Photo courtesy of Saigon Tiep Thi
Pham Kim Han of Ho Chi Minh City says her 9-year-old daughter never managed to leave her shoes and bags in the right place when she got home from half a day at school.
"She was in too much of a hurry to go to the bathroom. Sometimes when I was slow in opening the door, she peed in her pants."
Han said her daughter and many of her classmates do not dare use the "dirty and stinky" toilets at school.
Many children are forced to hold back the need to relieve themselves because of a lack of clean toilets, exposing to them infections that can spread to the kidneys and cause severe damage to their health, doctors say.
Dr. Le Tan Son, head of the kidney and urinary department at the city's leading pediatrics facility Children's Hospital No.2, said when a person denies the brain signal from the bladder that it is full, pollutants that need to be discharged will be held up instead and become an environment for bacteria.
Hoang Diep Chi, also from HCMC, has learnt this the hard way.
Chi recently took her son, a fifth-grade student, to Children's Hospital No.2 after he complained that he felt a burning sensation when he passed urine, and his hips ached. He also had high fever for a week.
This followed after a long time of his failing to hold his bladder well, needing to use the bathroom more often but only peeing a little each time, sometimes nothing.
Doctors diagnosed him with severe bladder inflammation, or cystitis, that had scarred his kidneys.
They said 10-15 percent of children suffering from severe cystitis have their kidneys damaged, which can lead later to high blood pressure and chronic kidney failure.
The boy's holding his urine for a long time had allowed bacteria to grow in the bladder. The dominant bacterium culprit is E.coli, which lives around the bowel and anus and causes the infections when it moves to the opening of the urethra, usually due to poor hygiene.
Chi said that it was only when her son developed serious symptoms that she noticed that he was drinking little water and refusing soup to avoid having to pee at school.
"And he asked me to drive fast anytime I came to pick him home, so he could run into the bathroom."
Doctors from the hospital's kidney and urinary department said they received dozens of children every week that came for examinations for urinary tract infections, and half of them usually end up having to stay for treatment.
Son said infections in early stages, when the kidneys are not affected, will heal ten to 15 days of using antibiotics. But the child will need a surgery if the infections are connected to abnormal structures in the urinary system.
Some parents have brought their teenage children, angry and suspicious that the latter have suffered the condition because unsafe sexual practices.
But the most common reasons, based on what children tell doctors, are that they skipped peeing at school because the restrooms were dirty, lacked privacy and they were embarrassed to tell teachers they needed to use the restroom.
People suffering higher risks of these infections are those with poor immunity or having conditions that hinder urine flow such as kidney stones, spinal cord injury or enlarged prostate that prevents the bladder from emptying itself; or women who use a diaphragm for birth control.
Son said some urinary tract infections are caused by bacteria in contaminated blood, and those were much more serious cases.
He said like Chi's son, many children were too afraid of peeing in dirty places and did not drink enough water, which only worsens their problem.
Son said the boy's case had been ignored for too long, and parents should pay better attention to their children's restroom habits so early interventions are possible.
Early signs of the conditions include burning sensations, frequent peeing and peeing very little each time, and cloudy urine. Son said these conditions are difficult to spot in infants, so parents need to be alert to fever and digestive disorders. They should consult a doctor if an infant refuses to be fed or does not gain weight for some time. They also need to check diapers often to change them once the babies pee.
Girls are at higher risk of the infections due to shorter urinary tracts and because their urethral opening is closer to the anus.
Thus they need to be instructed to keep their private parts clean every time they use the restroom, and to clean them from the urethral opening back to the anus to limit E.coli entrance, Son said.
The doctor also said the authorities need to make sure there are enough clean toilets at schools and other public places. He said a failure to do this will affect the health of the nation's population, especially children.
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