‘Something’s Not Right:’ Mom Seeks Answers for Daughter’s Potty Problems
By Tim Barker, Editorial Contributor
The first sign that something wasn’t right with Zoë Graham was the toddler’s curious potty-training habit of announcing a need to go – only to reveal shortly after that the urge had passed.
Later, Zoë began experiencing pain in her left side. The irritation would come and go – often with a month or so passing between episodes, says her mother, Teresa Graham. The family lives in the Hillsborough County community of Riverview.
Worried over these developments, Zoë’s parents took her to a urologist, where a sonogram revealed degeneration of the left kidney. The doctor suggested keeping an eye on it for a year. The wait-and-see strategy, however, failed to yield any improvements. In fact, the bouts of pain increased both in frequency and intensity.
Teresa and her husband, Gary, grew increasingly worried for their energetic daughter and the condition’s impact on her love of music, dancing and swimming.
“As she got older, it would happen every week. It would just hit her like a ton of bricks, and she’d be down on all fours,” says Graham. She decided it was time to seek a second opinion for her daughter, who is now 6 and in first grade. “Being a mom, you know when something’s not right.”
Looking for Answers
Desperate for an answer, the Grahams sought the advice of doctors at Orlando Health Arnold Palmer Hospital for Children in December 2020. Dr. Benjamin Rhee, a pediatric urologist, and Dr. Mark Rich, chief of pediatric urology, examined Zoë and found she had vesicoureteral reflux (VUR) – a condition that causes urine stored in the bladder to leak back into the kidneys. When functioning properly, there is essentially a check valve between the bladder and kidneys to prevent this from happening.
“If the valve mechanism isn’t what it’s supposed to be, or if the child generates a lot of pressure – voiding by not relaxing – the pressure has to go somewhere,” Dr. Rhee says. “So, it will go back up into the kidneys, which is abnormal.”
Over the years, the series of infections from Zoë’s VUR created scarring on her left kidney, preventing it from growing normally. Further complicating matters was a pelvic floor dysfunction – responsible for those instances where Zoë’s need to potty slipped away.
It’s not uncommon for young children to suppress the urge to potty by tightening their pelvic muscles. That forces the bladder to relax for a while. Sometimes, they’ll even do it subconsciously, which can create problems later when the bladder demands to be emptied.
“What happens is that when they really do need to go, they can’t relax those valve muscles,” Dr. Rhee says. “So they push, which increases the pressure. If you have a little bit of reflux like Zoë did, that reflux gets worse.”
As she got older, it would happen every week. It would just hit her like a ton of bricks, and she’d be down on all fours. Being a mom, you know when something’s not right. – Teresa Graham
Neither of Zoë’s conditions was particularly rare. The reflux, in particular, is quite common, though most children grow out of it. In Zoë’s case, Dr. Rhee recommended surgery for the reflux because of the damage already done to the left kidney.
Using a surgical robot, Dr. Rhee inserted tubes through 7mm incisions to repair the connection between the ureter and bladder. This will prevent infected urine from flowing into the kidneys and causing more damage. The minimally invasive procedure is ideal for situations where larger belly incisions would need longer recovery times and heavier use of narcotics for pain relief.
“Ninety-five percent of the kids go home the next day with nothing more than Tylenol,” Dr. Rhee says. “I can do the procedure on a Friday. They go home on Saturday. And they can be back at school on Monday.”
After trying for several years to figure out what was wrong with her daughter, Graham is happy to finally have answers.
She especially appreciates Zoë’s doctors at Orlando Health Arnold Palmer.
“They listened and didn’t think I was crazy,” Graham says.
She also was impressed by how the doctors and hospital staff handled her young daughter.
“It was amazing. There wasn’t a want or need she could dream up that they couldn’t make happen,” Graham says, recalling the morning they made a batch of custom pancakes for Zoë.
Getting Back on Track
After the successful treatment, the inquisitive child is getting back on track. Zoë, whose favorite movies include Cruella and Frozen 2, has turned her attention to gymnastics and wants to learn to play the piano.
The damaged left kidney will always be smaller than its healthier twin. And she’ll need routine monitoring throughout her life to watch for high blood pressure and other issues that scarred kidneys can cause.
“But most kids do very well,” Dr. Rhee says. “She’ll be able to have children of her own. Everything should be fine.”