21mo DS's foreskin is tight, now swollen, he wakes up screaming and had balanitis (now cured). Any advice?

[schroedingersdodo]

My 21mo DS wakes up screaming, as if in pain. I take his nappy off and then he pees (a lot) and stops crying. It's not UTI. What can it be? Has any of you any had this problem or have any idea of what to do?

A little bit of background:

1. when I was pregnant one scan showed some dilation in the tubes (wrong word, I guess) to the kidneys. He had 2 weeks of antibiotics after birth and a couple of scans, one at 2 weeks, other after 6 months, and then as everything was normal he was discharged.

2. He has always been a bad sleeper, waking up crying many times a night (or during the nap) since he was 4 months old. We never managed to find out why. He's had antacid (ranitidine), gaviscon, paracetamol, etc. Nothing solved the problem. A couple of times he would wake up crying, and then pee, and calm down.

3. about a month ago, when I was cleaning his penis, some whitish thing started to come out of it (I thought it was pus but apparently it was smegma). His foresking was very tight. Suddenly the skin came off and it bled. I took him to A&E and they diagnosed mild balanitis. He's had a urine test and there was no UTI.

Doctor told me to pull the foreskin back 4 times a day and use fusidic acid in the area. For the first days it was painful but after a while he stopped complaining when we were cleaning it. And then, for the first time in almost 2 years, he slept for the whole night!! It may be a coincidence, of course, but I was intrigued.

4. now the foreskin is tight again - not as much as before, but I can't pull it back (one side is tighter than the other). One side of the glans is swollen, with apparently some white stuff in it. I can't open the skin to see what is it, and he doesn't like it I fiddle with it (painful?). In the last week he's been waking up apparently in pain, and when I take his nappy off he pees and seems to feel better.

What the heck is going on??

I know we are advised to leave the foreskin alone, but in this case there is a problem, he's had an infection (and maybe another one on the way?) and I don't know what to do about it. I'm taking him to the GP, but honestly I have more hope of getting help here than with the (mostly clueless) gp.

Thanks! (and thanks for reading it all!)

Try hv? Sometimes they know more than the gp with babies and toddlers. I would definitely push for answers though, obviously something is wrong. If not happy with the gp's answers ask for a second opinion or to be referred on, maybe to a urologist.

HV told me I had to do controlled crying! I was so angry as she clearly had no idea what was wrong but kept repeating that leaving him to cry was the solution.

I would ask your GP for a referral to discuss circumcision. There is an alternative "stretching" operation that can be done, short of circumcision, but that can be discussed with the consultant.

Pull forwards not back and swish on plain water in bath. At 21 months it may just be it's not ready to go back yet and has got irritated. If he's ok when he pees it's almost certainly ok.

If not settling head to hv or gp

Ask for a referal. Ds had this and the consultant gave me steroid cream to stretch it. It helped relieve the pain and stretched the foreskin slightly.
In the end ds had to be circumcised but nhs would not do it under the age of 4. It was painful for him but has sorted him out. He is now 15 and perfectly fine.

If you go for circumcision be warned that you may spend a lot of time informing people it's a medical reason.

People can be very judgy. It's was still worth it though.

Dances what do you mean by pulling the skin forward? (how can I describe it? You mean pulling and stretching the skin to make the penis look "longer"? :) )

Oldlady and Theone I don't want him to be circumcised, at least not unless it's absolutely necessary. (I had no idea NHS wouldn't do it until 4. Why would that be?)

A steroid/hormonal cream worked wonders to loosen my son's foreskin - paed cons surgeon prescribed this. Drs need to know if the penis "balloons" ie wee goes under the skin and then out when weeing and what the spray looks like eg one stream or more than one stream. Circumcision is not usually the first treatment suggested. Yes pull and wiggle gently! Dads can offer advice!

We had four years of steroid cream first. They like to wait because up until that age it can still be corrected with the cream which is preferable as the operation is quite painful.

Ds could wee fine but he did balloon and you had to wait for it to all dribble out. The problem was with repeated infection due to retained urine.

If you ask to see the consultant and they tell you that all is well then you've not lost anything. On the other hand they may prescribe something that can help and therefore avoid an operation.

