Help PLEASE forcible retraction at ER

[tribalmax]

Hi ladies,

I am just to upset right now to go into many details. The short version is that my 16 month old son had been fussy for a few days, occasionally crying and pulling at his genitalia. He is uncircumcised.

Last night, I noticed some light pink in his diaper where his penis would have been. I thought it might just be marker or crayon from our earlier art project (that had gotten on his hand and wiped on the diaper somehow). So I decided to watch him carefully.

He was very fussy, waking up crying. He nursed ALL night long -- and drank lots of water.

In the morning when he woke up, his diaper was totally dry. He had not urinated at all. We waited until about 15 hours after the last time he had urinated and then took him to the ER. By this time, he was crying and holding his crotch.

When we got there, they said he had adhesions that were blocking the flow of urine. They did an ultrasound to confirm that he had urine in his bladder.

I know that no one is supposed to retract the foreskin. I know that. I went into the ER visit assuming I would have to fight for this. But was not prepared to have the doctor tell me the adhesions were blocking the flow of urine.

So I allowed them to retract the foreskin slightly -- and he was able to urinate -- so it seemed to solve the problem.

Anyway -- now I don't know what to do. They told me to retract 3 X a day w/Vaseline or the adhesions will grow back.

What do I do??

Please -- I feel just devastated about this. I need information. Any advice is welcomed...

Rachel

[MCatLvrMom2A&X]

I suppose it is possible he cut his foreskin and it caused the foreskin to adhere to the opening but I just cant imagine it.

Without seeing your ds I am just guessing here. Did they check him at all for a UTI? Was his foreskin swollen at all? He could have just been dehydrated causing him not to go so long.

The pink in the diaper is often a sign of dehyrdration.

When they pulled on his foreskin did it make a sore spot anywhere?

Sometimes when the retraction process starts it burns for them to urinate that may have caused him to hold his urine.

As many details and you can provide will be helpful. Anything you can think of.

[glongley]

I don't really buy the "adhesions blocking the flow of urine" thing in the sense of the foreskin actually growing over the urinary opening, as I have heard some doctors scare some parents. My guess is that very very occasionally a foreskin will get stuck to itself or aligned with the head of the penis in such a way that it prevents the pressure of the urine from opening it up for normal urination. Obviously, a kid's got to pee, so the slight manipulation that you describe seems reasonable. Although I also think that perhaps a warm tub soak might have loosened things up in a similar way.

It sounds from your description that the manipulation of the foreskin was not forcible or traumatic. But on the other hand, if the foreskin was torn away from the glans at all, there is the chance that it could grow back together with scar tissue, which is why they recommended the vaseline, etc. There is disagreement about the need for this however. You might want to read this article about forcible foreskin retraction and aftercare.
http://www.kindredmedia.com.au/libra...ractions/401/1

Hopefully some others will have some other thoughts. Sorry you all had to go through this.

Gillian

[tribalmax]

OK -- a few things. I don't think he was dehydrated yesterday (before we saw the pink in the diaper). He had been eating, drinking and nursing all day.

He was also not dehydrated at the ER -- the ultrasound showed lots of urine in his bladder.

He has no UTI -- we tested for that at ER.

They retracted the foreskin ever so slightly -- and urine came out -- kind of in a spurt.

My question now is if I need to retract 3 X a day like they said -- it seems horrible to do this -- but after the retraction has been done once -- most of what I read talks about scar tissue forming..

So what I need help with now is what to do after the retraction.

[tribalmax]

And yes, the retraction was violent -- he bled. It was more horrible than you could imagine..

[l_olive]

Oh geez, I'm so sorry.

But I don't have a clue what to say. I also can't imagine that his foreskin was actually blocking him from peeing somehow, but from your post it seems that you believe that was indeed the case. Has he been able to pass urine without you having to manipulate his foreskin today? If so, I would just be leaving it alone, honestly. But I'm not sure what I'd do if he seemed unable to urinate at all without his foreskin being retracted. I hope someone has more answers for you -- if he truly can't void his bladder without help, then this seems more unusual than what we hear in this forum sometimes.

[MCatLvrMom2A&X]

This is actually the first time I have heard this here in the 5 years I have been posting on this forum. Gental movement of the foreskin isnt going to cause issues. But what happened to him in the ER might cause scare tissue to build up. I dont see any problem with applying some sort of diaper cream to the tip of the foreskin if you are very gentle.

I actually think you should get some OTC bacatracin ointment to apply until the trauma heals from the forced retraction in the ER just as a precaution since the hospital is a great place to pick up germs.

The pain of the retraction might have actually caused him to urinate all by itself. So I still am not convinced that the retraction allowed him to urinate.

Severe pain can and will cause release of the bladder so it could have just been a coincidence.

But just because I have never heard of anything like this dosnt mean it isnt possible. But I just cant see the foreskin healing over the urethra like that to begin with.

[tribalmax]

Yea, I am skeptical as well.

I feel horrible. I feel like I didn't protect my son from this.

But it sounded reasonable at the time -- what she said was that the adhesions had formed tightly around the urethra -- blocking or limiting the flow of urine.

