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• Pain With Urination ( Chemical Urethritis )
• Urinary Tract Infection
• Vaginal Irritation and Itching ( Chemical Vulvitis )

• Discomfort with passing urine (dysuria).
• Burning or stinging with passing urine.
• Urgency and frequency are occasionally present.
• Uses bubble bath, bathes in soapy water, or washes genitals with soap.
• No evidence for a urinary tract infection.
• Pre-pubertal girl.

The most common cause of mild pain or burning with urination in young girls is an irritation of the vulva (vulvitis) and the opening of the urethra (urethritis). The irritation is usually caused by bubble bath, shampoo or soap that was left on the genital area. Occasionally, it is due to poor cleansing of the genital area after passing a bowel movement. This chemical urethritis occurs almost exclusively before puberty. At that age, the lining of the vulva is very thin and sensitive. However, since 5% of young girls get urinary tract infections (UTI's), one must always consider this diagnosis. A UTI is a bacterial infection of the bladder (cystitis) and sometimes kidneys.

With warm soaks, the pain and burning usually clear in 12 hours.

Warm Baking Soda - Water Soaks
Have your daughter soak her bottom in a basin or bathtub of warm water for 20 minutes. Put 4 tablespoons of baking soda in the water. ( Note: Baking soda is much better than vinegar for young girls who have not entered puberty. ) Be sure she spreads her legs and allows the water to cleanse her genital area. No soap should be used. Repeat this every 4 hours while she is awake for 1 day. This will remove any soap, concentrated urine, or other irritants from the genital area. It will also promote healing. With soaks the burning will usually clear in 24 hours. Thereafter, cleanse the genital area once daily with warm water.

• Wash the genital area with water. Don't wash the genitals with soap until after puberty.
  
• Don't use bubble bath before puberty; it's extremely irritating. Don't put any soaps or shampoo into the bath water. Don't let a bar of soap float in the bathtub. If you are going to shampoo your child's hair, do this at the end of the bath.
  
• Keep bath time less than 15 minutes. Have your child urinate immediately after baths.
  
• Teach your daughter to wipe herself correctly from front to back, especially after a bowel movement.
  
• Encourage her to urinate at least every 4 hours during the day.
  
• Sexually active young women should urinate after sexual intercourse.
  
• Have her wear cotton underpants. Underpants made of synthetic fibers
  (polyester or nylon) don't allow the skin to "breathe." Discourage wearing underpants at night

If you are told to bring in a urine sample, try to collect the first one in the morning. Use a jar and lid that have been sterilized by boiling them for 10 minutes.
Wash off the genital area several times with cotton balls and warm water. Have your child then sit on the toilet seat with her legs spread widely so that the labia (skin fold of the vagina) don't touch. Have her start to urinate into the toilet, and then place the clean container directly in line with the urine stream. Remove it after you have collected a few ounces but before she stops urinating. The first or last drops that come out of the bladder may be contaminated with bacteria.
Keep the urine in the refrigerator until you take it to the office. Bring it in chilled ( put the jar in a plastic bag with some ice. )

IMMEDIATELY if :

• The pain with urination becomes severe.
• Any abdominal pain or back pain occurs.
• Your child starts acting very sick.

Within 24 hours if:

• The pain and burning continue for more than 24 hours after warm baking soda-water soaks.
• Your child develops any fever (over 100 degrees F).
• You have other questions or concerns.

A urinary tract infection (UTI) occurs when bacteria get into the bladder or kidney. The bacteria enters the bladder through the urethra (the tube connecting the bladder to the hole where the urine exits the body). UTI's are more likely to occur if the urethra is irritated by bubble baths, fecal soiling, or poor hygienic techniques (for instance, girls should always wipe from front to back especially after a bowel movement).

• Pain with urination
• Increased frequency of urination
• Urine ‘accidents’
• Abdominal pain (especially the lower part of the abdomen)
• Foul smelling urine
• Fever
• Vomiting

To confirm the diagnosis, a urine sample will be examined in the office (called a urinalysis). If our suspicion of infection is high (by history and office urinalysis), we will empirically begin treatment with an antibiotic that is usually effective against the bacteria responsible for UTI's. Your child’s urine will then be sent for a culture. The culture results (which can take 48 - 72 hours) determine if an infection is present and which antibiotic will eliminate the infection.

Other treatments include:

• Plenty of fluids to ‘flush out’ the bacteria
• Acetaminophen or ibuprofen for pain or fever

A follow-up urine culture will be obtained after completing the antibiotic therapy.

Some children with urinary tract infections are found to be susceptible to repeated infections or have an associated condition (such as urinary reflux) which can cause kidney damage over time. Therefore, your practitioner may recommend a work-up for your child. Two tests are often recommended:

• Renal/Bladder ultrasound. This test identifies structural anomalies in the urinary system.
• Voiding Cystoureterogram (VCUG). This test identifies children with kidney (urinary) reflux, a condition in which the bladder contents are forced up toward the kidneys when the bladder contracts to empty. It is performed by inserting a catheter into the bladder and filling the bladder with a radio-opaque dye. An x-ray is then taken while the patient urinates.

• Stopping use of bubble baths
• Limiting bath time to less than 15 minutes
• Using soap and shampoo only at the end of bath time
• Not letting the soap float around in the water
• Having your child urinate after baths
• Encouraging frequent bathroom breaks (every 4 hours) to prevent holding back of urine
• Watching for and treating constipation
• Teaching girls to always wipe from front to back after using the toilet

IMMEDIATELY if:

• Back pain occurs.
• Your child can pass only very small amounts of urine.
• Your child starts to act very sick

Within 24 hours if :

• Fever or painful urination is not gone after your child has taken the antibiotic for
  48 hours.
• You have other concerns or questions.