Participants: Agatha Thrash (Host), Don Miller
Series Code: HYTH
Program Code: HYTH000203
00:01 A lot of people have urinary tract
00:03 problems, and some these are quite easy to treat.
00:07 Some of them are not so easy.
00:08 I hope if you have an interest in this,
00:11 that you will join us for this program, as we'll be
00:13 talking about some of the very common ones, mainly
00:17 in children, and we think that you will enjoy our
00:20 program on how to treat these urinary tract problems.
00:43 Welcome to Help Yourself To Health
00:45 With Dr. Agatha Thrash of Uchee Pines Institute.
00:49 And now here's your host Dr. Thrash.
00:52 Children handle urinary tract problems quite well.
00:56 I remember the first patient that I had
00:59 with a urinary tract problem.
01:00 A little fellow probably about 13 or 14 moths old.
01:06 He had been born with ureters that did
01:12 not connect into the bladder in a proper way.
01:15 So of course a very serious problem,
01:17 and he had to be operated on,
01:18 and as a part of the treatment we used a
01:22 cystostomy which was going in just above the
01:25 pubic bone and putting a hole in the bladder
01:29 so that we could put a catheter in it,
01:31 and that would enable him
01:33 to pass his urine through this catheter.
01:35 The little fellow seemed to always
01:37 smell of urine, but that didn't seem to bother him at all.
01:42 He was so happy in the hospital, and of course all the nurses
01:45 and the doctors paid a little close attention to him.
01:48 Especially he and I seemed to bond
01:51 together really well, so any time I
01:53 walked on his ward, he would just hold
01:55 his hands up for me to pick him up, so
01:57 I would pick him up and put him on my
01:59 hip, and he would walk with me around
02:01 to do all of the rounds I had to do.
02:04 Eventually the time came when we closed up the cystostomy
02:09 and we were going to send him home.
02:11 So when he left, he smelled all fresh and clean,
02:15 and no more urine smell.
02:16 He was very happy and we were too.
02:19 Except sad to say "goodbye".
02:21 That young man is now well into his forties
02:25 and he is doing quite well he has never had any more
02:29 urinary tract problems.
02:31 His little connections function very nicely.
02:35 He is hale and, hardy and very healthy.
02:37 Now we can start our urinary
02:42 tract problems even before birth, or as
02:45 in the case of many children at the bed.
02:48 While a lot of children are broken to the house,
02:53 by the age of 18 months, there are some who
02:57 require a great deal longer than that.
03:00 I have here Dr. Don Miller who is going to talk with you
03:04 about bed wetting problems.
03:06 That's a serious problem in some homes.
03:08 What can you tell us about what to do for it,
03:10 and how it comes about.
03:12 Well, it is indeed a serious problem.
03:15 When we have a small animal like a dog,
03:17 we usually put their little nose in it
03:19 and we spank them.
03:20 and I will say this, that spanking and
03:23 punishing is not this cure for a child who is still bedwetting.
03:26 About 4% of children still bed wet by the age of 12
03:30 and punishing, will only make the matters worse.
03:33 As a matter of fact emotional causes are one of the things
03:36 that precipitate the bed wetting, and so if a child
03:40 is in a home where there is turmoil,
03:41 where there is anger, where there is strife,
03:44 that child may be more likely
03:46 to be a bed wetter, so we need to have peace in the home.
03:50 It's pretty uncommon now days
03:53 to have that peace in the home, but we need to find that
03:55 peace in the home.
03:56 There are other causes for bed wetting.
03:58 One could be just that the child was
04:00 born with a smaller bladder.
04:01 Now a good way to find out whether that's the problem is,
04:04 does the child urinate frequently through the day.
04:07 Basically if they have a small bladder, it fills up,
04:10 they've got to void, fills up they've got to void,
04:12 and that could continue through the night.
04:15 So we have to make sure the child
04:17 basically, as the evening starts
04:19 wearing on, they quit drinking fluids,
04:22 really no fluids after 5 p. m. in the afternoon.
