Painful Urination in Otherwise Well Children- Does This Mean UTI?

See The Accompanying Video

Urinary tract infections are a common cause of painful urination, especially in girls where the bacteria from the stool (bowel movement) can easily reach the vaginal area and thus enter the bladder through the short female urethra. Symptoms of a bladder infection might include fever, painful urination (dysuria), needing to urinate frequently (frequency) and having the feeling of still needing to urinate, even right after having just used the bathroom (urgency). If your child looks ill and has any of these symptoms, you will want them seen to find out if they may have a UTI (urinary tract infection) or worse – a kidney infection (pyelonephritis) – where high fever is more prominent. The topic for this video is a unique presentation of painful urination in young boys (typically preschool age though they can be older) who are otherwise totally well with no fever, no urinary frequency or urgency BUT they do have painful urination. It REALLY hurts to urinate and they try to avoid it. There is no history of trauma/injury to the genitals. Ask if your son has constipation or may have been straining while trying to have a bowel movement. What can happen is that while straining to pass a bowel movement, if you urinate, the urine leaves with such force that it can tear the male urethra. Most older boys and men have learned to relax and stop forcing a bowel movement when they urinate. It’s the younger boy or perhaps one who is rushing or less attentive who may strain while simultaneously peeing and pooping and thus force the urine out with such pressure as to cause a tear.

I call this:

Painful Urination Associated with Urethral Trauma by Forceful Urination. In cases where there is a tiny opening to the urethra (urethral meatal stenosis) the urine stream can be so tiny that the urine comes out with enough force to again cause pain. These boys typically have pain all the time, but it is similar to that just described in that it is again caused by a forceful urine stream irritating or tearing the urethra. These boys will have a tiny forceful urine stream that could hit a target 10 feet away.

 Dr Paul

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