 5+ times in an hour. Not always though.

She does this really weird thing where she will get really red in the face and sort of squat down holding herself. She will moan and sometimes cry. These episodes usually last 30 seconds or so. Then she will run to the potty and pee. When I ask her what is wrong while it is happening, she won't talk to me and gets mad and embarrassed. Afterward, she tells me that it tickles and she has to do that behavior to "keep her pee in" It is really, really weird.

She swears up and down that it doesn't hurt when she pees. I ask constantly. And when I take her potty in public restrooms she doesn't act like she is in pain when she pees.

This has been going on for probably six months, and getting steadily worse.

A couple months ago, I took her to the doctor because it seemed to me she had a UTI. They looked at her urine and said she didn't. They also checked her blood sugar, which was fine. The doctor thought it looked like she might have a yeast infection from being wet so much. We treated that.

 

I sometime feel like the wetting her pants is a stubbornness thing. She is very stubborn in general, but why in the world would she want to pee her pants? I'll have talks with her about trying to stay dry, and she will for a couple days, but never for more than that. I am totally stumped.

[Ottakee]

I would take her to a pediatric urologist. Spastic bladder can cause the dribbling, frequent wetting, etc. They can also look at other things that might be causing the strong smell in her urine.

 

Is she on anyeds or vitamins or have an unusual diet? I notice that for me asparagus can cause a change in urine smell soon after I eat it.

[UncleEJ]

I would take her to a pediatric urologist. Spastic bladder can cause the dribbling, frequent wetting, etc. They can also look at other things that might be causing the strong smell in her urine.

 

Is she on anyeds or vitamins or have an unusual diet? I notice that for me asparagus can cause a change in urine smell soon after I eat it.

No meds or vitamins. I don't think she has an unusual diet.

[Rosie_0801]

I'd try a chiropractor first, then a urologist.

[TechWife]

Has she had any follow up appointments with the pediatrician? If not go back and if they are stumped get a referral to the pediatric urologist. Time to get a team working on the problem.

[J-rap]

One of my dd's had a kidney reflux issue.  Kind of like urine back-tracking down again.  They only caught it though because it resulted in an infection eventually, which I guess is pretty typical with that condition.  

[TCB]

I would definitely look into this further. It could be that she has reflux. My dd had reflux  at around this age. It seems that constipation can cause voiding dysfunction. This seemed to be what was causing my dd's problems. I didn't think she was constipated because she went every day, but not enough I guess. Anyway, after many investigations and trips to the dr we started giving her benefiber and it stopped her problems completely.

 

 

 

 

 

 

 

 

 

 

 

 

 

[Ausmumof3]

Fishy smell can be a sign of some vaginal infections you need to take her to the dr again and get them to test again.

[Pink and Green Mom]

I would take her to a pediatric urologist ASAP..  When I was a bit younger than your daughter I had to have surgery to have my urethra enlarged/opened/unblocked (not sure of the correct terminology).  I believe what triggered my mom's concern was that I would go to the bathroom often and only little dribbles would come out, my outflow of urine didn't match my intake of liquids, and I cried every time I had to pee.

[SamanthaCarter]

No, not stubborn. :(

 

This is very much like my daughter. Did your ped actually culture the urine specimen? Because that foul fishy smell in the urine is a sure sign in my experience. And it doesn't always hurt.  Also in my experience, the initial test comes back negative and then when they culture it, sure enough, UTI. I think my ped has gotten to where he trusts my instincts. 

 

The rule of thumb is that if there are three UTI's within a short period of time, as in one a month for three months, they will order an ultrasound to check for reflux. They did this with my girl and found everything completely normal. I think some people are just predisposed to UTIs, but I think you need to push for the ultrasound just so you can know. <hug>

[UncleEJ]

The first time she was seem about this was at urgent care. They didn't send off a culture. I will get her in to her ped ASAP and have that done. And follow up with a urologist if nothing show up there. Thanks for all the advice

[Katy]

Yes, make sure they do a urine culture.  I would also make sure she's wiping front to back, and if dad helps her wipe, make sure he knows the front to back thing too. Many times with girls that small dad helps them, but dads often don't know that wiping back & forth can cause infections.  It's not intuitive to them.

[wapiti]

I would definitely do a culture ASAP.  I would also seriously consider the constipation angle.

 

PSA:  there are other, more rare non-urological conditions that can be related to voiding dysfunction, spinal cord stuff, so if there are any weird skin markers in the general area of the bottom of the spine (e.g sacral dimple, hair tuft, etc.) I would raise that with the ped.  (Both our ped and the ped urologist *missed* that angle with our ds, who had a tethered cord.)

[UncleEJ]

I would definitely do a culture ASAP. I would also seriously consider the constipation angle.

 

PSA: there are other, more rare non-urological conditions that can be related to voiding dysfunction, spinal cord stuff, so if there are any weird skin markers in the general area of the bottom of the spine (e.g sacral dimple, hair tuft, etc.) I would raise that with the ped. (Both our ped and the ped urologist *missed* that angle with our ds, who had a tethered cord.)

She does have a sacral dimple, but had an ultrasound at a few weeks old, which ruled out a tethered cord. She was born with a diastasis recti. The doctors were sure it would close when she started to crawl, sit up, walk, but it never did. Her ped wants her to have it fixed at age 5. She is also VERY thin, tall and has hyper-mobile joints.