04:24 They should drink plenty during the rest of the day,
04:26 but 5:00 p. m. quit the fluids,
04:28 then make sure that just before they go
04:31 to bed they void, it's purposefully
04:34 "I don't need to go", go anyway.
04:36 I remember in Marine Corps Boot Camp,
04:39 there was even at that time, there were a couple of guys
04:42 in my platoon that were bed wetters, and they would be
04:45 made to go into the bathroom before
04:48 they went to bed, and void and then twice during the
04:51 night they were woken up by the fire watch,
04:52 and made to go in there even
04:54 if they didn't have to go, they were made.
04:57 That sort of separated out those who
04:59 were doing it just it just to get out of the corps
05:01 or something because they didn't like
05:03 getting woken up at night, but that sometimes can't help.
05:06 As a matter of fact, they got a little device
05:07 called a wee guard.
05:08 Some type of little alarms, that are placed on the child,
05:12 and when they start to get wet,
05:13 they send an alarm that wakes the child up
05:15 and they can go in and void.
05:17 Which is not a bad idea.
05:18 But probably the main cause of bedwetting is food allergies.
05:25 Some type of an allergy in their system, in their environment
05:31 that's causing them to have this problem.
05:33 and it's interesting to note that usually if a parent
05:37 has an allergy like hives, or hay fever,
05:40 or other types of allergies,
05:42 It's more likely that the child will have allergies
05:45 and then it can manifest itself in bed wetting.
05:48 There are certain major foods that lead to bed wetting:
05:51 Probably the number one food, which about 60% of children
05:54 who bed wet after the age of 12 are allergic to cows milk,
05:59 and I would say probably all dairy foods.
06:02 So that needs to be eliminated
06:03 from the child's dietary.
06:04 There are some other thing that they could be taking
06:07 chocolate, of course if you take chocolate
06:08 you are taking milk, so it could be the chocolate
06:11 although there are things in the chocolate that irritate the
06:13 bladder, which could cause you to urinate
06:16 when you don't want to, there's also milk in there.
06:20 Eggs and citrus, wheat, grain, corn, and chicken
06:24 some of these are good foods but if a child is sensitive
06:26 they need to stay away, and what we recommend is
06:29 a child withdraw these things.
06:31 I'm going to read this list slowly.
06:33 If you have this problem in your home,
06:35 write down these and go on what we call an elimination diet
06:40 take all these things away from them,
06:42 for a period of a week or two, probably at least 2 weeks
06:46 and then add back the ones that are good,
06:50 Ok, you can make that determination,
06:52 but here is the list: cow's milk, all dairy products,
06:56 that means cheese, that means ice cream, that means milk,
07:00 that means high fat, low fat, any fat, no fat
07:03 whatever, none of that.
07:04 Chocolate, eggs, citrus, wheat, wheat is a major allergen
07:09 Probably because it's one of the earliest foods that we
07:14 introduce into the child, and because we don't properly cook
07:18 our wheat products.
07:19 The next one is grains, we need to properly
07:21 cook our grain products.
07:22 Corn, chicken, meat, peanuts, and fish, so eliminate those
07:29 from the dietary, and see if that does
07:31 not take care of the problem.
07:32 If that does take care of the problem,
07:36 then you know what it is.
07:37 Add one back, which might be a decent one
07:39 If the problem does not come back, you have found out
07:42 what the problem was, and the child is cured of their problem.
07:45 Constipation can also be a cause of bedwetting.
07:51 Basically a constipated bowel is pushing against the bladder
07:56 which causes it to not have as much volume
07:59 and pushes out urine in the night.
08:01 So a child should not be constipated.
08:04 None of us should be constipated.
08:05 Of course we cure that by making sure the child
08:07 drinks plenty of water, during the day
08:10 and has a high fiber diet
08:12 and stays away from all those other things
08:14 that cause constipation.
08:16 Those highly refined carbohydrates,
08:20 and sugary junk foods.
