As a hollow organ in the lower part of the abdomen, the bladder stores urine after it is made by the kidneys. Vesicoureteral reflux is a condition in which urine from the bladder goes back into the tubes that connect the kidneys to the bladder (ureters) and can affect one or both kidneys and ureters.
Mild cases usually do not cause problems and do not require treatment. Children with severe vesicoureteral reflux may have more frequent urinary tract infections (UTIs), especially kidney infections (pyelonephritis). When a UTI involves the kidneys, it may lead to scarring and kidney damage. Treatment can help prevent these serious problems.
There are two types of vesicoureteral reflux.
- This type is caused by a birth defect. The child is born with a ureter that is too short, which leads to an abnormal connection between the ureter and the bladder. As a result, the valve where the ureter meets the bladder cannot keep urine from flowing back into the ureter.
- This type can be caused by a blockage that prevents the normal flow of urine through the urinary tract. The blockage can result from swelling caused by an infection or from an abnormal fold in the tube that empties urine from the bladder (urethra). Increased pressure in the bladder from infrequent or incomplete urination can also lead to vesicoureteral reflux.
This condition occurs most often in infants and young children, but it can be found at any age. The main risk factor for vesicoureteral reflux is having a family history of the condition. The condition is seen more often in girls than in boys.
Vesicoureteral reflux often does not cause any signs or symptoms. In many cases, no symptoms appear until a UTI has developed because of the condition. Common symptoms of a UTI may include:
- Frequent urination.
- Pain or burning sensation with urination.
- An urgent need to urinate.
- Blood in the urine.
- Bedwetting or other wetting accidents.
When a UTI involves the kidneys, the child may also have other symptoms, including:
- Lower abdominal or back pain.
- Nausea or vomiting.
- Feeling generally ill.
Children with vesicoureteral reflux may have repeated UTIs. Over time, the condition can lead to further problems if not treated. These may include:
- Scarring and damage to the kidneys.
- High blood pressure.
- Kidney failure.
Your child’s health care provider may suspect vesicoureteral reflux if the child has a UTI or repeated UTIs, especially if the UTI occurred with a fever or involved the kidneys. In some cases, a health care provider may suspect this condition if an ultrasound showed possible problems with the urinary system before the child was born.
- Your child’s health care provider will take a medical history, perform a physical exam, and check your child’s blood pressure.
- Your child’s health care provider will ask about your child’s bowel and bladder habits to help determine if bladder and bowel dysfunction are present.
- Common tests to help confirm the diagnosis include:
- Urine tests and blood tests.
- In this test, sound waves are used to produce images of the urinary tract.
- Voiding cystourethrogram (VCUG). In this test, X-rays are taken of the urinary tract while your child is urinating. A dye (contrast medium) is put into the bladder and urinary tract so that they can be seen more clearly.
Vesicoureteral reflux often goes away on its own with time, especially if it was caused by a birth defect. The child’s ureter grows to the proper length, which allows the valve to work properly and resolves the problem.
In some cases, antibiotic medicine is used to control or prevent UTIs, or another medicine may be used to help improve the child’s control of the bladder. The child may receive bladder training, which involves teaching him or her to urinate regularly and have regular bowel movements. The child will have frequent follow-up visits with the health care provider to make sure no problems are developing.
For severe cases that cause a lot of UTIs, especially kidney infections, surgery may be done to reduce vesicoureteral reflux. Various surgical techniques may be used to increase the length of the ureter. An endoscopic technique is sometimes used to insert a gel-like material to reinforce the valve where the ureter meets the bladder.
Follow these instructions at home:
- It is important to keep all follow-up visits as directed by your child’s health care provider.
- Give medicines only as directed by your child’s health care provider.
- If your child was prescribed an antibiotic medicine, have him or her finish all of it even if he or she starts to feel better.
- To help prevent UTIs:
- Encourage your child to empty his or her bladder often and not to hold urine for long periods of time.
- Encourage your child to empty his or her bladder completely during urination.
- If your child is female, teach her to wipe from front to back after a bowel movement. Each tissue should be used only once.
- Have your child avoid bubble baths or soaking in a tub with shampoos or soaps in the bath water. These substances may irritate the urethra and can contribute to developing a UTI.
- Have your child drink enough fluid to keep his or her urine clear or pale yellow.
Contact a health care provider if:
- Your child has swelling of the eyes, face, ankles, or feet.
- Your child is very tired or is sleeping much more than usual (lethargy).
- Your child is making very little urine.
- Your child has a fever.
- Your child has back pain or lower abdominal pain.
- Your child has nausea or vomiting.
- Your child has blood in his or her urine.
- Your child has frequent urination.
- Your child has pain or a burning sensation with urination.
- Your child has a loss of appetite.
Seek immediate treatment if:
- Your child has confusion or is difficult to wake up.
- Your child who is younger than 3 months old has a temperature of 100°F (38°C) or higher.
This information is not intended to replace advice given to you by your health care provider.