HELP! huge swollen foreskin on 22 month old

[lari]

Yesterday morning DS foreskin started to look red and swollen. It got progressively worse during the day and by the afternoon I could tell it hurt him. He cried when I wiped him, grabbed at his diaper and was very clingy (not like him at all) He went on the potty a little and it didn't seem to hurt him to pee, because he didn't wince in pain or anything. I figured I'd take a wait and see approach, but this AM it was HUGE and angry and red. the tip part is swollen too. It looks horrible and he's definitely in pain. I'm making an appt with the pedi when they open this AM but I'm worried about how they are going to examine him and what I need to know or do. Any ideas on what this is? DH is circ'd so he didn't have any suggestions. Please help. I'm worried and I don't know enough to speak strongly to the pedi when we go. I don't know how knowledgable our pedi is on uncirc'd children because 95% of parents circ here.

[PuppyFluffer]

The issue is not to inflict damage to his foreskin by retracting it. The foreskin and the penis are connected by a layer of connective tissue (much like your fingernails are to the ends of the fingers). That layer gradually separates over time and the foreskin becomed able to slide back and expose the glans (head) of the penis. There is no reason to force this exposure as it tears the genital tissue and creates an opportunity for infection.
Just make sure the doctor does not push the foreskin back. State that you do not consent to his foreskin being retracted AT ALL before the diaper/underwear comes off.

[So-Called]

I agree, there's no reason to retract, and more than that it shouldn't be done. It will only hurt him, and probably make the problem worse.

My son has never had anything like this, but I've heard of it happening when the foreskin gets scratched or abraded (often from overzealous self-exploration) and the wound gets infected. Even a tiny break in the skin you wouldn't otherwise pay much attention to can be the culprit, considering the area. Yeast might also be a possibility.

Obviously, your son's discomfort indicates that some kind of treatment is needed, but nothing you describe sounds any kind of indication for circumcision or retraction of the foreskin. If there's any kind of discharge, it's a relatively simple matter to swab the tip of the foreskin for a culture. It's very important to differentiate between a bacterial infection and yeast, since treating him for an infection when he has yeast would only make it worse, and treating him for yeast when he has an infection would be ineffective at best.

Good luck! Just remember, swab only the tip for yeast or infection, and if they insist on a urine sample (even though this doesn't sound like a UTI at all), they can put a collection bag on him for that. There is no need for them to retract, so simply refuse if it's brought up. The aforementioned measures should be all that's necessary to get a preliminary answer and point you to the right treatment. Hope your LO feels better very soon.

[eepster]

Don't let the Dr try to retract or suggest a catheter (to get a urine sample.)

It is probably just him having an especially herd time with normal separation, but it might be an infection. If it is an infection, it could be either a yeast infection or a bacterial one. Since treating with antibiotics will make a yeast infection worse, it should be swabbed to see what it is. The swab should just be rubbed on tip and outside. Do not let them try to insert the swab under the foreskin.

If they suggest neosporin (polysporin,) do not use it. It has a high incidence of causing reactions on extra-sensitive genital tissue.

[kcparker]

Consider too: how much foreskin does your guy have?

You know what, my son has had a number of these episodes, often the result of a night of heavy peeing in his diaper (even though we rouse him for a midnight pee, he can still pee very concentrated urine while everyone is sleeping, and even a double-stuffed pocket diaper doesn't totally wick away all the moisture). He has what I believe is a longer than average foreskin, so there's a lot of loose tissue that extends beyond his glans (he will kill me for revealing this when he is older). DH is intact, but his foreskin is significantly different than what DS1 has (he will kill me for revealing this now), and I had sort of trusted him to take care of the "man stuff," but apparently that hasn't happened.

I was so hyper-paranoid about NOT EVER RETRACTING DS1's foreskin that I would not even touch it for fear of hurting him. He has had four or five of these incidents that get so bad that he gets blisters (definitely a "Mommy, you suck" moment), and my husband actually mused that maybe we didn't do him any favors by leaving him intact. I finally learned from a lovely PA that it is okay to pull all that extra skin back enough to rinse it with water and then dry it with a cotton swab or q-tip, and it is okay to tell my son to pull it back when he is peeing so that it isn't holding extra urine/moisture in there. So, do not be as shy as I was about gentle manipulation of the foreskin to make sure that it is getting cleaned and dried.

