Summertime is upon us once again. Children will be spending countless hours by the pool, at the beach, or swimming in lakes and rivers across the country. It is also time to be on the lookout for problems that may arise from such water activities.
Melissa is a healthy 4 year old who is brought to the office by her mom because she thinks that Melissa has a urinary tract infection. For the past three days, she has complained of pain when she urinates. Although there has been no fever, and she has not acted particularly ill, it has gotten to the point that she "holds it" because she is afraid it will hurt to void. Mom did notice some vaginal redness over the past day or two, but she did not see any discharge or notice any bedwetting at night. Melissa did not have a fever, and her blood pressure was normal. Her exam was perfectly normal with the exception of some redness in the vaginal area. There was no suprapubic tenderness nor any flank tenderness...typical findings of a urinary tract infection. I obtained a urinalysis in the office, and it too, was normal. I then directed my questioning to Melissa’s activities during the previous days. I was not surprised to find that since pre-school let out for summer, Melissa and her brother have virtually lived by the swimming pool. Mom said that she is in a bathing suit from morning until late afternoon. She and her brother would swim, get out of the pool and run around and play, swim again, then come in for lunch and play, and then swim again. This happened all day long. As it turned out, Melissa did NOT have a urinary tract infection, rather, she had vaginitis--inflammation of the vaginal area from the constant wetness and drying of the bathing suit, and the friction from running around in the suit. This macerates and irritates the sensitive vaginal skin and surrounding structures. This is what caused her discomfort every time she would urinate.
The treatment in Melissa’s case was quite simple. I instructed mom to give her a sitz bath twice a day for a couple of days. Mom was to fill the bathtub with warm water and let Melissa soak in the tub for 7-10 minutes each time (to soak only, not bathe with soap). Afterwards she was to dry her very well in the vaginal area, and then apply a thin layer of over the counter antibiotic ointment. This relieved the redness and inflammation as well as her symptoms within 24 hours. Most importantly, I told mom to get a spare swimsuit for Melissa. Every time she got out of the pool, she was to take off the wet suit and put on the dry spare one while allowing the wet one to dry. This did the trick as Melissa did not have a recurrence the rest of the summer.
Bob is a 5th grader who couldn’t wait for summer vacation to arrive as he was looking forward to being back in Junior Lifeguards. This would be his third summer in the program. I had to stop by the office early one morning on my way to the hospital to make rounds. When I pulled into the parking lot (which I expected to be empty), I was surprised to see a car parked there. As I approached the car, both doors simultaneously opened and mom and Bob got out in unison. Mom apologized for "just showing up", but was relieved that someone was there to see Bob. It seems that he was up all night with an earache. That explained why he was holding a hot water bottle to the side of his face. When we went into the office, I took his temperature which was normal, and he had no symptoms of an upper respiratory tract infection. When I went to look in the ear that was bothering him, he would barely let me get near it because it was so sensitive. He flinched as I tried to put the ear speculum in the ear. I managed to get a good look at the ear drum and it looked completely normal. I did a tympanogram (which measures the status of the middle ear) and it too, was normal. What was striking however, was the swelling and redness of the ear canal leading up to the drum. It was angry and red. Bob had an outer ear infection, a so-called swimmers ear infection. When I told this to mom, she thought for a moment and said, "Now that you mention it, I think he had this a couple of times last summer". I looked at Bob’s chart and found that he actually had it 3 times last summer.
The infection was treated with antibiotic drops and it cleared-up right away. Because of the recurrent nature of this problem, and Bob’s passion for the water, I thought it was wise to try to prevent this from happening again. I told mom about three different drops that she could put in Bob’s ears when he gets out of the water...two drops in each ear. She could choose from an over the counter preparation (Swim Ear) that could be found at any pharmacy or major market, use plain rubbing alcohol, or make a concoction of equal parts of vinegar and water. She opted for the over the counter drops and Bob did not have another problem with swimmers ear again.