Managing Pediatric Urinary Pain After COVID-19 Diagnosis

COVID-19 positive with urethritis?

Hello, doctor.
We are a family with a confirmed patient, and we came here to consult because it was inconvenient to seek emergency care.
Please do not take offense.
My 8-year-old son, weighing 25 kg, was diagnosed with COVID-19 in the early hours of May 1.
At that time, a urinalysis showed a slight urinary tract infection.
Over the past few days, he has frequently experienced abdominal pain, mostly around the navel, which feels like regular stomach pain.
Sometimes it lasts for a few hours, and other times it doesn't occur for half a day.
From May 1 to 3, he often had severe lower abdominal pain very close to the genital area, which made him scream in pain.
He does not have symptoms of frequent urination or painful urination.
The severe pain occurs a few hours after taking medication and lasts for about ten minutes.
He has more frequent mild abdominal pain.
In the past two days, the severe pain near the genital area has occurred only occasionally.
The urinalysis showed the following results: protein 30 (1+), RBC 3-5, WBC 10-19, bacteria 1+.

I would like to ask:
1.
Originally, he was prescribed the antibiotic doxycycline for three days, and he just finished it last night.
Yesterday, he had a consultation through the Health Buddy app with a pediatrician from Kaohsiung Chang Gung Hospital.
At that time, my son did not have severe pain, and she said we could just observe him and prescribed additional antibiotics and some medications to relieve symptoms.
I would like to know if there will be antibiotic resistance since the new medication will only arrive tonight.
Should he take additional doses?
2.
I see that his symptoms do not seem to match anything serious.
He has not had a fever for three days, his blood oxygen levels are normal, and most of the pain is around the navel.
It might be related to COVID-19.
He does not have rapid breathing, his heart rate is normal, and he does not experience painful or frequent urination.
Moreover, when he feels well, he has been in good spirits and able to play from this morning until 4 PM.
However, starting at 4 PM today, he experienced severe lower abdominal pain near the genital area for about ten minutes, causing him to scream, sweat, and cry.
After that, he had a few minutes of pain again after a while, and then it stopped for a while before recurring.
I initially considered going to the emergency room but was worried about long wait times and being sent home without treatment.
Around 4:30 PM, he fell asleep until 7 PM, sleeping soundly with normal breathing.
If there were really a problem, why would the pain come and go? He should also wake up from the pain while sleeping.
Since May 1, he has not woken up at night due to this pain.
If it were truly an issue, shouldn't he be waking up in pain? I found that in the U.S., it seems that young girls may experience severe pain during COVID-19.

3.
He had a bowel movement two days ago and another this morning, but I feel the amount was not much.
Could it be that the pain near the genital area is due to constipation? Is it possible that this could cause severe pain in that area? Can I buy an enema to help him at home? I feel really helpless and sincerely ask for your help, doctor.
Thank you very much for your assistance.

Xingfu, 0~9 year old female. Ask Date: 2022/05/05

Dr. Xiao Kaiwen reply Pediatrics

Missing a day of antibiotics should not lead to antibiotic resistance.
In some children, abdominal pain can indeed be caused by retained stool.
I think trying a one-time enema is acceptable, but if the abdominal pain persists or worsens, it is important to discuss it with your telemedicine physician.

Reply Date: 2022/05/05

More Info

Managing urinary pain in pediatric patients, especially following a COVID-19 diagnosis, requires careful consideration of various factors, including the child's symptoms, medical history, and the potential impact of the virus on their overall health. In your case, your 8-year-old son has been experiencing abdominal pain and urinary symptoms after being diagnosed with COVID-19, which raises several important points to address.

Firstly, it's essential to understand that COVID-19 can affect children differently than adults. While respiratory symptoms are common, gastrointestinal symptoms, including abdominal pain, have also been reported. Your son's intermittent abdominal pain, particularly near the genital area, could be related to several factors, including urinary tract infection (UTI), constipation, or even post-viral syndrome. The presence of protein, red blood cells, and white blood cells in his urine suggests a possible urinary tract infection, which can cause discomfort and pain.

