Participants: Agatha Thrash (Host), Don Miller
Series Code: HYTH
Program Code: HYTH000203
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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. |
Revised 2014-12-17