Does that make more sense? One theory was that he had pulled at himself too hard (and he has been really tugging on his penis in the last month) -- had accomplished some retraction -- but that this had healed more tightly causing the blockage of urine??

I don't know what to think...

[MCatLvrMom2A&X]

I can sorta see that happening but I would think the flow of urine would have prevented it from healing wrong. I am at a loss on this one all I can do is guess.

I would do the bacatracin until the damage the ER dr did heals. It will also help things not "stick" together that shouldnt as well. I wouldnt retract to do it I would just put a big blob on the very tip at every diaper change. Right now messing with things is going to increase the risk of scare tissue.

I am sorry you and your ds are going through this and I wish I could be more helpful.

[vachi73]

Wow!

I am so sorry to hear your story!! I wish there were something I could offer to console you.

It does strike me that this had a somewhat "sudden onset" - adhesions would take more than a few hours to develop ... and it sounds like you are describing something that came on within, say worst case, 12 hours. It's not impossible that they were building up slowly over time, but it just seems kinda sudden to be adhesions from playing with himself.

I can only imagine how horrible it was for you in the ER. I agree with PP that using an antibiotic cream/ointment is a good idea.

Hang in there.

[latinalonestar]

There is no way that his foreskin was blocking his urine, this just doesn't happen unless someone has forcibly retracted him causing a wound to close up.

My guess is that he was holding his urine b/c either there is some soreness due to normal separation or b/c he has a uti. Or perhaps he was NOT holding his urine, he might have just peed b/c they were manipulating his penis. By forcibly retracting him they actually only made it more likely that his foreskin opening will become scared. You have to understand that most American doctors don't know about foreskin so they automatically see "problems" where non exist. They also tend to blame everything on the foreskin. My guess is they did not even catch any of his urine to culture.

At this point the worst thing you could do is to try to retract him and cause further damage to the opening. Remember the opening is very narrow (as it should be) so forcible retraction causes tears. My advice is to gently apply bacitracin ointment to the opening where he could have a wound. He is going to have some soreness now that he was forcibly retracted, especially when he urinates. The urine will burn his freshly separated glands for about 3-4 days until the wound heals. You can put him in water to urinate if it is very painful. My son had premature separation due to forcible retraction and it took about 4 days for him to heal to where he would not scream while urinating. Just do the best you can to comfort him and ride it out.

If you ever suspect he is holding urine, take his diaper off immediately after a nap or when he wakes up and hold him under the legs (face out like a squat) and have him urinate. You can do a clean catch this way if you ever suspect a UTI. Just pick up a cup at the doctors. Or you can bag his penis to do a clean catch.

DON'T go to the ER unless your baby is in a very serious condition. Never let anyone manipulate his foreskin again. Make sure all baby sitters know that they are NOT to touch his foreskin. We have had several moms find out that their child was being retracted at daycare.

(hugs)

Btw, he is probably teething and this causes him to drink less, thus pee less. When kids are sick or not feeling well they nurse but don't necessarily drink the milk (using the nipple as more of a pacifier), thus they don't urinate as much.

[TCA2008]

call Marilyn Milos,RN at 415-488-9883. She is the executive director of NOCIRC and she is extremely knowledgeable and helpful with concerns like this.

[tribalmax]

Thanks for the advice.

I have found an intact friendly urologist that I am going to try to get in touch with tomorrow -- as well as the RN someone mentioned.

I appreciate the ideas...

Just to clarify, he did not have a UTI. Also, he was not dehydrated -- as he had been nursing like crazy and drinking several cups full of water (1 during the night, and an entire cup the afternoon/evening prior).

So something was blocking his ability to urinate -- I do believe this. I don't know what it was -- but he was holding his groin and screaming before we took him to the ER.

[latinalonestar]

Originally Posted by tribalmax

Thanks for the advice.

I have found an intact friendly urologist that I am going to try to get in touch with tomorrow -- as well as the RN someone mentioned.

I appreciate the ideas...

Just to clarify, he did not have a UTI. Also, he was not dehydrated -- as he had been nursing like crazy and drinking several cups full of water (1 during the night, and an entire cup the afternoon/evening prior).

So something was blocking his ability to urinate -- I do believe this. I don't know what it was -- but he was holding his groin and screaming before we took him to the ER.

When my son was experiencing premature separation he was SCREAMING while urinating. It was the most I had ever seen him cry!!! The urine on the raw, freshly separated glands is very painful when it happens all at once. I bet this is what is happening. I put an anti-inflammatory cream on it and gave him infant motrin for about 4 days. My son had some swelling too so we also used an anti-biotic ointment with the other cream. After four days the pain had subsided but it took him a bit to gain the confidence to urinate. This all happened b/c my son had been manipulated months prior by a doctor. You should be sure that no one is doing this to your son. If the foreskin is manipulated and some of the natural adhesions break it will cause urine to sting the glands until the skin on the glands heals.

Be VERY careful with a urologist. They are extremely dangerous to an intact boy. Remember they are surgeons. If your son is urinating, I'd give it a few days to see if it gets better before rushing him off to another doctor. Further manipulation is not the answer here, bottom line, so be firm with any other doctors that see your son.

