opinion? info?

[Momof2xy]

my 4.5 year old uncirc'd son has had recurrent ballanitis - 5 separate infections since july 2007. he was seen today by urology. my husband took him so all of this info is "second" hand if you will.

from what i understand, they basically said that he has a very very
small opening in his foreskin (dh understood this to mean
"abnormally small") but that it has detached from the head of his
penis so urine is getting stuck between his penis and his foreskin and
causing infections. this is also the explanation we got as to why his foreskin balloons when he pees - there is usually some delay between when he pees and when it comes out, and his foreskin balloons quite a bit. apparently, it should be retractable (not b/c of age, but some how apparently he could tell - dh didn't seem to understand this part) but said that the hole in his foreskin (you know, where urine goes out) was tight and wouldn't allow it to
retract. he said he wants to avoid circ, so he gave dh a cream to
use with ds for "several weeks to a few months" to see if it would
help - i haven't picked up said cream yet bc it's spring break and the
base pharmacy waits are over 2 hours at this point, so I figured i'd
just pick it up next week when the lines go down a bit, so i don't
know what it is. he said if we do not notice a change over the course
of several weeks to several months AND he gets another infection, that
we will need to look at circ at that time (not during the infection,
but more as a "this is what we look for to re-evaluate our current
course of treatment).

so, anyone have any idea what he's talking about? i'm kinda lost.

i would love opinions/info/advice.

thanks!

[Nandi]

Sounds like ballooning. From the resources page http://www.mothering.com/discussions....php?t=764732?

"Ballooning is a normal developmental stage and is not a cause for concern and does not require treatment, it is actually a sign that nature is doing it's job. Ballooning occurs when separation of the foreskin from the glans has started but the sphincter at the tip of the foreskin is still tight causing urine to pool under the foreskin. This is not harmful but it can be disconcerting to see it as the foreskin can balloon up quiet dramatically. It can last a short time or can come and go for months or years.

A child temporarily may report some discomfort or pain while urinating during this period. This occurs because the ballooning may tear at any residual connection to the glans. The discomfort will stop when separation is complete. The foreskin may still not be retractable at this point because the opening of the foreskin, sphincter, is still narrow. With increased growth and maturity, the ballooning will end when opening of the foreskin widens. "

Please don't circumcise him as it sounds as if he is going through the ballooning stage. Give the steroid creams a try!

[Momof2xy]

we don't want to circ him no worries there.

this has been ongoing now - we're nearly to the two year mark. we are going to try the cream, ofc. trying to figure out why he keeps getting infection after infection.

[Nandi]

Took me a while, but I found this for you.
http://www.cirp.org/library/disease/balanitis/

One of it's recommendations is good handwashing, which I was thinking as well.
It also mentions soap irritation and excessive washing as a cause. So maybe just wash his genitals in water with no soap, and consider switching the soaps you are bathing him with.

"Birley et al. documented that balanitis is associated with excessive washing of the penis, with the use of soap or other irritants, and with fungal or other infections.6 Excessive washing removes normal skin oils and causes non-specific dermatitis (NSD) which is confused with balanitis.6 If the inflammation is caused by NSD, the treatment is to stop washing with soap, apply emollients, and allow natural skin oils to return.6,13 Washing may worsen the condition."
Some mommas on here have gentle soap recommendations. Chime in mommas!

[MCatLvrMom2A&X]

Sounds like it is just seperation issues and not infections at all. http://www.mothering.com/discussions...d.php?t=764732

It is normal during the seperation process for some redness, swelling and discharge to occure and it left alone it will resolve itself in 24-48 hours

Some thoughts has he ever been retracted by you the dr's during exams or at any other time?

The natural retraction process can take years. And it is perfectly normal for the opening to stay tight even after the foreskin has released from the glans until the hormones of puberty hit.

I would NOT use any steroid cream at all on your ds. There are several reasons why once being that at his age using steroids is messing with his body two while using the cream the foreskin will open but once you stop the body takes over again and it will close right back down the way it is ment to be.

Obviously this dr is not up to date on intact care.

What was done to diagnose the infection? Was a swab taken to confirm it was indeed an infection and not just normal seperation? I urge you to do more research on the normal development of the intact penis.

