Symptoms
Many children with VUR have no noticeable symptoms, especially if they don't have a UTI. When VUR is associated with UTIs, symptoms may include:
Fever
Frequent urination
Burning sensation during urination (dysuria)
Urgent need to urinate
Cloudy or foul-smelling urine
Abdominal, flank (side), or back pain
Bedwetting (in older children who are toilet trained) In infants, symptoms can be vague and may include:
Unexplained fever
Poor feeding
Irritability
Failure to thrive
Causes
The most common cause of VUR is a defect in the valve-like mechanism where the ureter joins the bladder (primary VUR). This defect allows urine to flow backward. It is often congenital, meaning present at birth. Secondary VUR occurs when a blockage or malfunction in the urinary tract causes increased pressure in the bladder, forcing urine back into the ureters. This can be caused by:
Blockage in the bladder or urethra
Neurogenic bladder (bladder dysfunction due to nerve problems)
Infrequent voiding and constipation
Medicine Used
Antibiotics: To prevent urinary tract infections (UTIs), low-dose antibiotics are often prescribed prophylactically (preventively). Common antibiotics include trimethoprim-sulfamethoxazole (Bactrim, Septra), nitrofurantoin (Macrobid, Macrodantin), and cephalexin (Keflex).
Medications for Bladder Dysfunction: If secondary VUR is caused by bladder dysfunction, medications like anticholinergics (oxybutynin) may be used to improve bladder function.
Is Communicable
Vesicoureteral reflux itself is not communicable. It is not an infectious disease and cannot be spread from person to person. However, if a UTI develops as a result of the VUR, the UTI itself may be caused by bacteria that could potentially be spread (though UTIs are generally not considered contagious in the traditional sense).
Precautions
Proper Hygiene: Teach children proper hygiene practices, such as wiping from front to back after using the toilet, to prevent UTIs.
Frequent Voiding: Encourage frequent urination to prevent urine from sitting in the bladder for extended periods.
Adequate Hydration: Ensure adequate fluid intake to help flush bacteria out of the urinary system.
Treat Constipation: Address constipation promptly, as it can contribute to bladder dysfunction.
Adherence to Medical Recommendations: Follow the doctor's instructions regarding medication and follow-up appointments.
How long does an outbreak last?
VUR is not an "outbreak". It's a chronic condition. However, associated UTIs can last from several days to a couple of weeks with proper antibiotic treatment. The goal of VUR management is to prevent UTIs and long-term kidney damage.
How is it diagnosed?
Voiding Cystourethrogram (VCUG): This is the primary diagnostic test. A catheter is inserted into the bladder, and the bladder is filled with a contrast dye. X-rays are taken while the bladder is full and while the child is urinating. This allows the doctor to see if urine is flowing backward into the ureters.
Renal Ultrasound: This imaging test uses sound waves to create pictures of the kidneys and bladder. It can detect abnormalities in the kidneys and identify hydronephrosis (swelling of the kidneys due to urine backup).
Radionuclide Cystography (RNC): Another imaging test that uses a radioactive tracer to detect reflux. It uses less radiation than a VCUG but may not provide as detailed images.
Urine Culture: To detect a UTI.
Timeline of Symptoms
The presence of VUR itself often has no specific symptoms, therefore no timeline of symptoms can be shared. The *onset* of symptoms is related to the presentation of a UTI, or kidney damage. If VUR is identified on imaging due to other causes, there will be no UTI symtpoms.
Important Considerations
Severity of VUR: VUR is graded on a scale of I to V, with V being the most severe. The grade of VUR influences treatment decisions.
Family History: VUR can run in families, so siblings of children with VUR may also be screened.
Spontaneous Resolution: Mild VUR (grades I and II) often resolves on its own over time, especially in younger children.
Surgical Options: Surgery (ureteral reimplantation) may be considered for severe VUR, VUR that does not resolve with time, or frequent UTIs despite antibiotic prophylaxis.
Long-term Monitoring: Children with VUR require long-term monitoring to detect and manage UTIs and to assess kidney function.