[latinalonestar]

Please read though this thread so you can go through my experience. I have a strong feeling this is what is happening:

http://www.mothering.com/discussions...853&highlight=

Only difference is my son was only 10.5 month so he wasn't yet able to hold back his urine or have the understanding that he could hold it. Your son is older so he if probably holding it to avoid the pain.

The anti-inflammatory cream was really great for us during this time b/c it allowed the opening to widen until the glands had healed. The cream we used is called desonide .05% It is good for a short-term treatment like this. We stopped the cream after 7 days.

[jaidymama]

Hey-

First of all,

Secondly, please remember he may heal just fine. None of the articles said the damage is guaranteed or permanent. You say they only retracted his foreskin slightly, so maybe the damage is only slight. I would steer clear of retracting it as prescribed; seems like more retracting may cause more damage.

How's he doing now? has he peed? Have sitz baths helped comfort him?

Sounds like you have some other resources lined up to consult with, hope that goes well for you.

[l_olive]

Checking in to see how the little guy and his mama are doing today.

[foreskin friendly]

During surgery, when my son was 2 yrs, the doctor who told us he wouldn't even touch my DS's penis (because it was a "non-issue" when we addressed concerns over his genital integrity during the consult for a hernia repair)...
actually went ahead and forcibly and surgically retracted him ANYWAY.

Your first post said it was slightly, then one of your follow-up posts said it was horrible. So I am not sure of the degree of force/retraction that occured with your son...

I thought at the time I was going crazy with all of the emotions I was dealing with-I thought I did everything I needed to as well, to protect my son, the doctor just plainly LIED to me and DP (and afterward, never mentioned ANYTHING about what he did until we were almost home, I did a diaper change, and realized, then called him-he claimed his reasons were "phimosis"-impossible to diagnose on a 2 yr old!!!...)... my son was sore and screaming bloody murder when he urinated for about 3-4 days....but ever since then has been scarred to go to anyone with the title "Dr.".

Well, I talked to Marilyn Milos, David Llewellyn, and John Geisheker...some of the big players in the intactivist movement and they gave me advice that intuitively I knew was right. I put GOBS of vaseline on the tip of DS's penis (as it warms, gets very thin and would move around on its own), so that he didn't need to be retracted (as the so-called-surgeon advised during that call...)... my son did have some resulting iatrogenic adhesions, but they resolved on their own over the past two years. ALthough he does, however, have a build up of scare-tissue on the underside, the frenulum...

But keep in mind, and not to scare YOU, but when you go to the urologist, follow that deep gut feeling you have. DO NOT, no matter how gentle he seems, or how confident he portrays himself to you that he knows best, under no circumstances should you let him retract your son at all. I would preface your visit with those expectations CLEARLY.

YOU shouldn't be retracting your son at all...put whatever ointment you decide on (I would personally just use vaseline) liberally...it will work its way around.

Previous posters have talked about seperation trauma here...so you know for future ref (if your son's case was only slight retraction, and not a full retraction {my son was not even slightly retractable...and came home to us fully retractable...the surface of his glans and the circumferential underside of his foreskin was all red, raw and bloody-thank goodness I noticed it when he was still under the effects of anesthetic from the surgery!)...your son may still have seperation in the future-keep that in mind....

and lastly... little boys like to tug at and play with their penises (at least the intact boys I've witnessed, the circ'd boys-not so much it seems)...this is perfectly normal (and beneficial to help with the natural seperation process), so unless he is in pain (in the future), don't discourage it or get too worried that's somethings wrong if he's playing with his business...totally normal!!!

I hope he is doing better (use the warm baths for him to urinate in also-or if he is agreeable...he might find it amusing or like it , try holding (firmly-he is kind of young at may topple it...) a warm cup of water and have him put his penis in it...that may immediately induce an urge to pee and also won't burn as much if he does it in the water...

[jeliphish]

Originally Posted by tribalmax

So something was blocking his ability to urinate -- I do believe this. I don't know what it was -- but he was holding his groin and screaming before we took him to the ER.

He may have pulled on himself toooo hard causing the original adheasion? This is the only thing that comes to my mind when you say that when his urethra was unblocked he was finally able to pee. Please keep us updated

[tribalmax]

Hey guys,

Thanks so much for all of the support, stories and advice. I have a very limited time to type this -- so please excuse the brevity.

Tobin is SO much better today -- I talked to Marylin at nocirc.org last night -- very helpful, awesome lady - thanks to whoever posted her info. She didn't have any answers about the blocked urine and gave me the # of a ped. I called him at home and he was amazing. He asked if it could be a yeast infection that originally caused swelling. This totally fits because Tobin has enlarged adenoids, environmental and food allergies AND a history of sinus infections. So he has been on antibiotics more than I would have liked (Can't seem to cure the sinus infections naturally -- but that is another story).

So we treated with diflucan last night - and started the steroid cream to prevent adhesions (betamethasone). He is 10000 times better today. He fusses when he urinates, but it is nothing like what happened last night. I really think the yeast was a factor.

Thank you again -- I really needed you guys last night -- and you totally came through for me. Thank you!

Rachel