16 month old having difficulty urinating

[angie3096]

My intact 16 month old son has been having fussy fits for a while; I thought it was tummy trouble. I just had his diaper off, changing him, and he had a crying episode and I realized he is having difficulty urinating. He strained and squirmed and cried and his potty came out very slowly, drip drip drip. What do I do? The logical thing would be to call the doctor but I'm afraid he would be retracted or I would be advised to circ him or something. Does this sound like a foreskin issue?

[MyBoysBlue]

Sounds like a UTI issue which has nothing to do with the forskin. But they might want to cath him so you need to watch that they don't retract him.

[angie3096]

Thanks for the reply. A UA is probably in order. Can't tell you how much I'm dreading having him cath'ed. It will be hard to find someone who knows how to do it without retracting him.

The thing is, my daughter had chronic UTIs as an infant and after a few days she would get a fever, which my son doesn't have, and also I could always tell when she had one because her pee diapers would STINK, and his don't.

My daughter also has had chronic labial adhesions which sometimes obstruct the flow of urine and I'm afraid this is a foreskin adhesion. I looked up the treatment for that and came up with circumcision. :

[tutucrazy]

It would not be likely that the foreskin is obstructing the urine this usually only happens if there is an injury to the foreskin (like forcible retraction) and the wound heals the foreskin opening shut. Here are a couple ideas.

1. It could be a UTI and he is only dripping out pee b/c he doesn't have much in there. I would not let them cath him. Do a clean catch in the morning or right when he wakes up from a nap by holding him in a squat over a container. A cath can actually cause recurrent UTI so you want to avoid that. If you can't get a clean catch try doing the bag method by placing a bag over his penis. If he doesn't have a fever I guess it isn't likely to be a bad UTI, maybe just try cranberry juice first.

2. It could also be that he has some separation going on. When this happens the urine stings the newly separated glans (head of penis). If this is happening he might be holding his urine so it does not burn and only letting a little out at a time. Sting or painful urination without other UTI symptoms is a classic example of separation. The separation trauma will also cause a little swelling to the tissue which will make the opening more narrow, temporarily.

3. Yeast infection can also cause the opening to swell resulting in these symptoms.

Don't fret. This is one of these three things and I have a feeling it is the second. My son had a painful separation episode like this that caused sting and swelling. It took about 4-5 days for the glans to smooth over, swelling to decrease, and the pain to go away.

[tutucrazy]

Here is a link where I specifically discuss this:
http://www.mothering.com/discussions...830&highlight=

Be very careful that no one tries to retract him as this can cause more trauma and result in more swelling to the tissues.

I'd keep an eye on his urination patterns by taking him potty over the sink when he wakes up and you know he has a full bladder. Turn on the faucet and the water will stimulate him to go. If he pees fine then I wouldn't worry about this being a UTI. Then it would be more likely to be separation that is stinging and making him hold it.

[eepster]

He might be constipated. When he strains and tries to poop, he squeezes his whole abdomen including his bladder. The squeezing cause a little pee to come out.

Is he making plenty of wet diapers, but not many poopy ones?

[angie3096]

Originally Posted by tutucrazy

Here is a link where I specifically discuss this:
http://www.mothering.com/discussions...830&highlight=

Be very careful that no one tries to retract him as this can cause more trauma and result in more swelling to the tissues.

I'd keep an eye on his urination patterns by taking him potty over the sink when he wakes up and you know he has a full bladder. Turn on the faucet and the water will stimulate him to go. If he pees fine then I wouldn't worry about this being a UTI. Then it would be more likely to be separation that is stinging and making him hold it.

Thanks for the input and info. I had wondered about maybe a separation issue but I thought he was too young for that. Doesn't separation start to happen around preschool age?

[angie3096]

Originally Posted by eepster

He might be constipated. When he strains and tries to poop, he squeezes his whole abdomen including his bladder. The squeezing cause a little pee to come out.

Is he making plenty of wet diapers, but not many poopy ones?

Good idea. See, I thought it was a gastrointestinal issue at first. He is pooping as often as usual but his poop is harder than normal. You may be onto something.

[MommytoB]

If you are going to have a doc to do a UA avoid catheter all together they lead to a 10% false postive anyways and they are a pain. Use a bag over the foreskin(no retraction) .

If it is definetly a possiblity that the boy is having tears under his foreskin making urine burn along it . Get him into a warm tub with espom /sitz right around the time he's going to pee because the peeing in warm water should relax him in going pee again especially without hurting.

[Yulia_R]

Originally Posted by MyBoysBlue

Sounds like a UTI issue which has nothing to do with the forskin. But they might want to cath him so you need to watch that they don't retract him.

I agree. When you have UTI you want to pee all the time even when you have just few drops in you bladder. And I'm second as far as telling them firmly to not retract if they need to cath + watching them ready to slap their hand in case they still decide to retract. I'd personally try to avoid cath-ing at any cost (even if it means changing a doctor); clean catch just as good (a doctor tapes a small bag to the penis and then you need to wait till your little one pees).

[tutucrazy]

Originally Posted by angie3096

Thanks for the input and info. I had wondered about maybe a separation issue but I thought he was too young for that. Doesn't separation start to happen around preschool age?

No my son separated at 10 months. It was a sudden separation in which all the foreskin came at once. It was very painful b/c the glans were raw. Separation does not mean retraction. Two different things. Retraction occurs after the foreskin has separated and the opening has widened. Your son can have minor separation happening and the urine is stinging so he is letting it out a little at a time to avoid the pain. I second the epsom salt bath idea. I wouldn't jump to the conclusion that he has a UTI unless he is urinating frequently and/or gets a fever.

The constipation is another idea. Give it some time, monitor the situation.