two types of UTI’s: the bladder (cystitis) or the kidneys (pyelonephritis). These can present
with no symptoms (asymptomatic) or with systems (symptomatic). I have always been taught by my doctors to never take antibiotics for an infection unless I was symptomatic. This would cut down on the chance of becoming immune to the prescriptions. However, you should speak to your own medical professional about what is best for your or your child.
Signs of infection to look for are:
• urine looks or smells different e.g. a 'fishy' smell
• wet in between catheterization when usually dry
• needing to go more often
• burning or stinging sensation
• blood in urine
• temperature, headaches, vomiting
When someone has cystitis, they generally need to pass urine more often than usual and if
sensation is present they may have to hurry to the toilet (urgency). The urine looks cloudy
instead of clear and may smell different from usual. Drink extra fluids and take your child to
your GP or Paediatrician who may prescribe a course of antibiotics. Ensure that laboratory
testing is carried out to confirm the presence of a UTI.
A much more serious situation arises in pyelonephritis in which the infection affects the
kidneys causing a high temperature, tummy ache, backache, and sickness and may
cause scaring to the kidneys.
Why UTIs are Common in Children with Spina Bifida?
Children with Spina Bifida often lack feeling and control of their bladder and bowel in the
same way as they may lack feeling and control of their feet and legs. This is because the
nerves in the spine connecting the brain to the bladder (or bowel or legs) have been
interrupted, or disconnected, by the Spina Bifida. The result is that they cannot usually feel
when their bladder is full, nor can they empty it properly. The bladder may still contain urine
(the residual urine) after they have tried to empty it. The stagnant pool or residual urine left
in the bladder gets smelly and easily becomes infected and over a period of time stones
may develop (urinary calculi) as well. Bladder Infections may affect the kidneys causing
pyelonephritis and kidney damage, making the child ill. This happens because the bladder
does not empty out the infected urine. It may also happen with ureteric reflux when the
infected urine travels up towards the kidneys.
Many children with Spina Bifida do not know when they have a urinary infection. Because
they lack feeling they do not suffer from the scalding pain which other children feel when they get cystitis, nor do they know their bladder is not emptying properly. UTI’s should be
confirmed with laboratory testing before treatment is administered. Treating children with
antibiotics and extra fluids works more slowly if the bladder is not emptying. The best way to
prevent urinary infections damaging the kidneys is to be sure that the bladder empties
regularly and completely. One way of doing this is by clean intermittent catheterisation
and by being vigilant with a hygiene program and following strict hygiene guidelines. (see
“How to prevent UTI’s)
How CIC Lessons the Chances of Urinary Infections
Clean Intermittent Catheterization (CIC) means inserting a narrow tube (catheter) into the
urinary passage (urethra) into the bladder. There are different length catheters available
suitable for either boys or girls. The urine flows out of the bladder through the catheter into
the lavatory, or into a container, until the bladder is completely empty and then the
catheter is removed after complete emptying. This should be done 4 – 5 times a day.
Regular drainage of the bladder will improve social continence and help to reduce UTIs.
Catheterization should take place at least four times a day but for those who have a
smaller bladder this may need to be increased to six times. With practice catheterization
becomes quite easy and may take less than five minutes. Twenty-five years of experience
of intermittent catheterization has shown that it reduces infections and prevents damage
to the kidneys as well as improving those already damaged, if CIC and hygiene regimes
are consistent.
How to Prevent UTI’s
• Maintain adequate fluid intake by encourage your child to drink at least 4 cups a day
and carry a drink bottle with them at all times. (The aim is to increase this fluid intake to 2
litres)
• Ensure regular complete bladder emptying
• Relieve constipation
• Ensure the use of appropriate catheter size and type
• Maintain a strict hygiene routine
Bowels
People with Spina Bifida are often constipated and pressure from an overfull bowel may add to the difficulty of emptying the bladder. They may also have poor control over their
bowel in the same way as they have over the bladder. Since most urinary infections are
caused by bacteria which normally live in the bowel, it is important to wash this part of the
body carefully. Girls should be taught always to wipe from front to back and not from back
to front.
Medicines
UTI’s should be confirmed with laboratory testing before treatment is administered. Antibiotics and other medicines are sometimes given in small doses for months or years to
prevent urinary infections. They are mainly used for children who have reflux or for anyone
with damaged kidneys to protect them from further harm. In spite of this, urinary infections
may still break through and need a course of a different treatment.
Other Remedies
Many remedies have been used over the years to prevent or relieve urinary infections and two of these are worth mentioning: Vitamin C (ascorbic acid) and cranberry juice. Vitamin
C acts by making the urine acidic and this discourages some of the bacteria which cause
urinary infections. Cranberry juice helps to clear infections and debris after operations on
the bladder (specifically e. Coli)
Key points
• In children with Spina Bifida urinary tract infections are mainly due to the bladder not emptying properly.
• Poor drainage from the bladder encourages infections to spread to the kidneys where
they may cause damage.
• Good drainage is as important as fluid intake.
• Intermittent catheterisation ensures good drainage and protects the kidneys. It may also
encourage social continence.
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