My understanding is that for bacterial infections, if you have some bacitracin type ointment, you could put it on there, and for yeast a monistat type cream is recommended. Iif he's potty learning, you can let him run around with no pants on. Dryness and lots of liquids so his urine doesn't get too concentrated are the key to fixing this, I think.

[MCatLvrMom2A&X]

When my ds's did that at about your ds's age it was a bacterial infection due to him playing with it with dirty hands. Totally my fault he had been outside and I brought him in for a diaper change and didnt stop him from playing or wash his hands.

Ds's swelled 3 times the normal size if not more. It was almost as large as his wrist

I have to say I do not agree with the PA at all on putting a q tip in there or pushing back the "extra" foreskin. I see to much opportunity to cause damage and I do not like the idea of messing with my kids genitals that much. The foreskin like the vagina is made to be self cleaning no extra work needed.

And a big huge to what everyone else said about not allowing retraction. A swab should be taken of the foreskin tip to see what if anything is growing there since it could be yeast or bacterial.

[kcparker]

It's not putting a q-tip IN there, it is gently moving that extra skin a little ways up so that it is over the glans instead of hanging down in front of it. My son's foreskin hangs down about a centimeter beyond the tip of the glans, like if the foreskin is a turtleneck sweater, maybe most boys' glanses are inside the turtleneck part, but my son's is totally behind it, if that makes sense. So, I think that for my son, that extra flesh retains moisture and provides a harbor for bacteria, and it tends to get red and swollen a lot. It's like a tube of flesh that extends well beyond the tip of the penis, and we are NOT trying to expose the glans at all. I understand that the foreskin is likely still at least partially adhered to the glans. If you have other suggestions for how to keep it from getting red and infected, bring 'em on. DS bathes regularly, we don't soap it, I never even touched it most of the time, being so concerned about not retracting, but this has only bought my poor son a red, sometimes blistered foreskin, so I think we have to do something differently.

[lari]

Thank you so much for the reassurance ladies. Not exactly a great way to start an intro on a board, but I have heard enough about this board elsewhere to know I would get some wonderful help. I took him in and they rx'd an antifungal and an antibiotic. the Dr didn't try at all to retract and didn't swab him either, but he seemed pretty concerned and wants us to come back later today again to see how it's doing. That definitely worries me. He's diaper free right now and napping. I'll update later today.

[MyBoysBlue]

Originally Posted by MCatLvrMom2A&X

I have to say I do not agree with the PA at all on putting a q tip in there or pushing back the "extra" foreskin. I see to much opportunity to cause damage and I do not like the idea of messing with my kids genitals that much. The foreskin like the vagina is made to be self cleaning no extra work needed.

I too don't agree. My son also has quite a bit of overhanging foreskin, at least a cm also. I have never retracted it ever and I have never actually washed him other then putting him in bath water. I don't even soap him up, except his hair. Just water. He has only ever had a bit of swelling once when he was not quite 3 that lasted a few days and we just put him in the bath with some baking soda in the water and watched it to make sure it didn't get worse. It was already back to normal on the third day. He does now balloon a bit when he pees which is normal. I believe it was just part of the separation process. He just turned 4 now and hasn't had an other episodes. My 9 year old who I never retracted either, also with a bit longer foreskin, never had even a single episode of swelling and is retractable.

Added: Red and blistering makes me think of yeast. You need to look at diet and yeast cream. Not more or different ways of cleaning.

[kcparker]

So, is it normal for older boys whose foreskins are deadhered to pull the foreskin back when they pee?

[Super~Single~Mama]

When you say that you were too shy about cleaning that you didn't clean his penis EVER, or that you just didn't touch the foreskin?

