Vaginal reflux in girls: dribbling after peeing

What is vaginal reflux?

In some girls, some urine enters the vagina during urination and temporarily collects there. When the girl gets up from the toilet, jumps, coughs or sneezes, this urine leaks out and wets her underwear. This is called vaginal reflux (vesicovaginal reflux, or vaginal voiding).

Despite the similar name, vaginal reflux has nothing to do with vesicoureteral reflux: the urine does not flow back to the kidneys.

Vaginal reflux is most common in young, toilet-trained girls and rare in young women. It is not life-threatening.

Why it happens

The main cause is peeing with the knees close together. When the legs are close, urine gets trapped at the vaginal opening. Factors that make it more likely are:

• being overweight,
• rushed or poor toilet habits,
• labial adhesions, meaning the inner labia are partly stuck together.

Symptoms

• underwear getting wet a few minutes after peeing, often when she gets up from the toilet,
• no other urinary symptoms (sudden urges, nighttime wetting),
• redness and soreness around the vulva, sometimes discharge and an unpleasant smell.

Tests

The diagnosis is based mainly on what you describe and on the doctor’s examination. The external genitalia often look normal. Not every girl needs an ultrasound; it is sometimes done to confirm that the urinary tract is normal and that the bladder empties fully.

Treatment: sitting the right way on the toilet

Vaginal reflux is corrected with toilet habits, not medicines. Teach your daughter to:

• sit upright on the toilet with her legs wide apart,
• rest her feet on a small step if they do not reach the floor,
• if she likes, sit backwards on the toilet facing the cistern, straddling it, which keeps the legs apart naturally,
• rock gently back and forth or cough when she has finished peeing,
• stand up, count slowly to ten, then sit down and try to pee again,
• press the tissue gently against the area between the vagina and the anus when wiping.

Drinking regularly through the day and going to the toilet on waking, before bed and every 2–3 hours also help. If she is overweight, losing weight may reduce the symptoms. A barrier cream may be prescribed for sore skin, and an estrogen cream if labial adhesions are present.

Results are usually very good, and if the leaking stops once she sits correctly, this also confirms the diagnosis. Symptoms may improve further as she grows, especially at puberty.

When to look for another cause

• If the dribbling is constant, meaning her underwear stays wet day and night even though she pees normally, this is not typical of vaginal reflux. An ectopic ureter, where a ureter opens outside the bladder, for example in the vagina or the urethra, must be ruled out; have her seen by a pediatric urologist within 1–2 weeks. This condition can be corrected with surgery.
• If there is no visible opening between the labia, she may have labial adhesions.
• If there are also sudden urges, frequent peeing or nighttime wetting, she should be assessed for daytime wetting.
• If there is fever, burning or pain, a urinary tract infection must be ruled out.