08:21 Have the child, when they are going to the bathroom,
08:26 urinating, have them do the start stop thing.
08:29 Basically it's almost like the kegel exercises,
08:32 they start the stream, then consciously stop the stream,
08:36 Start the stream, consciously stop the stream.
08:40 That will set up a mental system in their minds
08:44 that they are now under mental control.
08:47 Even when you are asleep you are under mental control
08:49 of this particular problem.
08:51 I have learned that if a child has been sick for a period of
08:56 time, and they are using a little hand urinal
09:02 and they roll over in bed and urinate,
09:04 that sometimes sends a signal to the brain that
09:07 ok, you don't have to get up,
09:08 just do it while you are laying there
09:10 That also goes for adults, if you are somehow bedridden
09:14 it could lead to a little bit of incontinence
09:16 in the nighttime season later on.
09:19 We've got to visibly or consciously
09:21 get up out of the bed and go to the bathroom
09:24 which is the best way.
09:25 Outdoor exercise, extremely important
09:28 for a child who has bedwetting problems.
09:30 We find that children with bedwetting,
09:33 bed wet more in the winter time
09:35 when they are not quite as physically active
09:37 than in the summertime, so exercise has a large amount
09:41 to do with bedwetting problems.
09:43 Then one thing that I've already mentioned we did there
09:48 in boot camp, that is not a bad idea.
09:50 If the child goes to bed at 8:30 at night,
09:52 which is a good time for a child to go to bed.
09:55 You might want to wake them at some specific time
09:58 later on in the night, just wake them up
10:01 take them to the bathroom and have them void then.
10:04 It gets them into that pattern, it might eliminate
10:07 them going into the problem.
10:09 These are some simple things that we can do
10:11 for a child, of course there other things that can lead to
10:14 bedwetting, a urinary tract infection
10:16 which Dr. Thrash will be talking about, cystitis
10:19 but these are some simple things Dr. Thrash
10:21 that I think might help a child.
10:23 You mentioned long cooking of grains,
10:26 did you say enough to make it so that I would be able to
10:30 know how to feed my child grains. Ok! Ok!
10:33 Not just the child Dr. Thrash, but even feeding us the grains.
10:37 We don't cook our grains well enough.
10:40 A grain is a carbohydrate.
10:42 A carbohydrate comes in a number of different forms.
10:46 We have sugars, we have starches, we have fiber.
10:49 It's the starches, which is nothing more than a long chain
10:52 of glucose molecules.
10:53 If it is not properly cooked or hydrolyzed
10:57 these chains do not break down, and these long chains
11:00 can get into the blood and circulate through
11:05 the system, and these long chains can cause real problems
11:08 in the system.
11:09 They can go into the brain and cause little lacunar scars
11:13 and anyone over 30 has a brain full of lacunar scars.
11:16 They can go down to the kidneys and cause
11:18 some type of problems there.
11:20 They can go into the bones.
11:22 They did an experiment they fed a lactating woman a solution
11:26 starch suspended in water, she drank that, and within
11:30 a short period of time they found that starch chains
11:33 in her blood, in her breast milk, in her urine,
11:36 so we need to cook our grains well.
11:39 Now what's cooking grains well, even instant oats should
11:41 be cooked for a half hour to 45 minutes.
11:44 I cook all of my oatmeal at night in a crock pot
11:47 all night long.
11:49 Rice, up to two to three hours.
11:51 Peoples say well how can you eat it like that.
11:53 Well you got to make a choice, you're going to have
11:56 the lacunar scars in your brain
11:57 or a little bit more mushy food,
11:59 If you take your rice or your other
12:01 grains, you dextrinize it first.
12:02 Put it in a hot skillet, heat it up until you hear
12:06 it start a little sizzle, that will dextrinize,
12:09 that will keep it from sticking together
12:11 as you are cooking it and give a nice nutty flavor.
12:14 It's a whole lot healthier, so I don't know if that helps.
