Post Micturition Convulsion Syndrome

by Manash Kr Sharma
(Tezpur,Assam India)

Pee shivers and frequent urination in my 7 months old girl worries me. Do infants with frequent urination need medical evaluation?

She passes urine 20 or more times in a day. And each time, just after she has peed, her little body jerks a few times. We noticed these after urination fit like movements sometime back. She shivers almost as if she is having a fleeting bout of chill.

What should I do?
I did consult a paediatrician, and had her Routine Urine Analysis done.
Are “pee shivers” and “frequent urination” normal in infancy?
Doctor please guide.

The Expert, Ren Chats Answers

As I understand, you have two major concerns, beyond which you have not mentioned any medical history of the 7 months old infant girl. I therefore presume that our daughter is otherwise in good health. Now let’s take one at a time.

Post Micturition Convulsion Syndrome
Micturition is the Latin word for “urination”, and the non-medical terms for the syndrome are ‘pee shivers’ and ‘shivering after urination’.

Urination in infancy is a reflex phenomenon.

The urinary bladder is a stretchable bag. As the urine collects in it, its wall stretches without a significant rise in its internal pressure. Only when the bladder is full, the stretch receptors in the bladder wall trigger off micturition reflex that sends message to the sacral region of the spinal cord (see “Reflex Arc” in illustration given above). In response, the parasympathetic sacral spinal nerves to the bladder get activated, and cause contraction of the bladder muscle and relaxation of the internal urethral sphincter. This leads to involuntary urination; a normal process in infants and toddlers.

Sudden release of urine from a full bladder gives shivers.

The sudden release of urine from a full bladder is associated with sudden change in the levels of neurotransmitters, the chemicals that bring about the transfer of the impulse to another nerve and muscle fibres. This could stir up a strange sensation that results in shivering.

The degree shivering after urination is related to the force and rapidness of voiding,

Infants void at much higher pressure as compared to older children who have adequate control over micturition. Besides, impaired coordination of bladder contractions in infancy causes considerable pressure fluctuation while voiding.

Pee-shivers are believed to be directly proportional to the fullness of the bladder.

Infants’ bladder can hold only a small quantity of urine. When measured in millilitres, irrespective of the age of the infant, the capacity of infant’s bladder is approximately 7 times the body weight in kilograms.

Post Micturition Convulsion Syndrome does not signify a movement disorder.

The shiver-like movements usually lasts for less than 10 seconds, after which the baby is absolutely fine.

Unlike jitteriness, post micturition convulsion syndrome is not the result of immature nervous system.

All infants do not have pee-shivers. On the other hand adults often experience it, particularly when they, in spite of the urge, had to hold on for considerable time.

Moreover the sensory signals from full bladder send messages to both, the sacral spinal cord and the higher control centres in the Pons and the Cerebrum. The higher control network arouses infants and toddlers on initiation of the reflex arc, but their voluntary control over micturition is not developed. It matures only at about 4 years of age.

Frequent Urination Calls for Medical Evaluation
There are several reasons for infants to pee frequently. In most cases it is just a passing phase that is normal for the age.

Serious causes are rare, and they usually present after first year of life. Those that do present in infancy are commonly accompanied by tell-tale signs and symptoms.

However, a case of more than 20 times a day is best if medically assessed.

Evaluation at doctor’s office together with urinalysis should have ruled out most common causes of frequent urination in your daughter, but you seem to be yet worried. So some basic questions need to be answered. These are:

1. Is the baby forming excessive quantity of urine?
The amount of urine baby passes each time is determined by how heavy the diapers are.

2. Why is the bladder unable to hold urine?

3. Are there any associated symptoms?

4. Is this a new development? If yes:
a.) For how long?
b.) Can it be linked with any particular event?
For example: change of daycare provider or initiation of potty training.

5. Is the baby constipated?

6. Is she drinking water or other fluids more than usual?

Some rare but worrisome causes of frequent urination during infancy:

Urinary tract infections

Female infants easily pick up infection of the lower urinary tract, whereas in boys it is usually the upper urinary tract infection which is associated with some innate deformity of the urinary tract.

An infant with urinary tract infection is in general not cheerful.

They pass small quantity of urine at short intervals, and each time they pee they suffer considerable discomfort. Those who can express themselves verbally describe it as “painful burning micturition”.

Loss of appetite and fever are common accompanying symptoms.

Their urine is not clear. It appears turbid, and at times it is even blood stained.

Inappropriate handling of diaper area

Abrasions and soreness around vaginal and urethral opening is a known cause of frequent urination. In infants this could happen either due to inadequate cleaning, or due to wiping the area with a rough cloth. Cleansing and moisturizing agents used in wet wipes may turn out to be corrosive for infants with sensitive skin. Click here for more on Cleansing Ingredients in Baby Wipes (opens new window)

Finally, watch for the possibility of molestation. It may sound absurd, but at times even infants do fall victim to sexual abuse.

Diabetes Mellitus

Type I Diabetes is very rare among infants,and its clinical presentation in them is unusual and inconsistent. This makes the diagnosis difficult. Unless we remain vigilant for the possibility of this unusual and potentially dangerous cause for the apparently innocent symptom like frequent urination diagnosis of Diabetes Mellitus in infants can be missed for a considerable time.

Diabetic babies urinate large amounts each time. They also drink a lot. Their growth suffers a setback.

Diabetes Insipidus – extremely rare in infancy

Deficiency of antidiuretic hormone or kidneys’ unresponsiveness to the hormone leads to a lot of water loss from blood in urine. Consequently these babies get very thirsty, which is expressed as unexplained fussiness, loss of appetite and fever. Their weight gain is poor and growth is delayed.

Other causes

Occasional case of “over active bladder” and “small bladder” have been reported, but cases of voiding dysfunction and frequent daytime urination syndrome are usually seen in school age kids.

Hope this helps!
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