Phimosis in toddler

[hm1610]

Hi all, my son, 3 years old has been suffering for around 3 weeks now which has eventually been diagnosed as phimosis. To begin with it was suspected UTI and a course of antibiotics completed, no improvement and then balanitis diagnosed so a second lot of antibiotics completed. STILL no improvement so it would now appear to be phimosis. He has been prescribed a steroid cream to be applied daily after bathing and I've to try and retract foreskin afterwards, this is for 3 months. He has been referred to surgeon however how long is a piece of string.... looking for advice and experiences as he's still ballooning and in a lot of pain when urinating each time. Thank you in advance... he had just nailed toilet training so this is a major set back as he now doesn't have full control of his bladder. - worried first time mum!

Poor wee boy, and poor you. Our son had this and it sorted itself out quite quickly after his foreskin was retracted by the doctor during the consultation. I think the steroid cream and gentle daily retraction during bathing (I think doing it in warm water won't hurt as much) will soon remedy the problem. Good luck. Our son had no further problems, and surgery wasn't needed.

@thisgardenlife

Thank you so much for replying. I have and will continue to do this daily. When I'm retracing though I can't get any further than his 'pee hole' sorry don't know medical term. He complains of pain each time he urinates and it balloons to around 3 x normal size. I'm worried about him returning to nursery after the holidays as ideally he will need someone to support him at the toilet due to the pain although I've asked multiple times I've only been advised to use calpol & nurofen

Personally I'd be looking into getting him circumcised. He can't be taking pain killers every time he wees, poor love. I know circumcision has a bad reputation these days , but this condition needs treatment and at 3 he'd get a good result and a quick recovery.

@ShippingNews

Personally I'd be looking into getting him circumcised. He can't be taking pain killers every time he wees, poor love. I know circumcision has a bad reputation these days , but this condition needs treatment and at 3 he'd get a good result and a quick recovery.

Thank you, yes he is on the waiting list to see the surgeon but again how long is a piece of string. In the last 2 weeks we have been to out of hours twice and hospital twice but yet to meet actual surgeon! We are in Scotland and the surgeon is based in Edinburgh and only does 1 day a week at our local hospital so need to await appointment coming through. Its just so frustrating as a parent as I feel he's been misdiagnosed twice and received 2 lots of antibiotics that were never going to help however we are where we are. I was just looking for some experiences and advice :-(

Did the doctor retract your son's foreskin, or just recommend you do it?

The reason I ask is that I remember the doctor doing it very firmly, but but very quickly, so it was over in moments. I was so surprised at the time, but once retracted it was clear it could be done, so I never had to force it.

I'm generally against circumcision but if it is recommended on medical grounds I would consider it if the problem doesn't resolve naturally.

Hi I have done some Paeds surgery . Phimosis often ressolved spontaneously. My own son had as a toddler and it’s no longer an issue.
This however does sound a real problem and needs urgent review. I wonder if you could offer to take him to the central hub to be seen in an earlier clinic. Phone the consultant secretary to offer this option. If the diagnosis is a very tight foreskin ( phimosis) then a circumcision could be performed. It is straightforward in a you d child but does involve a GA.

@thisgardenlife

Did the doctor retract your son's foreskin, or just recommend you do it?

The reason I ask is that I remember the doctor doing it very firmly, but but very quickly, so it was over in moments. I was so surprised at the time, but once retracted it was clear it could be done, so I never had to force it.

I'm generally against circumcision but if it is recommended on medical grounds I would consider it if the problem doesn't resolve naturally.

So it was originally the nurse practitioner at out of hours that first mentioned phimosis. I assumed it was a UTI. Further doctors since then have looked but probably not retracted as much as they are expecting me to. They are communicating with surgeon who is the 'expert' via email. So he's never been seen to date by a specialist which is where my frustration lies as this has been going on for around 3 weeks now with no prior issues. We will now have to wait for appt with specialist but I just feel so helpless in the meantime when he is complaining of pain every time he passes urine and I can see for myself that the swelling isn't improving. Thank you for taking the time to reply I really appreciate it.

