Conditions & Treatments

Information for Parents and Carers

Bedwetting, also called nocturnal enuresis, means wetting during sleep in a child old enough to be expected to be dry at night. It is very common and is usually not caused by laziness, poor behaviour or emotional problems. Many children who wet the bed are deep sleepers, produce a large amount of urine at night, or have a bladder that is still learning to hold urine reliably overnight.

A consultation is useful when bedwetting is distressing, persistent, associated with daytime symptoms, or starts again after a long dry period. The aim is to understand the child's bladder and bowel habits, fluid intake and night-time pattern, and then agree a plan that is realistic for the family.

Please Seek Urgent Medical Advice If:

• Your child has new bedwetting with excessive thirst, weight loss or passing very large amounts of urine.
• Bedwetting starts again after a long dry period and your child also seems unwell.
• There is pain passing urine, fever, blood in the urine or recurrent urinary infection.

What We Usually Ask About

• How often the child wets the bed and whether there has ever been a dry period.
• Whether there are daytime symptoms such as urgency, frequency, holding manoeuvres or daytime wetting.
• Fluid intake, especially whether the child drinks regularly during the day or mainly in the evening.
• Bowel habits, as constipation can make bladder symptoms worse.
• Symptoms suggesting diabetes or another medical problem, such as excessive thirst, weight loss or passing very large volumes of urine.

Simple Measures That Often Help

It is important to keep the urine diluted during the day by drinking regularly and to empty the bladder regularly, usually every two to three hours. Children should be encouraged to pass urine before going to sleep. Caffeinated and fizzy drinks can make symptoms worse in some children.

Star charts and rewards should focus on positive behaviours, such as drinking well, using the toilet before bed and helping change bedding, rather than only rewarding dry nights.

Treatment Options

• A bedwetting alarm can be very effective, but it requires motivation, consistency and support from the family.
• Desmopressin can reduce night-time urine production and is often useful for sleepovers, school trips or when an alarm is not suitable.
• Medication works best when evening drinking is controlled safely according to medical advice.
• Daytime bladder symptoms should be addressed first, because untreated daytime dysfunction can make bedwetting treatment less successful.

What Happens in Clinic

A urine test may be performed. Scans are not needed for every child with simple bedwetting, but may be arranged if there are daytime symptoms, recurrent urinary infections, abnormal examination findings or other concerns.

Information for Parents and Carers

Daytime wetting and bladder dysfunction describe a range of symptoms including urgency, frequent trips to the toilet, holding on for too long, small damp patches in underwear, sudden accidents or difficulty emptying the bladder completely. These symptoms are common in children and often relate to bladder habits rather than a serious underlying abnormality.

In clinic, a major part of treatment is understanding the pattern: how much the child drinks, how often they pass urine, whether the urine is concentrated, and whether constipation is present. Many children improve with a structured bladder programme before any medication is considered.

Please Seek Urgent Medical Advice If:

• Your child cannot pass urine.
• There is fever, loin pain or your child appears unwell with urinary symptoms.
• There is visible blood in the urine or severe pain.

Common Symptoms

• Rushing to the toilet or not getting there in time.
• Crossing legs, squatting or holding manoeuvres.
• Passing urine very infrequently, sometimes only two or three times during the day.
• Small leaks after delaying voiding.
• Recurrent urinary tract infections or urine that is often very concentrated.

The Bladder Programme

Children are usually advised to drink regularly so that the urine stays pale, and to pass urine every two to three hours during the day rather than waiting until they are desperate. They should take their time on the toilet, sit comfortably with feet supported, and try to empty the bladder to completion.

Constipation is very important. A full rectum can press on the bladder and worsen urgency, frequency and wetting. Treating constipation is often a key part of improving bladder control.

Investigations

Many children need only a urine test and careful history. Depending on the symptoms, an ultrasound scan may be arranged to look at the kidneys, bladder, bladder emptying and sometimes rectal diameter. Flow tests may be used in older children when there is concern about bladder emptying.

Treatment Options

• Urotherapy: regular fluids, timed voiding, posture and bowel management.
• Medication for overactive bladder may be considered when urgency and frequency persist despite good bladder habits.
• Antibiotics are not used for bladder dysfunction itself, but may be needed for proven urinary infection.
• More specialist tests are reserved for children with complex symptoms, previous surgery, abnormal scans or poor bladder emptying.

Information for Parents and Carers

A urinary tract infection is an infection in the urine, bladder or kidneys. Symptoms vary with age. Babies may have fever, poor feeding, vomiting or irritability, while older children may complain of pain passing urine, needing to pass urine more often, tummy pain, wetting, fever or foul-smelling urine.