Regarding your concerns about antibiotic resistance, it is generally unlikely that a short gap of one day without antibiotics would lead to significant resistance. However, it is crucial to follow the prescribed course of antibiotics as directed by your healthcare provider. If the new medication arrives soon, it is advisable to start it as prescribed without skipping doses, as this ensures that the infection is adequately treated. If symptoms persist or worsen, further evaluation may be necessary.

Your observation that your son has not experienced fever or significant respiratory distress is reassuring. The fact that he can engage in activities and has normal oxygen levels indicates that he is stable. The intermittent nature of his pain, especially if it does not disrupt his sleep, may suggest that it is not an acute emergency. However, the severe pain episodes you described, particularly those that cause him to cry out and sweat, warrant close monitoring. If these episodes become more frequent or severe, seeking immediate medical attention would be prudent.

Regarding the possibility of constipation contributing to his symptoms, it is indeed plausible. Constipation can lead to abdominal pain and discomfort, particularly in children. If you suspect that he may be constipated, you could consider gentle measures such as increasing fluid intake, encouraging a diet rich in fiber, and possibly using an over-the-counter stool softener or enema if necessary. However, it is crucial to consult with a healthcare provider before administering any treatments, including enemas, to ensure they are appropriate for your son's specific situation.

In summary, managing your son's urinary pain and abdominal discomfort involves a combination of monitoring his symptoms, ensuring he completes his antibiotic course, and addressing any potential constipation. If his symptoms do not improve or if you have any concerns about his health, do not hesitate to reach out to a healthcare professional for further evaluation and guidance. Your vigilance and proactive approach to his health are commendable, and it is essential to prioritize his well-being during this time.

Similar Q&A

Understanding Persistent Pain After Pediatric Urinary Tract Infection Recovery

My daughter is over 3 years old. A little over a week ago, she had a urinary tract infection (caused by E. coli) and was on antibiotics for a week. After a follow-up check, it was confirmed that there were no bacteria and no blood in her urine. However, she still experiences pain...

Dr. Xiao Kaiwen reply Pediatrics
The vast majority of urinary tract infections (UTIs) are simple and uncomplicated infections, which can typically be effectively treated with antibiotics for 5 to 7 days. However, in cases of more severe and complicated infections (such as those that have ascended to the upper ur...

Child Experiences Back Pain While Urinating: What Parents Should Know

Hello Doctor: My child complained of back pain while urinating today, and it took her three attempts to finish urinating. Upon further questioning, I found out that she did not use the restroom at school all day, nor did she at her after-school care. She went from 7 AM until 8 PM...

Dr. Pei Rensheng reply Pediatrics
Dear Maggie: Hello, the symptoms in your child strongly suggest a urinary tract infection. Please ensure they drink plenty of water and urinate frequently. It is important to consult a pediatrician. Generally, the physician will perform a urinalysis, and if a urinary tract infect...

Understanding Urinary Abnormalities in Elderly Patients After COVID-19

My father (A-Chuan, 91 years old) visited the doctor on May 13 due to benign prostatic hyperplasia and had an emergency catheter placed. On May 15, he tested positive for COVID-19 and started antiviral medication. Starting May 18, he experienced abnormal urination, with decreased...

Dr. Du Shixi reply Urology
Hello: If blood tests are normal and there is no edema, it is common for older individuals to experience this condition. Generally, older adults should first consult an internist. A heart rate of 85-90 beats per minute is considered normal. Wishing you good health.

Vaccination Guidelines for Infants After COVID-19 Diagnosis

A six-month-old baby tested positive for COVID-19 the day before receiving vaccinations! Currently, the baby is at home. How long should we wait before returning to get the originally scheduled vaccinations? The baby had a fever for three days, with a maximum temperature of 40.9 ...

Dr. Pei Rensheng reply Pediatrics
Hello: After a confirmed diagnosis, you can receive the vaccine for six-month-olds at least 14 days later, provided there is no fever or discomfort (mild cough and runny nose are acceptable). If there is decreased activity after the fever subsides, it is likely due to the side ef...