I can't see any balooning, the wee seems to go out in a nice single stream.

DH is helping a lot with all that, as DS is my first child and I never in my life had to deal with a penis on that level of detail ;) I don't know exactly how the whole thing works...

And what about the pain? Is it possible that he is feeling pain when he wees? Or having any difficulty to make the urine go out?

It does seem that the pain comes when he needs to wee rather than during or after. That may be an entirely different thing and I don't really know anything about it. Sorry.

I would still go to a consultant about his foreskin though.

This may be a stupid question but are you sure the white is not remnants of nappy cream. It can be hard to clean off.

Sorry. Just reread your op. What I'd smegma?

*is

Sorry tired now.

In your shoes, I would go back to the GP to discuss the latest symptoms and request a referral (perhaps to same team who saw him as a baby) for a complete plumbing check.

I would choose circumcision over repeated bouts of balanitis, and I believe NHS will carry it out at any age if medically indicated.

Theone smegma is that substance thing that accumulates in the folds of the penis if it's not cleaned. It can accumulate in the vagina as well. I've read it's perfectly clean and sterile, but have also heard it can cause infection. I think it's a mix of sweat, skin, etc... (a bit bleurgh...)

Definitely it wasn't nappy cream - I nearly don't use any, and it was a LOT of the thing (and it had a different texture)

Edith a plumbing check is a good idea, I have no clue if the pain to wee is related to the foreskin or the kidneys...

So far it was just one bout of balanitis, I hope he doesn't have many more...

I so wish DS could tell me what is going on! He still doesn't talk, and even if he could I doubt a toddler would be able to explain much...

DH had balanitis then a really tight foreskin as an adult. Tried the steroid cream but it didn't work. Didn't want to circumcise due to the risk of reduced sensation even though it was the option most likely to be successful. Went for a 'z' shaped cut instead, can't remember what it was called. It worked a treat. Anyway, just fyi!

Thanks Fullofregrets

When is your next gp appointment? Let us know how you get on?

mrsrisotto thanks, it is reassuring!

My gp is fully booked for weeks, so i'll try an emergency appointment tomorrow or baby clinic thursday. (hopefully yomorrow).

Will report back after seeing the doctor :)

Yes, pull forwards to make foreskin look longer under bathwater and clean that way. It's how we recommended to clean them in little lads with balanitis when I worked at a kids' hospital. It's often just not ready to retract yet.

I've never hear of that, dances but I think it's worth a try. Thanks!

We've been to the GP today, he said DS's willy is in fact a bit swollen and prescribed an antifungal cream to use 2 times a day for a week. He'll refer us to a pediatric urologist, which I think is good. And DS will have a urine test.

What should I ask the urologist?

PS: Thanks for your help, by the way :)

I'm glad he's going to be seen. I don't know what you should ask but write everything down in chronological order so you don't forget anything or get muddled.

My Mum told me that my brother was circumcised as a baby as he was born with a tight foreskin. He cried non-stop until he was 9 months old, then had the op and became a happy little boy. My Mum had taken him to see the (male) GP continuously but he just thought she was a neurotic first time Mum.

Make sure you get referred and keep badgering them until it gets fixed. Poor baby must be in a lot of pain poor thing. There may be loads of other treatments before circumcision is suggested, but if it comes down to it, you need to do what is right for your child.

Best of luck. xx

TheOne I'll write everything down (problem is, I always feel like a crazy first time mum doing that - not that I'm not one...)

ReadySteady oh your poor brother... Some doctors think "babies cry": no, they don't, unless there's something wrong! The fact that we can't find out what it is doesn't make it less wrong!

Fortunately, DS very rarely cried (and has been like that since birth). I think that's why I'm so intrigued about these crying wakings...

I write stuff down and I have 3dcs! :) It runs in the family here too. Ds, his dad and ds's grandad have all been circumcised for medical reasons.

TheOne thanks for the reassurance, I'll overcome my embarassment and pop up with a few sheets of notes.

(DS's grandad had a similar problem, and he took a lot of care to avoid circumcision in DH. So, I'm not exactly surprised with it all. Hopefully we won't have any more infections and we'll be able to wait for the skin to get less tight by itself)