Not every child with a UTI has an underlying urological problem. However, recurrent infections, kidney infections, infections in very young babies, unusual bacteria, poor response to antibiotics or abnormal scans may need further assessment.

Please Seek Urgent Medical Advice If:

• A baby under 3 months has suspected UTI or fever.
• Your child has fever, loin pain, vomiting, dehydration or appears very unwell.
• Symptoms do not improve after starting antibiotics, or your child deteriorates.

Diagnosis

A urine sample is important before or at the start of treatment whenever possible. The method of collection depends on the child's age and whether they are toilet-trained. A urine dipstick can be helpful, but urine culture is often needed to confirm the infection and identify the best antibiotic.

Treatment

Children with suspected UTI are treated according to age, severity and local antibiotic guidance. A child who is unwell, very young, vomiting or suspected of having a kidney infection may need urgent paediatric assessment. Antibiotics should be reviewed when culture results are available.

Preventing Recurrence

• Encourage regular drinking so the urine is not constantly concentrated.
• Encourage voiding every two to three hours and avoiding long delays.
• Treat constipation carefully.
• Girls should wipe from front to back and avoid irritants if vulval soreness is present.
• Antibiotic prevention is not routinely needed after a first simple UTI, but may be considered in selected children.

Investigations

Imaging is tailored to the child. Some children need an ultrasound scan. Others may need a test for vesicoureteric reflux or a DMSA scan to look for kidney scarring, particularly if infections are recurrent, atypical or associated with kidney involvement.

Information for Parents and Carers

Hydronephrosis means dilatation or stretching of the drainage part of the kidney. It is commonly seen on pregnancy scans and may also be found later in childhood during investigation for pain, urinary infection or another concern. Hydronephrosis is a scan finding rather than a diagnosis by itself.

Many children with hydronephrosis are well and do not need surgery. The important question is whether the kidney drains safely, whether infections occur, and whether kidney function is preserved over time.

Please Seek Urgent Medical Advice If:

• Your child has fever and urinary symptoms.
• There is severe loin or abdominal pain with vomiting.
• A baby with known hydronephrosis becomes unwell or feeds poorly.

Possible Causes

• Temporary or mild dilatation that improves as the child grows.
• Pelvi-ureteric junction obstruction, where drainage from the kidney into the ureter is restricted.
• Vesicoureteric reflux, where urine flows backwards towards the kidney.
• A duplex kidney, ureterocele or other congenital urinary tract difference.

Investigations

An ultrasound scan is usually the first test. Depending on the severity and pattern, further tests may include a MAG3 renogram to assess drainage and split kidney function, an MCUG/cystogram to assess reflux, or urine tests if infection is suspected.

Treatment and Follow-Up

Mild hydronephrosis often improves or remains stable and can be monitored with ultrasound. Surgery, such as pyeloplasty, is considered when there is significant obstruction, worsening dilatation, symptoms, infections, or concern about kidney function. Decisions are based on the whole picture rather than one scan measurement alone.

What Families Should Watch For

• Fever or urinary infection symptoms.
• Recurrent abdominal or loin pain, especially with vomiting.
• Poor growth or unexplained illness in babies.
• Any change in the plan after a new scan or test result.

Information for parents and carers
Vesicoureteric reflux, or VUR, means urine can flow backwards from the bladder towards one or both kidneys. It is usually diagnosed after urinary infections or during investigation of hydronephrosis. VUR can be mild or severe, and the significance varies from child to child.
The aim of assessment is to reduce the risk of kidney infection and protect kidney growth and function. Many children with reflux are managed without surgery, especially if infections are controlled and the kidneys are healthy.
Please seek urgent medical advice if:
• Your child has fever, loin pain or appears unwell with urinary symptoms.
• There are recurrent infections despite prevention measures.
• Your child is unable to pass urine or has severe pain.

How VUR is diagnosed
VUR is usually diagnosed with a cystogram/MCUG, where the bladder is filled with contrast and X-ray pictures are taken. Ultrasound and DMSA scans may also be used to assess the kidneys and look for scarring or differences in kidney function.
Management options
• Observation and bladder/bowel optimisation.
• Antibiotic prophylaxis in selected children, especially younger children or those at higher risk of infection.
• Treatment of constipation and bladder dysfunction, which can make reflux and infections worse.
• Surgery or endoscopic injection in selected cases, particularly with breakthrough infections, high-grade reflux or kidney concerns.
Bladder habits matter
Children with VUR should avoid holding urine for long periods. Regular drinking, timed voiding and complete bladder emptying reduce urinary stasis and may reduce infection risk. Constipation should be actively treated.
Long-term outlook
Many children outgrow reflux as they get older. Follow-up depends on the grade of reflux, infection history, kidney scans, age and bladder function. The plan should be individual rather than automatic surgery for every child.
 

