Sore swollen penis + fever?? Help!

[BekahMomToOliver]

First off, I have to say I'm so glad I've found the wisdom of this forum! I've learned so much in one evening here What a wonderful resource!

I do have a question, though, as my son's symptoms don't quite seem to be adding up to "normal".

DS is 20 months. Intact, of course He has a typical toddler fascination with his 'dink', as he calls it, so it gets alot of pulling and tugging.

The past few days he's been complaining that his penis hurts. At first it was just after car rides, so I adjusted the straps a bit so they were a bit more forgiving in that area and it seemed to help. Then this morning, it seemed to be bothering him quite a bit despite the fact that we hadn't been near the car, and I chalked it up to his maybe pulling it a bit too roughly.

As the day wore on, tough, he came up to me several times, especially after peeing, whining about his 'dink' and wanting his diaper off. He had some diaper free time, a warm bath, and seemed okay. Then he felt a bit warm, stopped eating and wasn't himself, etc. I called the family doc, she suspects a UTI and has called in a script for antibiotics and a urine sample in the morning.

The thing is, shortly after we got that sorted, the top of his penis began to swell. It's now about 50% bigger than usual, a bit red, but you can tell it's not his foreskin swelling, it's underneath that and closer to the top. No discharge or anything. It got so tender he was walking with his legs apart, couldn't lie on his side and jolted if it was touched.

So, he's showing signs of seperation pain, right? But then why does he have a fever?
And if it's not seperation, would a UTI cause his penis itself to swell up and be tender?
He's kind of got signs of both, but I know that can't be right, can it??

Idosed him with Tylenol because he was really super uncomfortable, and the fever's gone now too. I'm nervous to take him to the hospital because I just know someone would try and retract, especially since his foreskin looks fine and you can tell it's the underneath part that's swollen.
He keeps waking up crying and shaking.
Any ideas??

[MommytoB]

Anyways, since he is almost 2 could definetly be showing signs of seperation. Do you use disposables or cloths ?

Swelling under the foreskin as in creating the foreskin to balloon ? If that's the case it definely a symptom of seperation.

Also, there are viral sickness going around so does your son have anything other than a 'fever' ,like a runny nose, stuffy nose ?

I wouldn't think seperation trauma would be related to a fever but I guess you never know since teething can be related to colds, fever, and tummy issues .

How long has he had the fever and was it before the penis pain ? If it was how long has he had the penis pain & does he still have a fever ?

[eepster]

If it was just the pain, swelling and redness, I would be inclined to think separation, but the fever is not a sign of separation it is a common sign of infection. Also, separation symptom usually (though not always) clear up in 24-48 hours.

Is it possible he was retracted by anyone? It is possible that the carseat strap caused a bit of premature retraction.

Off hand, I don't think you need the ER tonight, but if things get worse and you do take him, be very vigilant. They don't need to retract, they can do a swab on the outside. If they want a urine sample, say no to the catheter, and insist on a baggy. Make sure they don't try to retract while cleaning him to put it on. Do not trust them just b/c they say they won't retract, they normally say this about a minute before they decide to retract. If he does need a catheter at some point (unlikely, but good to be prepared) ask for a nurse to come down from the NICU, or one who went to nursing school in Europe (where I live there is usually at least one Irish train nurse on each ward, but it may be different where you live) or another non-circing region.

See if you can get an appointment with his pediatrician tomorrow.

In the mean time, you might want to put some Bacitracin on it. Don't use Neosporin, since many people will have reactions to it when used on mucus membrane.

[MCatLvrMom2A&X]

Sounds like a bacterial infection. It could have started out as simple seperation then him messing with it and possibly introducing bacteria has lead to an infection. Like pp said put some bacitracin on there it will help get a jump start on treatment.

I hope he feels better soon. Also here is a thread that has some suggestions on what to do to help him with the pain http://www.mothering.com/discussions...d.php?t=764732

[tutucrazy]

Sounds like it could be separation and he has a fever from some illness or cold. If there were a bacterial infection the swelling would extend up his penis and his penis would be like 3X the normal size, also the swelling and redness would get increasingly worse and eventually extend into the groin.