If you are trying to retract the foreskin he needs to be in the warm bath but I suspect if very tight as this sounds it will be impossible. Did the doctor actually manage to retract it?

@olympicsrock

If you are trying to retract the foreskin he needs to be in the warm bath but I suspect if very tight as this sounds it will be impossible. Did the doctor actually manage to retract it?

No one had managed to restract past where he urinates. He doesn't appear to be in pain when I or anyone else dose this but it physically doesn't go any further and he is still in pain every time he urinates. However in saying that none of the doctors we have seen are urologists as the paed urologist only does 1 clinic a week at our local hospital (dundee) at which we are awaiting an appt for. I just feel that he shouldn't need to be in this pain for so long?

If circumcision is the resolution I'm not against it at all. I just want what's best for my son and for him to not be in pain. It would just appear that we need to wait until a specialist appt is available and I'm just frustrated that I don't know what to do in the meantime? We've spent around 5 days in the last 2 weeks being assessed by different doctors who said they need to just refer him to specialist. He's absolutely fine otherwise but when passing urine he asks me to sit with him and is visibly in pain which is hard to watch. He is also having frequent accidents which isn't like him. I suppose I'm maybe looking for advise on whether I should push this further even though we were given steroid cream for 3 months? I just feel helpless and want to take his pain away. I also worry about him returning to nursery? I own a nursery and i wouldn't expect my staff to support a child in so much pain without any medical training.

Yes - push this further and see the specialist - see if you can explain the situation to the secretary who could alert the specialist about the issue?.

I think it is a problem if he is in this much pain to urinate. My son has a phimosis that hasn’t resolved, but it is non painful. The pain may be infection on top - Could be UTI but could also be balanitis.

My son had this issue from a few months old, as he got older he would grow out of it for a while but it came back by the time he was 4. His dad had the same when he was a child and had the surgery when he was about 3. He had recurring infections, he had steroid cream and nothing helped but they were reluctant to operate as ‘its a last resort etc etc’. It got increasingly worse and I really felt that no one was listening, we ended up in a&e one night and it was really traumatic (will spare the details). They couldnt operate at that point because of infection and they then put him on the waiting list and it would be at least 6 months. So they wanted to leave him 6 months screaming in pain everytime he needed to wee. We went private and had it done very quickly but we very much felt we had no choice. Operation went fine and he’s been fine since.
I should add that some of the reluctance to operate was because he is autistic, although in reality this wasnt an issue at all, but it also just felt like every Dr was saying that children should grow out of it.
I know every situation is different but if I could go bavk in time I would have made sure he had the operation much earlier, it would have saved a lot of trauma for him (& us!). Like you, we just wanted him to be comfortable and if that involved surgery then we weren’t against it at all.
Good luck.

I meant to start a new paragraph after saying his dad had the surgery at about 3. After that poont i’m talking sbout my son not his dad.

Thank you so much to everyone for sharing your experiences.

It's been really helpful!

@sazza76

My son had this issue from a few months old, as he got older he would grow out of it for a while but it came back by the time he was 4. His dad had the same when he was a child and had the surgery when he was about 3. He had recurring infections, he had steroid cream and nothing helped but they were reluctant to operate as ‘its a last resort etc etc’. It got increasingly worse and I really felt that no one was listening, we ended up in a&e one night and it was really traumatic (will spare the details). They couldnt operate at that point because of infection and they then put him on the waiting list and it would be at least 6 months. So they wanted to leave him 6 months screaming in pain everytime he needed to wee. We went private and had it done very quickly but we very much felt we had no choice. Operation went fine and he’s been fine since. I should add that some of the reluctance to operate was because he is autistic, although in reality this wasnt an issue at all, but it also just felt like every Dr was saying that children should grow out of it. I know every situation is different but if I could go bavk in time I would have made sure he had the operation much earlier, it would have saved a lot of trauma for him (& us!). Like you, we just wanted him to be comfortable and if that involved surgery then we weren’t against it at all. Good luck.

Do you mind me asking how much going private cost?