Information for Parents and Carers

It is normal for the foreskin not to fully retract in babies and young boys. Natural adhesions between the foreskin and glans usually separate gradually during childhood. A non-retractile foreskin alone is not usually a reason for surgery.

Specialist advice is helpful when there is scarring, recurrent inflammation, ballooning with infections, pain, urinary problems or concern about balanitis xerotica obliterans (BXO), a scarring skin condition that can narrow the foreskin and sometimes the urinary opening.

Please Seek Urgent Medical Advice If:

• The foreskin is pulled back and cannot be brought forward again.
• Your child cannot pass urine.
• There is severe swelling, increasing pain, fever or spreading redness.

What Is Normal?

• A foreskin that does not retract in a young child can be physiological and normal.
• Gentle retraction only as far as comfortable is acceptable during bathing once the foreskin begins to loosen.
• Forced retraction should be avoided because it can cause pain, bleeding and scarring.

Common Problems

• Ballooning during urination, which may occur when the foreskin is tight but is not always dangerous.
• Balanitis: redness, soreness or discharge from inflammation or infection.
• Phimosis: a tight foreskin that cannot retract.
• BXO: a white, scarred, tight ring sometimes associated with meatal narrowing.

Treatment Options

Treatment depends on the cause. Mild tightness can often be treated with a steroid cream course and gentle stretching. Recurrent infections, significant scarring, BXO or persistent troublesome symptoms may require circumcision or another foreskin procedure. If the urinary opening is narrowed, this may also need assessment.

Practical Advice

Avoid harsh soaps and bubble baths if the skin is sore. Keep the area clean with water. Do not force the foreskin back. If the foreskin is retracted, it must always be brought forward again to avoid paraphimosis.

Information for Parents and Carers

An undescended testis means the testicle is not sitting in the scrotum. It may be felt in the groin, may move in and out of the scrotum, or may not be palpable. This is different from a retractile testis, which can be brought down into the scrotum and stays there when the child is relaxed.

Assessment is important because a true undescended testis usually benefits from surgery. The aim is to place the testicle in the scrotum, make future examination easier and support the best possible long-term testicular health.

Please Seek Urgent Medical Advice If:

• There is sudden testicular pain, swelling, redness or vomiting.
• A groin swelling becomes painful or cannot be pushed back.

Retractile Versus Undescended

Retractile testes are common and often related to an active cremasteric reflex. When the child is warm and relaxed, the testicle can usually be brought into the scrotum without tension. These children often need observation rather than surgery. A testicle that cannot be brought down, or immediately springs back under tension, is more likely to be undescended.

Investigations

Most palpable undescended testes are diagnosed by examination and do not need an ultrasound scan before referral. Non-palpable testes may require examination under anaesthetic and laparoscopy to identify whether the testicle is inside the abdomen, absent or very small.

Treatment

Orchidopexy is the operation to bring the testicle into the scrotum. For a palpable testis this is usually a day-case operation through a groin or scrotal incision. For an intra-abdominal testis, laparoscopic surgery may be needed and occasionally the repair is staged if the vessels are short.

Why Timing Matters

• Surgery is commonly recommended in infancy or early childhood once spontaneous descent is unlikely.
• Earlier treatment may support fertility potential.
• Having the testicle in the scrotum makes future examination easier.
• Parents should seek review if a testicle previously in the scrotum appears to have ascended.

Information for Parents and Carers

Hypospadias is a condition present from birth in which the urinary opening is on the underside of the penis rather than at the tip. The foreskin may look incomplete or hooded, and some boys also have a bend of the penis called chordee.

Hypospadias varies from very mild to complex. Not every child needs the same operation, and some very mild forms may not require surgery. The decision depends on the position of the opening, the urinary stream, penile curvature, foreskin appearance and family preference.

Please Seek Urgent Medical Advice If:

• After surgery, the catheter stops draining, the dressing is soaked with blood, or your child is in severe pain.
• There is fever, increasing redness, pus or your child cannot pass urine.

Assessment

The specialist will examine the position of the meatus, the quality of the urethral plate, the amount of curvature and the foreskin. If one or both testes are not in the scrotum, or the hypospadias is severe, further endocrine or genetic assessment may occasionally be needed.

Aims of Surgery

• To allow the child to pass urine with a good forward stream.
• To correct significant curvature.
• To place the urinary opening closer to the tip when appropriate.
• To achieve an appearance acceptable to the child and family.

Treatment

Surgery is usually performed under general anaesthetic, often in infancy or early childhood, but timing is individual. Mild distal hypospadias may be repaired in one stage. More complex hypospadias may need staged surgery. A catheter or dressing may be required after the operation.

