Child with painful urination, no obvious cause. Please help.

[ajl123]

Hi.  A few days ago my 4 year old boy started crying out in pain when he urinates (and he tries to stop the flow bc of the pain).  He also started wetting his pants often (although he doesn't seem to complain of pain then).
Pediatrician did urine culture, it was negative. Sent us to urologist. He did physical examination and said all looks ok. sent for further urine tests. Below are the results. We also went for an Ultrasound and everything was clear.

Any suggestions what to do now?  What it could be?  

SG 1.02 SG

LEUCOCYTES UR. NEGATIVE

NITRITE NEGATIVE

PH (URINE) 5.50

PROTEINE UR 20.00 MG/DL

GLUCOSE URINE NORMAL

KETONES NEGATIVE

UROBILINOGEN NORMAL

BILIRUBIN UR NEGATIVE

ERYTHROCYTES NEGATIVE

[jemma116]

As all the urinary tests have come out normal and your son was examined by the urologist for any abnormalities and all was fine, seems as it may be a psychological issue.

You say your son has started to wet his pants, but does not complain when he urinates in his pants.  This too can be a psychological problem or in the case of most children and be due to not wanting to miss anything when they have to go to the toilet to urinate.

As he is only 4, keep an eye on what he does, when he starts to fidget, remind him to go to the toilet for a pee.  If he argues and says he does not want to go, insist that he does, and if he is watching a programme, put it on hold for him, or switch the TV off, this usually works.

Because he is only 4, you are probably giving him his baths.  In that case, teach him to gently draw back his foreskin to wash his private bits.  Make sure that he has a bath or a shower before going to bed.  If there is any little accidents, the urine on the pants can start to aggravate the private area and this can make it feel sore, so when he pees again, it will hurt.

Ensure that he has adequate liquids to drink - don't give too much squash and sugary drinks and don't give him any fizzy drinks.  Encourage him to have a milky drink as well as plain water with a squash drink from time to time.  Don't give him to many sweets and sugary foods.

If he attends pre school or nursery, ask him about his day.  There may be an issue there, or even at home, that is making him feel anxious.  Children his age are not able to express in words what is bothering them, but things can manifest themselves, in the child doing things that are not acceptable.

Don't shout at him if he does have a mishap, but help him to get to the toilet.  Sometimes, children will take off their wet pants and hide them, so keep an eye out for that and if he does end up doing that, reassure him that even adults do have mishaps from time to time.

When you do bathe him, discreetly look at his private area to see if is red.  If it is take him urgently to see the doctor.  Even little boys can get balanitis (infection in the tip of the penis).  They can also get fungal infections.

Give him lots of hugs and reassure him that you do love him.  Children still need to know and be shown that they are loved.

Let me know how things go.

Best wishes.

[Tuckamore]

Hello and Welcome,

I assume the physician that ordered the UA (urine analysis), viewed them and said they were fine. Is that correct?

In my opinion a child that cries out in pain when he urinates has something going on. My heart goes out to you - and your son. It's simply not normal. I highly suggest you obtain a second opinion.

This may be a physiological issue. I'm leaning more towards a structural issue. I think more tests should be run. Has his kidneys been evaluated?

I have no good answers for you except to keep searching for answers. Your young son is counting on you. Please let us know what you find out.

Best of Luck,
~Tuck