Ballooning and sting during urination is a common symptom of separation. This can often be confused with UTI since the urine stings the freshly separated glans. In fact for my son it was very painful. It took a week for the stinging pain to go away b/c the natural adhesions came loose all at once. We usually say that separation symptoms disappear in 48 hours, but in my son's case it was much longer. I find that the more dramatic the separation the longer it takes. Every boy is different. There was some moderate swelling and redness for my son as well.

Here is a thread I wrote about this. Pain/Sting during urination:
http://www.mothering.com/discussions...ting+urination

I have found that yeast often exaggerates separation symptoms like this. So if you son is using cloth diapers (which can harvest yeast) you might need to change him to sposies and strip the cloth diapers with vinegar and hang in direct sunlight to dry. In the link below I have great tips for treating yeast and more info about the development of the intact boy.

Normal development of intact boy:
http://www.mothering.com/discussions...893&highlight=

I'd avoid the fever reducer and see if his fever comes back before considering a larger problem. You can have a doctor culture the tip to see if there is yeast or bacteria present. Please be sure you watch the doctor like a hawk and make sure they do not try to manipulate his foreskin. Discuss this before the diaper comes off. Any yeast or bacteria will be present on the tip, there is no need to retract. Antibiotics are usually not recommended unless you have done a culture, since yeast is more common than bacterial infections. Yeast is worsened with ABX treatments and if he doesn't have yeast already the ABX can cause yeast infection.

As for the urine sample, can you get a clean catch? If not, I would take the wait and see approach. Many times intact boys have been forcibly retracted from a doc or nurse trying to put in a catheter. Most of the time these parents are told that their son won't be retracted only to have it happen. The catheter itself also increases the likelihood of introducing infection. If you can't get clean catch when he wakes up in the morning, I would advise you to wait and see what happens. If he is anything like my son these symptoms will clear in about 5 days.

[MCatLvrMom2A&X]

From the OP

It's now about 50% bigger than usual,

This tells me that his penis is double in size in that one spot that is far bigger than what you would expect to see with seperation.

That is how my ds's started and it did get more swollen over the next several hours but not every single infection will react the same way. Even though ds's penis was swollen to the size of an adult male he did not however have any swelling into his groin/fat pad/scrotal area. I am saying this because not every single case will present the same way and odds in this case are very high there was some infection involved.

It very well could have been secondary to the seperation process since there are open wounds there and kids dont always have clean hands no matter how hard we try.

[BekahMomToOliver]

Thanks everyone for your insight!
We didn't need to see an ER doctor after all, which is nice because I just KNOW it would have been a huge battle. I already remind them he's not to be retracted whenever he's seen for other things, but the doctors around here are so old-school I just know they would have insisted on catheterizing/retracting/otherwise messing around with him this time. I wouldn't have consented, of course, but it was nice not to have to even go there.
I managed to get a urine sample from him myself, so that's off to the lab. He started Amoxicillin on Friday and although things got worse before they got better, it really seems to have helped. All day Thursday and Friday he was very resistant to diapers (he's in disposables right now as he's 33+ lbs and has outgrown our entire stash ) so I just let him air it out. I put one on at night with a little bit of diaper cream to soothe it, and by morning on Saturday the swelling was pretty much gone. Fever was only in the evenings Thursday and Friday, then seemed to go. *touch wood*!
I think it's separation, at the top of his penis only. But he had no discharge, and the rest of his penis seemed normal and didn't swell at all, which seems a bit strange to me. No blood or anything either.
His penis now seems back to normal, and isn't bothering him at all today. Hopefully it stays that way!
Thanks again for all your wisdom!

[tutucrazy]

My son's penis swelled like that too when he had separation. It was like 50% larger, which I considered to be moderate swelling. This is why I tend to think it is separation which is an educated guess since I can't actually see.