Possible Complications

Families should be aware that hypospadias surgery can sometimes need further treatment. Possible complications include fistula, narrowing of the new opening, wound healing problems, persistent curvature or cosmetic concerns. Complex and redo cases have a higher risk of additional surgery.

Information for Parents and Carers

An umbilical hernia is a soft swelling at the belly button caused by a small gap in the abdominal wall. It is very common in babies and young children and often closes by itself. An epigastric hernia is a small lump in the midline between the breastbone and the belly button, usually caused by fat pushing through a small defect.

These hernias are usually not dangerous, but they can worry families because the swelling becomes more obvious when the child cries, coughs or strains. The management differs: umbilical hernias are often observed, while epigastric hernias are less likely to close spontaneously.

Please Seek Urgent Medical Advice If:

• The hernia becomes painful, hard, red or irreducible.
• Your child vomits repeatedly or appears very unwell.

Umbilical Hernia

Most umbilical hernias are painless and reducible. Many close naturally during early childhood. Surgery may be discussed if the hernia is large, persists as the child gets older, causes symptoms, becomes trapped, or for family preference after discussion.

Epigastric Hernia

Epigastric hernias usually present as a small, firm lump in the midline. They may be more noticeable when standing or straining. They do not usually close by themselves, and repair can be considered if symptomatic, enlarging or cosmetically concerning.

Surgery

Repair is usually a day-case operation under general anaesthetic. The surgeon closes the small defect in the abdominal wall, usually through a small incision. Children normally recover quickly, but activity advice will be given after surgery.

What to Look For

• Pain at the hernia site.
• A lump that becomes hard, tender, red or cannot be pushed back.
• Vomiting or abdominal distension.

Information for parents and carers
A hydrocele is a collection of fluid around the testicle, causing scrotal swelling. An inguinal hernia is a swelling in the groin caused by a small channel that has remained open, allowing bowel or other tissue to pass into the groin. In boys, hydroceles and hernias are related to the pathway the testicle followed before birth.
The key distinction is that a hernia can become trapped and therefore usually needs surgery once diagnosed. A simple hydrocele in a baby may be observed because it can resolve naturally, but persistent, tense or communicating hydroceles may need repair.
Please seek urgent medical advice if:
• A groin or scrotal swelling becomes painful, hard or cannot be pushed back.
• Your child has vomiting, abdominal distension or appears very distressed.
• There is sudden testicular pain or marked scrotal redness.

Typical features
• Hydrocele: painless scrotal swelling, often soft and sometimes changing size.
• Communicating hydrocele: swelling may be smaller in the morning and larger later in the day.
• Inguinal hernia: intermittent groin swelling, often appearing when crying or straining.
• In girls, an inguinal hernia may contain an ovary and still needs specialist assessment.
Diagnosis
Diagnosis is usually clinical. Ultrasound is not always needed when the examination is typical. The surgeon will check whether the swelling is confined to the scrotum or extends into the groin, and whether it can be reduced.
Treatment
Inguinal hernias are repaired with a day-case operation. Hydroceles may be observed in infants, but surgery is considered if they persist, enlarge, fluctuate significantly or are associated with a hernia. The operation closes the patent channel and prevents further fluid or hernia contents passing down.
After surgery
Children usually go home the same day. Some swelling and bruising can occur. Families are advised about wound care, pain relief and return to school or nursery.
 

Information for Parents and Carers

A varicocele is enlargement of the veins around the testicle, usually on the left side. It can feel like a soft bag of worms above the testicle and may become more obvious when standing. Varicoceles are uncommon before puberty and are usually found in adolescent boys.

Many varicoceles cause no symptoms and simply need observation. The reason for specialist assessment is to check testicular size, symptoms and whether there is any sign that the affected testicle is growing less well than the other side.

Please Seek Urgent Medical Advice If:

• There is sudden severe testicular pain.
• A new hard lump is felt in the testicle.
• The scrotum becomes acutely swollen, red or very painful.

Symptoms and Signs

• A painless swelling above the testicle.
• A dragging ache or discomfort, especially after sport or standing for a long time.
• A difference in testicular size noticed by the family, GP or specialist.
• Many boys have no symptoms at all.

Assessment

The specialist will examine the child standing and lying down and compare testicular size. Ultrasound may be used to measure testicular volume and confirm the diagnosis, especially if there is concern about asymmetry.

Treatment Options

Observation is appropriate for many adolescents. Surgery or radiological treatment may be considered if there is persistent pain, significant testicular size difference, progression on follow-up, or selected fertility-related concerns. Treatment decisions should be individual and discussed carefully.

Follow-Up

Adolescents may be reviewed periodically during growth. Families should report increasing pain, rapid change in size or any new hard testicular lump, which should be assessed promptly.