My son had this. Retracting the foreskin just didnt work. he had a procedure under (useless) local anaesthetic where the doctor rammed what looked like a crochet hook down there during a routine appointment. We were not expecting it. It really hurt and frightened my poor liitle boy, he was about 7 I think. And it didnt make any difference.

Eventually he was medically circumcised at 10.

Incidentally, in case anyone wants to use this as evidence that ritual circumcisions at birth are justified, our consultant surgeon told us that he spends most of his time repairing botched ritual circumcisions that were done shortly after birth. So many men and boys grow up with injuries, disfigurements and the inability to pee properly or perform sexually normally because of them.

As for the circumcision, he was in and out as a day patient, it was done privately under GA. He was VERY sore for a few days afterwards and a bit delicate for a couple of weeks, but it was totally worth it.

How is your boy now did you get to see a specialist? If so did resolve his phimosis without having to circumcise him?

Just an update for anyone interested, have been using steroid cream for 2 of the 3 months prescribed now. Son was in a lot of pain when passing urine again last week and swelling has never reduced. Called GP who escalated referral to surgeon and now have a pre assessment appt scheduled for mid March. Fingers crossed for a resolution whether that be surgery or not🤞 I've noticed today particularly as he was at work with me (private nursery, he's 3 years old) he was continuously touching that area throughout the day although saying he didn't need the toilet. He's fully toilet trained day and night.

@fhtshop

How is your boy now did you get to see a specialist? If so did resolve his phimosis without having to circumcise him?

Apologies I have just seen your comment. I have posted my update, are you experiencing similar? If so please PM me and hopefully we can support each other. I will update this thread though with any updates on our situation.

Hi,

How is your son now?

I came across your chat whilst searching for my son. He is in a similar situation. 21 months old and the last few weeks been tugging at his nappy while looking in discomfort and saying "pee pee" we took him private and the urologist diagnosed him with phimosis and provided the steroid cream to apply. It has been a week however yesterday we took him into a&e as he is not doing wet nappies. He went over 16 hours without doing one so the doctor placed a syringe in the tip of his penis with some sort of gel which instantly made him urinate. We were advised to continue to use the cream and will meet back with the urologist in 6 weeks but i am just worried that he is in discomfort while trying to pee. Its so scary when they are so young ☹️

@Mano2020

Hi,

How is your son now?

I came across your chat whilst searching for my son. He is in a similar situation. 21 months old and the last few weeks been tugging at his nappy while looking in discomfort and saying "pee pee" we took him private and the urologist diagnosed him with phimosis and provided the steroid cream to apply. It has been a week however yesterday we took him into a&e as he is not doing wet nappies. He went over 16 hours without doing one so the doctor placed a syringe in the tip of his penis with some sort of gel which instantly made him urinate. We were advised to continue to use the cream and will meet back with the urologist in 6 weeks but i am just worried that he is in discomfort while trying to pee. Its so scary when they are so young ☹️

Apologies I just seen this.

We seen the surgeon a week ago today who finally diagnosed with 'BXO' and confirmed that while the steroid cream may make him a little more comfortable it would never resolve the issue as its due to scar tissue and the only resolution is circumcision that she wanted to do sooner rather than later.

She was quite surprised as apparently the youngest case she had ever seen was on a 5 year old.

I had a call from the waiting list dept at hospital today and he is scheduled for surgery on April 7th so although im gutted as very much expected surgery as last resort I'm also really happy at how quickly it has been dealt with.

Wishing him all the best. Hope the surgery goes well and he recovers well and fast. We are still on the steroid cream. Seeing the Urologist again in 6 weeks so will see what he says then. Thanks

@Mano2020

Wishing him all the best. Hope the surgery goes well and he recovers well and fast. We are still on the steroid cream. Seeing the Urologist again in 6 weeks so will see what he says then. Thanks

Thank you. Wishing you all the best too and I'll update after surgery :-)

Apologies for the (very) late response. Son had circumcision in April and issues immediately resolved. He has since had his first follow up appointment where all went well, surgeon was happy with outcome. She did however say that after this procedure it can be common for pee hole to narrow so to be on watch for any struggles. Next follow up will be via telephone rather than in person. Happy for anyone to message with any queries :-)