12:16 You did some experiments with cooking grains, didn't you?
12:18 We did and we found that whole kernel wheat,
12:23 or whole kernel oats, required about four to five hours
12:28 to completely cook them.
12:30 Corn grits which we like a lot in the south, requires a good
12:34 four hours of cooking in order to make them about
12:37 the consistency of mashed potatoes.
12:40 Which is a very fine dish when it's properly prepared,
12:45 and also a very healthful dish.
12:47 There are some other things associated with bedwetting
12:53 that are far more serious.
12:54 One of those is epilepsy, and of course that is very rare
12:59 but if you find that your child's bed is wet,
13:03 and the bed is disheveled quite a lot more than you think
13:07 the child usually does with ordinary sleeping,
13:10 you might just check to see if the child might be having
13:14 a seizure during the night, a nocturnal seizures
13:18 are more common probably than we might think they are
13:22 in children who are going to have epilepsy.
13:25 Then of course it can be associated with
13:28 juvenile diabetes, and you want to check for that
13:33 if the condition persists or worsens.
13:36 Then sometimes sleep walking is associated with bedwetting
13:42 and speech disorders of various kinds can also be associated
13:47 with bedwetting, not that they are a cause,
13:50 but just that if your child has some of these
13:52 other conditions, know that they may have more difficulty
13:57 when they try to control their incontinence at night.
14:02 Cystitis is an important thing in children,
14:06 especially little boys, little boys seem to have more
14:11 cystitis than little girls,
14:12 although little girls can certainly have it.
14:16 I remember one little girl who was put with,
14:19 I think her father had either milk goats or milk cows
14:24 and they were put in a pasture that did not have a gate.
14:29 So the little girl was set there to mind the cows
14:32 in the pen while the older members of the family were doing
14:37 something else, and she began to notice that she couldn't
14:42 hold her urine long enough to be able to get ready
14:46 to pass her urine, so she began to wet her clothing.
14:49 After she smelled like urine several days in a row her mother
14:55 said, what happening with you, why are you smelling like
14:59 you have wet yourself, and she said "well I am. "
15:02 I do wet myself and I don't know why, I really try.
15:05 Then the mother realized that she had an incontinence problem
15:10 due to cystitis.
15:12 So they began to check and the doctor found that there
15:16 were puss cells and bacteria in the urine,
15:19 and with proper treatment the young lady was cured within
15:24 a short time.
15:25 So this can be and infection of little girls as well,
15:30 but little boys tend to have it more frequently,
15:33 and older women, so it's mainly a problem
15:36 with little boys and older women.
15:38 Older women because of the short urethra, and because
15:42 of difficulties with back infection
15:48 from a short urethra and the perineal area.
15:51 But if a woman is very careful and uses
15:55 a perineal pour after every voiding
15:59 then that will minimize the cystitis problem.
16:02 In children often it is due as it is in bedwetting
16:07 to food sensitivity, these should be checked
16:11 and eliminated so you first eliminate all the foods
16:15 that your going to test, and when the cystitis has cleared up
16:20 the child no longer has the problem, then you start adding
16:25 the foods back one food at a time
16:27 until a food starts making the problem again
16:30 and at that time you start making a list.
16:33 Make a list of all those foods that cause
16:36 the child to have the symptoms.
16:38 Now the symptoms of cystitis are first urgency, and frequency
16:42 just like the little girl who was not able to hold her urine
16:46 until she could get ready to void, and would wet her clothing
16:50 That urgency is also a hallmark of cystitis.
16:54 The urgency, the frequency, sometimes they can't wait
16:58 more than ten minutes between voiding,
17:01 and sometimes the urgency is so great
17:03 that they are unable to hold the urine
17:06 until they can get prepared to void.
17:08 Another thing is pain, pain or burning on urination
17:13 and if the pain is at the beginning of the urination
17:18 then you suspect that it is the lower part of the urinary tract
17:22 the urethra, and the neck of the bladder.
