Vaginal reflux in children

This leaflet aims to provide you with information on the symptoms and treatment of vaginal reflux in children.

What is vaginal reflux?

Vaginal reflux, also called ‘vesicovaginal reflux’ is a problem related to the way urine (wee) is passed. During the passage of urine some of the urine backflows into the vagina and then leaks back out later. Vaginal reflux is therefore a cause of wetting as the retained urine within the vagina leaks out when the child stands up, jumps, coughs or sneezes later.

Vaginal reflux can be diagnosed by a medical professional taking a history and on examination.

Labial fusion (a common occurrence in young girls where the labia are temporarily joined – see below), obesity and poor toileting habits can make vaginal reflux worse.

Symptoms of vaginal reflux

The signs of vaginal reflux are:

• wetness or dampness is noticed on your child’s clothing after they use the toilet
• vulvovaginitis, which is redness and pain around the vulval region
• vaginal discharge
• an offensive smell from around the vaginal region

The exterior genitals may have a normal appearance but in some girls the labia (inner vaginal lips) are partially fused together (called ‘labial adhesions’). In this instance the external genitalia may be inflamed due to irritation caused by urine being temporarily trapped.

How is vaginal reflux treated/ managed?

There are several ways in which a child can be helped to manage vaginal reflux. These are:

• If labial adhesions are present, some oestrogen-based cream may be prescribed to help increase the rate of their division.
• Sitting on the toilet with knees wide apart. Many young girls sit with their knees together when they pass urine, but this can cause ineffective bladder emptying and worsen vaginal reflux. It is therefore important that girls are encouraged to sit in an upright position on the toilet with their legs wide apart. If your child is unable to sit on the toilet with her feet flat on the floor, she will require a footstool to support her feet.
• Sitting on the toilet backwards, so your child is facing the cistern in a straddling position when passing urine can also help girls to empty the bladder/ vagina more effectively.
• Rocking – after finishing passing urine your child should be encouraged to rock backwards and forwards on the toilet to help encourage any collected urine to drain better.
• Wiping – as well as ensuring they wipe from front to back, a child should also be encouraged to gently press on the perineum when wiping after having passed urine to help absorb any urine that may have collected in the vagina.
• Coughing – Some children can find it useful to cough after passing urine to dislodge any urine that may have collected in the vagina.
• Double voiding – once your child has passed urine, she should be encouraged to stand up and then slowly count to ten before trying again to void (wee). This promotes more effective bladder emptying.
• Weight loss – vaginal reflux has been found to be more common in girls who are overweight, so it may be helpful to consider weight reduction efforts where appropriate.
• Skin protectant creams can be helpful if the genital area has become sore.

Will vaginal reflux improve/ symptoms disappear?

Vaginal reflux, and associated wetting, can be managed and improved by following the advice described above. As children grow and develop their anatomy changes, especially during puberty, and as such symptoms may also improve with time.

What else can I do to help?

Alongside implementation of the advice above, it is important that your child has a good fluid intake, taking drinks regularly throughout the day with the aim of passing clear (rather than yellow) urine.

Regularly passing urine is also important in maintaining bladder health. Urination should always take place on waking and before bed and should be planned for every two to three hours throughout the day.

Contact for further information / queries

Clinical nurse specialist team for paediatric urology
Monday to Friday 08:00 (8am) to 18:00 (6pm) 01223 586973