If your ds has been retracted by these dr's ie if they pulled the foreskin back ANY they retracted him and this could be the cause of all his issues. Because it opens up micro tears allowing bacteria to enter and even if he didnt get an infection from the retraction it could still have caused him pain and irritation.

What kind of soap do you use? Does he sit in the bath after the soap has been used? How have you been washing his penis? Do you rinse him well after he is washed? Has he had yeast issues on his bumm in the past?

Any and all details would be helpful in figuring out what the issue is.

[eepster]

Tight sphincter and balloning are normal in a 5 yo.

Steriod creams are for teenagers and adult and need to be combined with stretching excersizes. The cream will almost certainly fail to have a lasting effect and then the Dr will recommend circ.

It is highly likely that the ballanitis is being misdiagnosed, and that something else is going on.

It might be, irratation from soap, swimming pool chemicals, bubble bath, etc. Another possibilty is that he is getting recurring yeast infections (easily treated with the same OTC stuff women use.) If anyone tries to force retarction that could cause an infection.

If these "infections" always clear up within 48 hrs, it may just be seperation trauma.

[Momof2xy]

hey guys sorry it took me so long to get back.

couple of bits of info - 2 or 3 out of the 5 infections have been confirmed w/ a swab. the first 2 or 3 they did not swap (i can't ever keep it straight -this has been going on since 7/07), so they aren't 100% confirmed, but they behaved identically, so i really do think that there were 5 infections.

as to bubble baths etc, that was the first thing we changed. he does not use soap on his penis.

this does cause him a lot of pain, and he has now asked repeatedly for us to make his penis "like L's" (his brother) because he doesn't get infections. coincidentally, L is also circ'd (we didn't know better with him - when we knew better, we did better, obviously, since R isn't circ'd.). R knows and understands (to some extent) what circ is, and seems to think that that is the reason why "L's penis doesn't get sick like mine does" - it just makes me feel awful for him.

usually the infections last around 7-10 days with abx use (red/swollen painful for around 7-10 days with a slow resolution happening usually by day 14). usually cloudy urine accompanies these infections, although for some reason, no one has ever checked him for a UTI.

thanks again for the info and ideas. we do not want to circ him. we also want him to *stop* getting infections and to *stop* hurting .

Liv

[eepster]

With the new info, it seems likely that the problem really is recurrent UTIs, possibly caused by a defect.

Contrary to what is often claimed being intact does not cause the infections that are common in intact boys with these conditions, but being intact does make the symptoms more obvious (circ'd boys with the same defect simply don't get dx till they are older and don't start treatment as early since they are asymptomatic.)

[MCatLvrMom2A&X]

:

[eepster]

OK, now I'm doubly annoyed at the urologist. He gave you bad info about a normal foreskin, and didn't address the possibility of recurring UTI in a boy and ignored that it usually is a symptom of a defect in the urinary tract.

You definitely need a new urologist.

[InDaPhunk]

USAF spouse here. Are you seeing base or civilian drs for all this? So far our experiences with military drs regarding intact penises have varied from somewhat knowledgable to fairly clueless (these are typical base pediatricians, not specialists, just routine WBVs- which we stopped going to at about 12-15 months), though not as awful as some of the reports of civilian drs I've read about here and heard about IRL. In any case, the dr sounds quite ill informed. Where in Alaska are you stationed? Maybe you could get a DOC Dr. (Doctors Opposed to Circumcision) to consult. If it weren't for the cultured infections I'd say that it was a case of misdiagnosis of yeast/bacterial infections (wrong abx for strain of bacteria, did they culture for exact bacterial type or just for infection in general?), but if so many infections were cultured positively then you probably need to consider UTI infections which means you needs a really good urologist (and in any case either way, it doesn't have shite to do with DS's foreskin, it might be a reflux issue). Good for you for leaving him intact! FWIW, we're friends with 5 other USAF families that left their DC's body parts alone. GL to your DS, keep us updated.

[robertandenith]

Also, please make sure his immune system is strong and able to fight infections. Make him eat tons of vitamin c foods and get some echinacea herbs for kids it comes in a dropper - echinacea can only be taken when there is a sign of infection or illness. Probiotics are also a must, they have been used to prevent urogenital tract infection and kids needs about 10 billion beneficial bacteria in their gut daily.

If you want to try some chewable vitamin c until it clears, you can do that too! Give him 1,000 mg every 4 hours or so. But if he eats the whole foods (which I prefer) is even better.