17:25 But if the pain is at the end of urination when the bladder
17:30 is contracting doing its little toilette.
17:34 Which it should do all the time, it should squeeze down
17:37 at the end of each urination, and that squeezes off any debris
17:44 that may have accumulated on the lining of the bladder
17:49 and helps that to be passed from the body.
17:51 So that little squeezing is a hygienic measure
17:54 on the part of the bladder to keep itself clean.
17:57 If at that time, if when the squeezing occurs
18:00 if that's the time of the pain, then it means that
18:02 the problem is higher up, which may be interstitial cystitis.
18:08 Now the interstitial cystitis is certainly a big problem but
18:14 that's mainly in adults and not the subject right now.
18:19 With children as you find those foods to which
18:22 they are sensitive, and remove them
18:23 often that's the end of the problem for them.
18:26 Lack of proper water drinking is a big issue with cystitis
18:31 so if your child frequently has cystitis, then be certain
18:36 that they drink enough water.
18:37 How much water, well it's still eight glasses, but it's just
18:41 eight child size glasses, so a very small child has a little
18:45 glass, a bigger child has a little bigger glass.
18:48 They can simply mark down every time they have a glass of water
18:52 and by the time they've gotten their eight glasses,
18:56 you know that they are finished.
18:58 So those two things getting enough water, being certain that
19:03 there is no food, and of course the infection matter
19:07 being very clean with the child, that those can be very helpful.
19:10 Another thing that a lot of people don't think about
19:14 is the use of soap.
19:15 Soap or bubble bath those are very common causes
19:20 of having some kind of cystitis.
19:23 Wearing panties that are not made of cotton,
19:29 that can also be a problem.
19:31 So armed with these bits of information you should be able
19:35 to handle this problem quite nicely.
19:38 Another thing that happens in children, it's quite rare
19:42 but it might be of interest to know that dehydration can
19:47 proceed to the point that it can cause a
19:50 renal vein thrombosis.
19:52 If you allow the child to become so dehydrated that the blood
19:59 pools in the veins that drain the kidneys,
20:04 and return the blood to the heart,
20:07 then a renal vein thrombosis is certainly
20:10 a great threat to the health of the child.
20:13 Fortunately it's not very common,
20:16 but long before we have a child
20:19 capable of making a thrombus in the renal veins
20:22 we should be hydrating the child.
20:24 So if they cannot keep fluid down by mouth,
20:28 if they cannot keep fluid in because of diarrhea
20:30 then they still need to have fluids taken.
20:34 At that point you need to get professional assistance
20:38 and get some IV fluids.
20:40 Another thing that we have in childhood is acute
20:45 glomerulonephritis, the scene develops in this way.
20:50 The child has a streptococcal sore throat,
20:53 or a streptococcal infection somewhere else,
20:56 such as a boil or elsewhere, an infected wound
21:00 and the streptococcus does not cause the person to
21:04 the child to have the glomerulonephritis directly
21:08 but a couple of weeks, following the problem with the sore throat
21:15 or the streptococcal infection, then the
21:19 glomerulonephritis occurs.
21:21 The first thing that the parent may see,
21:27 may not be any symptoms in the child.
21:30 They may just notice that the urine is dark.
21:33 If this is a very small child this can be seen on the diaper
21:38 but if it's an older child it may be seen in the commode
21:42 when they have passed their urine.
21:44 At that point some investigation needs to be made
21:49 but they may have pain, in the bladder,
21:52 or they may have pain in the back, where the kidneys are.
21:55 Fever and chills may also occur at that time,
21:59 and prostration so that the child is by no means
22:03 well enough to be up an around.
22:05 Acute glomerulonephritis is principally characterized
22:09 by blood, and by albumin in the urine.
22:14 When the child's blood pressure is taken, it is amazing
22:18 how high the blood pressure
22:19 can go under these circumstances,
22:22 the reason for that, is that an injured kidney from whatever
22:25 reason will release certain hormones that tend to cause
22:30 a constriction of blood vessels.
