Circumcision and Urinary Tract Infections

Some evidence shows that circumcised boys have a lower chance of developing urinary tract infections (UTIs) in their first years of life, but the added protectionCHOC Children's Urology Center  may be miniscule, say Dr. Elias Wehbi, a CHOC Children’s pediatric urologist, and Maryellen Kelly, CHOC Children’s nurse practitioner.

Learn more about circumcision’s possible effects on UTI rates and get answers to other questions about this common ailment in the following Q & A.

Q: Does circumcision help boys reduce the risk of UTIs?
A: One study that looked at the amount and type of bacteria around the penis before and after circumcision found a significantly greater amount of bacteria under the foreskin in uncircumcised boys. These bacteria are precisely the kinds of germs that can make their way into the urinary tract and cause an infection.

Some studies show a three- to ten-fold decrease in UTI rates in circumcised boys. However, because the rates of UTIs are already relatively low in boys, that finding means 50 to 100 boys would need to be circumcised to prevent one UTI in one boy, who might not have otherwise developed an infection.

Considering this, the decision to circumcise boys should be made with both the family and the physician working closely together to evaluate all the cultural and medical issues.

Q: Are UTIs more common in boys or girls?
A: During the first year of life, boys and girls get UTIs at about the same frequency. After age 1, females are more likely to have a UTI because of the channel from their bladder to the exterior, or the urethra, is shorter. Another theory for higher risk of infections in females is that increased moist tissue and folds of females’ genitals might allow bacteria to colonize the area more easily.

Q: What symptoms could indicate a UTI?
A: Identifying a UTI in young children can be difficult because they aren’t vocal. In many infants, a high-grade fever will be their first or only symptom. Older children might complain of abdominal pain; painful urination; burning when urinating; increased frequency and urgency of urination; blood in their urine; or urinary incontinence. These symptoms are the same for boys and girls.

Q: How are UTIs treated?
A: Children with UTIs should be treated with appropriate antibiotics that are specific to the bacterium that has infected their bladder. Following treatment, parents and children should receive education about preventing infections.

Baby boys with a very tight foreskin and recurrent UTIs may be offered a circumcision or a topical steroid cream to try to loosen their foreskin so that better hygiene can be conducted to reduce their risk or a another infection.

Q: How can UTIs be prevented in children?
A: Hydration is important in preventing UTIs. All children should drink at least one 8 ounce glass of water for each year of age until they are 8. For example, a 4-year-old should drink four glasses of water daily.

We also encourage children to urinate frequently, about once every two to three hours. Holding of urine is a major risk factor for more UTIs. Bacteria in a bladder doubles in quantity every 30 minutes, so it is important children don’t hold their urine for extended time periods.

Constipation is another risk factor. Families should focus on eating high-fiber foods and drinking plenty of water to help children achieve daily soft bowel movements that will reduce their likelihood of UTIs.

Learn more about urology services at CHOC.

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