Bladder & Kidney Care

Children born with Anorectal Malformations may also have changes in how their bladder and/or kidneys function.

If a urinary tract infection (UTI) is suspected, a urine sample should be obtained promptly and sent to the laboratory without delay for bacterial culture.

Clinicians often prescribe antibiotics while awaiting culture results.

Once culture results are available, the antibiotic regimen may need adjustment to specifically target the identified organism.

Timely and appropriate management is crucial, as untreated or inadequately treated UTIs can lead to kidney damage.
It is important to keep your child’s urologist informed of every infection and its treatment to support ongoing monitoring and long-term care.

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• Children may need to pass urine very often.

• They may have accidents or leaks (urinary incontinence).

• They may have difficulty fully emptying their bladder (urinary retention).

• They may get urinary tract infections (UTIs) more often.

Challenges children may face

• Vesicoureteral Reflux (VUR): Backward flow of urine from the bladder into the ureters or kidneys, increasing the risk of UTIs and kidney damage.

• Hydronephrosis: Swelling of one or both kidneys due to urine buildup, often caused by obstruction or reflux.

• Renal Dysplasia/Hypoplasia: Kidneys that are underdeveloped or malformed, which can affect kidney function.

• Neurogenic bladder: Abnormal bladder storage or emptying caused by spinal cord malformations.

• Detrusor–sphincter dyssynergia: Poor coordination between the bladder muscle and urinary sphincter, leading to urinary retention and high bladder pressures.

• Incontinence and retention: Urinary incontinence and difficulty emptying the bladder are common, especially in children with high anorectal malformations (ARM) and associated spinal defects.

• Recurrent urinary tract infections (UTIs): Often related to incomplete bladder emptying, vesicoureteral reflux, or constipation that increases pressure on the bladder.

• High anorectal malformations: These types are more likely to involve urinary problems, such as recto–bladder neck fistulas or cloacal malformations.

• Cloacal anomalies: The urinary, genital, and rectal structures share a common channel, increasing the likelihood of urinary issues.

Helping the Bladder and Kidneys Stay Healthy

• To keep the bladder and kidneys healthy, doctors will monitor these organs regularly.

• Regular check-ups help detect any problems early, before they can cause long-term harm.

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Checks Might Include:

Blood and urine tests

Regular blood tests help doctors check how well the kidneys are filtering waste from the body.

Urine tests can show signs of infection, protein loss, or other changes that may indicate how well the bladder and kidneys are functioning.

These tests allow problems to be picked up early, even before symptoms appear.

Ultrasound of the kidneys and bladder

A gentle scan (like those done during pregnancy) to see how the kidneys and bladder look and if urine is flowing well. Ultrasound scans give a clear picture of the kidneys and bladder, showing their size, shape, and how well urine is draining.

Bladder X-ray while peeing (VCUG)

Doctors may also use other imaging tests, such as a renal scan or a voiding cystourethrogram (VCUG), when more detailed information is needed.

This shows if urine is going backwards towards the kidneys instead of out of the body.

Bladder function test (urodynamics)

Measures how much the bladder can hold and how well it empties.

Spine scan (MRI)

To check if there are any nerve or spinal cord differences that could affect bladder control.
Your child’s care team will work with you to make a plan that fits their needs.

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Care at Home:

Regular toilet breaks

Encouraging your child to pee on a set schedule, even if they don’t feel the urge, helps the bladder empty completely and reduces accidents.

Medicines to calm the bladder

If the bladder squeezes too much or too often, certain medicines can help it relax so your child can hold urine longer.

Preventing Urine Infections

Constipation can put pressure on the bladder and make infections more likely. 
Your child’s team can guide you on diet, fluids, and other ways to help.

Low‑dose antibiotics

 In some children with higher‑risk urine flow problems, a small daily antibiotic may be recommended to help prevent infections.

Clean intermittent catheterisation

 Some children need help emptying their bladder fully. 

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A thin, flexible catheter can be used a few times a day at home to drain urine safely and comfortably.

When Surgery May Help

If urine is flowing backward toward the kidneys and medicines are not enough to control it, surgery may be offered to help protect kidney health.

If the bladder is too small or holds urine at high pressure, surgery may be needed to create more space and lower pressure, helping to protect the kidneys (bladder enlargement surgery).