22:33 Its not all the blood vessels in the body,
22:35 but principally, in fact specifically
22:39 the small blood vessels of the body
22:42 which are mainly composed of muscle.
22:46 Now if you will notice this diagram that I'm going to draw
22:51 on the board, you will see just what kind of artery
22:54 is involved with this.
22:56 It's an artery that's of almost our smallest size.
23:02 They have the outside wall there, and the inside lumen
23:08 is very small, and all of this is muscle here, and so the
23:15 hormone from the kidney is so strong, that it makes this
23:21 muscle contract.
23:23 As it gets tighter, then of course the area for blood to be
23:28 in that small lumen diminishes, and with the reduction in the
23:34 size of the lumen of the blood vessel,
23:36 then the blood pressure goes way up.
23:40 A child with acute glomerulonephritis
23:45 may have a blood pressure that's 350/180,
23:50 it can be enormously high.
23:53 The highest blood pressures that we ever see,
23:55 Of course this must be treated promptly so that the child
23:59 can resume normal activities.
24:03 Now acute glomerulonephritis usually runs it course in about
24:07 a week or two weeks, sometimes three.
24:10 We expect that recovery will be complete, that there will be
24:15 no residual whatsoever in the kidney, and the
24:19 kidney will function entirely normal ever there after.
24:22 But approximately 10% of children with
24:26 acute glomerulonephritis will proceed to chronic
24:30 or a sub-acute glomerulonephritis
24:33 does not clear in the usual few weeks that we expect
24:37 acute glomerulonephritis to clear.
24:39 But will last a number of weeks or a number of months longer,
24:44 with blood in the urine, and protein in the urine,
24:48 so that the child may still have some symptoms,
24:53 but usually the symptoms are only the sign
24:56 of the blood or the protein in the urine
24:59 May not be a lot of blood, but may be enough
25:03 so that the parent can see it in the commode
25:07 About 10% of those, that go into that phase, will go into a
25:14 chronic phase, so you expect more that 90%, maybe 95%,98%
25:21 of children with acute glomerulonephritis
25:23 will clear up, but a certain percentage will go on
25:27 to a chronic form of glomerulonephritis, which is
25:31 progressive, and the glomeruli, which are the
25:34 functioning units of the kidney.
25:37 They begin to constrict and to scar down and die.
25:42 When the little patient has lost enough
25:46 of the little nephrons in the kidneys
25:49 then the kidneys cease to function,
25:52 and we have a kidney failure.
25:55 In these children now we have a capability of giving them
26:01 some very good relief by getting a kidney for them,
26:06 and we can often relieve their problem if they have
26:10 complete kidney failure, by a kidney transplant.
26:14 This is a very good treatment for them,
26:16 and they are very good candidates,
26:18 they often do quite well with that.
26:20 Another form of congenital problem is that of polycystic
26:27 disease of the kidneys.
26:28 You may have heard of this its not to rare.
26:32 You may know a person who is in their 30's or 40's,
26:36 who has a kidney problem, and if you inquire,
26:40 they tell you its polycystic kidney.
26:42 What happens here is that the connection between
26:46 the little glomerulus, and the little tubule that drains
26:51 the urine produced in the glomerular apparatus.
26:55 That little tube, they do not match up exactly
26:59 in a lot of cases, and what causes this
27:02 can be multitudinous.
27:04 It can be something in the prenatal time when the mother
27:11 may have become intoxicated with fumes, or with some kind of
27:17 food, or some other kind of difficulty, or it may be
27:21 entirely a genetic problem.
27:23 At any rate, these cysts began to grow, and by the time
27:28 the person is 40 to 50 they are really quite large,
27:32 and sometimes do induce complete kidney failure.
27:37 Now we have not covered the entire gamut of genitourinary
27:42 problems in children, but we have covered a few of them
27:46 so that you can maybe under- stand the importance of the
27:50 kidneys, and keeping them in very good health.
27:53 May the Lord Bless you with good health in this way.