It's No AccidentThe following is excerpted from Dr. Hodges’ book, It’s No Accident: Breakthrough Solutions to Your Child’s Wetting, Constipation, UTIs, and Other Potty Problems.

Urine is mostly water, with a small percentage of harmless waste products. My point is: Urine should be bacteria free. But sometimes certain types of bacteria gain access to the bladder and grow in the urine. The result is a bladder infection, also known as a urinary tract infection ( UTI ).

To get a UTI, you need a source of bacteria, a pathway for this bacteria to enter the bladder and a bladder full of urine for the bacteria to grow in. UTI-causing bacteria can sometimes be found on the skin of the perineum, around your bottom, but all of these bacteria come from the stool itself. Sometimes bacteria from the stool enter the urinary tract by crawling up the skin between the anus and urethra into the bladder. There they set up shop and multiply, causing pain and irritation.

You can prevent these infections by getting rid of the source of bacteria, making the path to the bladder inhospitable or keeping the bladder empty. As I explain in this chapter, young girls typically do none of these things, which is why they are perfect candidates for UTIs.

News Release from Wake Forest Baptist Medical Center:

Researchers Identify Potential Risk Factors for Urinary Tract Infections in Young Girls

 Winston-Salem, N.C. – July 24, 2014 Young girls with an intense, red, itchy rash on their outer genital organs may be at increased risk of developing urinary tract infections (UTIs), according to new research from Wake Forest Baptist Medical Center. The treatment may be as simple as better hygiene and avoiding potential irritants such as bubble baths and swimming pools.

“Vulvitis is a common condition affecting women and girls of all ages,” said senior author Steve J. Hodges, M.D., associate professor of urology at Wake Forest Baptist.  “We found that girls with vulvitis were at least eight times more likely to have a lab-diagnosed UTI than girls without vulvitis, suggesting that vulvitis is a major contributor to UTIs in young girls.”

According to the research, which involved 101 girls who sought medical care for a possible UTI, vulvitis may cause UTIs by altering the type of bacteria normally found in the area between the vagina and anus.

Vulvitis is the most common gynecological condition in pre-menstrual girls and is the greatest reason for referral to a pediatric gynecological specialist. Because vulvitis in postmenopausal women has been shown to change the type of bacterial that binds to cells that line the vagina and increases the risk of UTIs, the scientists wondered whether there might be a link between vulvitis and UTIs in pre-menstrual girls.

Toilet trained girls between two and eight years with symptoms of UTI, such as urinary frequency, urgency, pain, hesitancy or night wetting, were enrolled in the study. The children’s urine was cultured and a “swab” from the genital area was analyzed in the lab.

More than half (57 percent) of the girls with suspected UTIs also had signs of vulvitis. The urine analyses showed that of the 101 patients, 35 percent had proven UTIs and 86 percent of those had vulvitis.

Almost eight out of 10 (79 percent) of girls with vulvitis had organisms commonly associated with UTIs, such as e-coli. Girls without vulvitis were more likely to grow bacteria not associated with UTIs.

The researchers hypothesize that the inflammation associated with vulvitis initiates the process that can lead to UTIs. Hodges said inflammation perturbs the normal bacteria in the area and may allow “competing” UTI-causing bacteria to colonize. Exposure to bubble baths, swimming pool water, urine, feces – all combined with suboptimal hygiene — contribute to a pro-inflammatory environment.

As UTI-causing organisms replicate and spread, they can ascend via the urethra to the bladder and cause a UTI.

The researchers cautioned that the study cannot conclude if vulvitis cases UTIs or vice-versa.

“However, given this association, we recommend that practitioners always assess young girls for the presence of vulvitis, and if present, work diligently with parents and patients to treat and prevent its recurrence.”

The condition is generally treated by preventing the continued irritation by using barrier creams or wipes and keeping possible irritants, such as urine, soaps/bubbles and pool water off the skin. In some cases yeast therapy or steroids are prescribed.

Hodges noted that there has previously been a lot of anecdotal evidence on pools and baths causing UTIs. “With this study, we have found a plausible cause of that relationship as irritation from certain pools or baths may increase the colonization of certain bacteria,” Hodges said.

Hodges’ co-authors on the research were Ilya Gorbachinsky, M.D., Robert Sherertz, M.D., and Gregory Russell, M.S., all with Wake Forest Baptist.

Hodges has written a book for consumers that covers this and other pediatric urology issues. “It’s No Accident: Breakthrough Solutions To Your Child’s Wetting, Constipation, UTIs, and Other Potty Problems,” published by Globe Pequot Press, will be released in early February.

Staying Clean, Dry, and Infection Free by using Dr. Soother’s Healthy Wipes;

As the above research shows, staying clean and maintaining a neutral skin pH is the key.

Here’s a little-known factoid: Menopausal women have a higher rate of UTIs than women who are actively menstruating. This is related to the pH of the vagina. When women are actively producing estrogen, the vagina is acidic, and it’s harder for UTI-causing bacteria to live there. When women are not producing estrogen, which is what happens after menopause, the pH of the vagina is neutral which allows bacteria to flourish.

As it turns out, the pH of a vagina before puberty also is neutral. This is one reason why young girls are so susceptible to UTIs. Of course you can’t go around putting girls on estrogen, which is a common treatment for menopausal women with recurrent UTIs. So how can you compensate for the pH predicament and lower a girl’s chances of getting a UTI?

You keep the skin between the anus and vagina clean and dry. At our clinic we noticed that all the girls we were seeing for recurrent UTIs had red, irritated skin along their labia majora. Most of these girls had been treated for yeast by their pediatricians, even though the redness is typically not caused by yeast. What does cause redness is voiding with the legs together, which is what girls often do.

The skin between the labia stays wet from the urine, and some of the urine enters the vagina and drips out later, keeping the vagina damp. Because urine is a skin irritant, the redness and irritation that often results is called vulvitis. In a study, our clinic evaluated the skin of fifty girls with vulvitis and fifty girls without irritation. In the children without skin irritation we tended to find typical, noninfectious skin and vaginal bugs. But in the girls with irritated skin, we almost always found E. coli or Enterococcus, the two most common UTI-causing bacteria. This is related to the pH issue. The pH of skin is supposed to be acidic but when the skin is irritated, it loses its protective acid mantle and becomes neutral, providing a pleasant pathway for bacteria from the rectum to the urethra. We call this the pH bridge.

It’s easy to tear down this pH bridge. First of all little girls should always void with their legs spread (picture sitting on the toilet backward), so the area doesn’t stay so wet. Plus they must wipe well on the inside, keeping all skin that is touching other skin clean and dry. It’s also helpful to use diaper cream overnight, either petroleum jelly or zinc oxide-based agents, or the skin may become irritated.

As a result of my clinical experience, I along with other colleagues have developed Dr. Soother’s Healthy Wipes, which contain an astringent formula that restores skin pH to counteract the effects of urine.