The one thing I would suggest is that you make sure you get him on some probiotics. The oral antibiotic can cause a secondary yeast infection (as it does with girls). To avoid yeast infection you should use a probiotic supplement during and for at least a week after the Antibiotics. You can not give the probiotics within the same hour as you give the antibiotics. The sell some OTC or you can get a prescription.

Did they culture his penis too? If not that would have been wise. Giving Antibiotics when there is no infection is not such a good idea. This is why a culture is recommended. The culture only takes a couple days so you could discontinue the antibiotics if both the urine and penis cultures came back negative.

[LCBMAX]

A NEW SCENARIO HERE -- NOT THE OP

Hey all you experienced ladies, op, pps.... reviving this thread to see if you think my son's symptoms tonight shout separation or infection to you (he's been out of diapers for over a year now):

3 weeks ago had a single pee that hurt - no other symptoms at that time.

10 days ago had a full on niagara-like runny nose, no fever, no complaints.

3 days ago said his penis hurt, but no other complaints and nothing to see.

This morning in the car seat said his penis hurt again, belt adjustment helped.

Normal looking penis at 12:30 pee before nap.

Somewhat red and swollen penis at 2:30 pee after nap but I hardly paid attention.

Cranky as hell this afternoon.

Then at 5:30 pee a very swollen foreskin, with redness, then the penis narrows, then there is a dusky red and swollen lower third, meeting the body with normal color.

Pee has been painless so far since that one time weeks ago. No fevers so far. 

Took warm bath before bed, and slathered with miconazole (anti fungal) at bedtime.

Dosed him with a little benedryl so I could check him more carefully after sleep, and I found a pus-like drainage, about 1- 2 cc volume, minimal odor but some slight smell, not sticky. When the flow stopped, I gooped him up with antibiotic ointment to counteract the sealing that the fluid was doing at the opening - that would otherwise really hurt in the am with first pee. I know this works against the miconazole, but that just didn't have the goop factor and I don't have any other ointments at hand. (I am 100% confident that I don't have to worry about stds so the fact that this would also ruin a culture didn't stop me.) Lymph nodes in the groin are palpable, not very large, but certainly present.

We haven't given any fever/ pain reducer since I want to follow that overnight, and I'll also be checking through the night for worsening redness or swelling. So far it's really limited to the penis.

We'll be seeing our trusted pro-intactivist md in the am.

Could this really just be separation? It's sooo dramatic, and it sure looks wrong, not like a healthy process... Wish we'd taken pics. Will try in the am if it's still notable.

Thanks for any thoughts you have time to share!

[MCatLvrMom2A&X]

Separation can indeed be very dramatic but it resolves within 24-48 hours generally.

The only way to know is with a culture to see if anything grows. Usually a true infection gets worse fast with major swelling and redness with or without discharge at the start. Here is a sticky you may find helpful http://www.mothering.com/discussions/showthread.php?t=764732 it describes what to look for with both infection and separation.

You would get more responses with a new thread rather than using this old one

[LCBMAX]

Originally Posted by MCatLvrMom2A&X 

Separation can indeed be very dramatic but it resolves within 24-48 hours generally.

The only way to know is with a culture to see if anything grows. Usually a true infection gets worse fast with major swelling and redness with or without discharge at the start. Here is a sticky you may find helpful http://www.mothering.com/discussions/showthread.php?t=764732 it describes what to look for with both infection and separation.

You would get more responses with a new thread rather than using this old one

Thanks - that sticky of yours was a big help last night, I would quote reassuring bits to get myself back to sleep.

And you're right - I'll copy over to a new thread. 

I had my husband take a picture this morning mid-bath which shows things somewhat better than last night, but it seems like images are really missing from the literature - understandably. Anyway, that's something I would be willing to share with established mdc members upon request by pm - it really helps to know what someone else means by moderate or severe swelling...

OK, off to start new post - Thanks!