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Are UTI Symptoms Always a UTI in Kids?

By Dr. Michael Garcia-Roig

Peeing is something we take for granted, because why should you think about it if everything is working smoothly? This is especially true in kids, parents sometimes go so far as throwing a party when their child is potty trained and out of diapers. It’s a headache when kids take a step back in bathroom behaviors such as urinating – maybe they start having accidents, pain with urination, or a urinary tract infection (UTI) which is present in up to 8% of children with a fever (1). There are very effective ways to prevent these symptoms and UTI’s in kids without medications!

What is a UTI?

A urinary infection is an overgrowth of the normal bacteria in the bladder. It’s normal to have some degree of bacteria in the bladder, these come and go without causing harm. An infection happens when bacteria grow out of control, causing inflammation in the tissue itself. When your doctor is concerned about a UTI they send a urine test, which has two parts – A urine culture where the bacteria is grown in a Petri dish, and a urine analysis that tells us chemical properties of the urine and suggests inflammation and/or infection. Your doctor uses both of these to tell if an infection is what’s going on based on very clear guidelines from the American Academy of Pediatrics (3).

UTI Symptoms Can Happen Without An Infection

Common UTI symptoms include urinary frequency, painful urination, urinary accidents, and abdominal pain. Most people attribute these symptoms, called lower urinary tract symptoms (LUTS), to a urinary infection, but in the setting of negative urine studies they can also be the bladder’s way of telling you something’s not right in that area.  Kids often present with these symptoms with a negative urine culture and parents and primary doctors baffled by the mysterious recurrent urinary infections that aren’t really infections.

What’s causing these UTI-like symptoms?

There are many, many causes of an overactive or unhappy bladder, especially in kids, but one that’s often overlooked is constipation. The bladder and rectum share the same fixed boney space in the pelvis, and its pretty small in kids. Think of these organs like roommates sharing 300 sq ft 2 bedroom manhattan “apartment.” There’s not a lot of room so the condition of one has a big impact on the other. In the case of urinary symptoms, a constantly full rectum will push on the back of the bladder. This causes a constant stretching of the bladder wall that gives it the feeling something is always in there, even when the bladder is full. To a parent this can look like your child is urinating very frequently, or running to the bathroom constantly with little or nothing coming out.

On the flip side, constipation causing a constantly filled rectum can get in the way of the brain’s ability to feel when the bladder is appropriately full or empty. The simplest way to explain this is that the bladder and rectum share similar nerves and pathways to and in the brain. With constipation, research tells us the “lightbulb” in the brain that tells us when our bladder is appropriately full or empty doesn’t work correctly (2). Some kids (and adults) can’t feel their bladder very well when they’re constipated. Because we’re all a little different, some people are more sensitive to this than others and bowel habits may be playing a role in what may be otherwise considered mild constipation.

Can constipation cause a UTI?

Yes. This can happen a in few ways. If the bladder isn’t emptying very often because your child can’t feel the full bladder, that urine will sit around too long allowing for bacterial overgrowth and infection. Also, if the child can’t tell when their bladder is appropriately empty because the full rectum is getting in the way of normal bladder sensation, they may not empty to completion when urinating. Those few ounces of residual urine can promote bacterial growth.

Constipation plays a big role in bladder function and associated lower urinary tract symptoms, and the majority of kids have some or significant room for improvement in their stooling. In fact, constipation is such a common cause of urinary symptoms that we almost always recommend starting kids on a daily low-dose stool softener when addressing urinary complaints. This is one of the few realms where parents have direct control of the situation (by giving the stool softener) so this common culprit of constipation can be taken out of the equation. I tell my patients the goal is a daily bowel movement that has the consistency of toothpaste or peanut butter and comes out in less than 10 minutes. Remember, the bladder and rectum share a small space in the pelvis, it’s really small in little kids, so a rectum that’s always full will impact the bladder.

You Might Need A Pediatric Urologist

I just reviewed how constipation can impact bladder function, causing urinary symptoms similar to a UTI or even predispose kids to a UTI. However, this is one piece of the puzzle in addressing lower urinary tract symptoms in kids. Most kids just need to be pointed in the right direction of healthy habits, but sometimes there is more going on than meets the eye. Your doctor will take a thorough history and physical exam, in addition to any imaging studies that are needed to give the right recommendations for your child.

If you’re searching for a pediatric urology office, look no further than Georgia Urology! We manage all genitourinary problems that involve the kidney, ureter, bladder, penis, scrotum, and testicles in youth aged newborn to 18 years from all across Georgia and neighboring states.


  1. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008 Apr;27(4):302-8. doi: 10.1097/INF.0b013e31815e4122. PMID: 18316994.
  2. Franco I. The central nervous system and its role in bowel and bladder control. Curr Urol Rep. 2011 Apr;12(2):153-7. doi: 10.1007/s11934-010-0167-8. PMID: 21240642.
  3. Kenneth B. Roberts, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management; Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics September 2011; 128 (3): 595–610. 10.1542/peds.2011-1330