I ALWAYS make sure that I use a baby wipe (or washcloth) to clean my ds's penis - never pulling the foreskin back EVER, but always making sure to get poop and pee off of it (and yes, there has been poop on my ds's penis before).

I would NOT put a q-tip in there at all!!! Getting little bits of cotton trapped in there would be awful. You ds pulling it back is totally fine, b/c he knows how far to pull it without hurting himself, but I wouldn't be putting ANYTHING in his foreskin, or manipulating it at all myself. My ds was cathed once, and I made sure that they only manipulated enough to be able to visualize his urethra (I practically held the nurses hand in place so she wouldn't retract - they thought I was CRAZY! But they were respectful, so it is what it is.).

Anyway, no more q-tips would be my advice.

[Mackenzie]

Originally Posted by kcparker

So, is it normal for older boys whose foreskins are deadhered to pull the foreskin back when they pee?

My sons don't. They both just wash in the shower. My ex (intact) said that he didn't start pulling back to pee until he was older and things...filled out more, making it almost effortless.

[MyBoysBlue]

My boys don't pull it back but DH does. It's just a personal preference. Little boys don't really care if they dribble a bit. Pee is sterile and the foreskin gets rinse out every time they pee. DH even tells me about how in the survival courses he took they talked about how to just hold the end of the foreskin and pee a bit to rinse it out. Gross but this was more of a no water hypothetical situation.

[MCatLvrMom2A&X]

Originally Posted by lari

Thank you so much for the reassurance ladies. Not exactly a great way to start an intro on a board, but I have heard enough about this board elsewhere to know I would get some wonderful help. I took him in and they rx'd an antifungal and an antibiotic. the Dr didn't try at all to retract and didn't swab him either, but he seemed pretty concerned and wants us to come back later today again to see how it's doing. That definitely worries me. He's diaper free right now and napping. I'll update later today.

As long as your ds is urinating I dont see why he would want him back. I fear that you may be going to hear circ talk in your near future because of this. I could be totally wrong about that though but it concerns me they want to see him back that soon (for fear they will try to scare you not that your ds is in danger). As swollen as my ds was he could still pee just fine and the Dr. never said a word about bringing him back. The thing about prescribing both the antifungal and antibiotic is that there is no way to know which is helping or if the antibiotic is irritating a yeast infection. I would pick one to use preferably the antifungal first and see if you see improvement then move onto the abx if not. That is my personal opinion.

[MCatLvrMom2A&X]

Originally Posted by kcparker

So, is it normal for older boys whose foreskins are deadhered to pull the foreskin back when they pee?

From what I have seen here from posts by intact men or their spouses it is personal preference whether to retract or not to use the bathroom. Some find it easier some do not. Some spray without it some do not so it is an individual thing.

[MCatLvrMom2A&X]

Originally Posted by kcparker

It's not putting a q-tip IN there, it is gently moving that extra skin a little ways up so that it is over the glans instead of hanging down in front of it. My son's foreskin hangs down about a centimeter beyond the tip of the glans, like if the foreskin is a turtleneck sweater, maybe most boys' glanses are inside the turtleneck part, but my son's is totally behind it, if that makes sense. So, I think that for my son, that extra flesh retains moisture and provides a harbor for bacteria, and it tends to get red and swollen a lot. It's like a tube of flesh that extends well beyond the tip of the penis, and we are NOT trying to expose the glans at all. I understand that the foreskin is likely still at least partially adhered to the glans. If you have other suggestions for how to keep it from getting red and infected, bring 'em on. DS bathes regularly, we don't soap it, I never even touched it most of the time, being so concerned about not retracting, but this has only bought my poor son a red, sometimes blistered foreskin, so I think we have to do something differently.

Ah I see what you mean now but I still wouldnt do it. Like pp mentioned blisters usually go along with yeast. I would use monistate if it happens again and see if it helps. Red tip of the foreskin is pretty normal really. My ds who is fair skinned has one a lot actually but it isnt irritated just red. I have noticed the older he gets the redder the tip gets from time to time.

Not saying your ds dosnt have issues other than normal redness just pointing out it can be normal.

The things the foreskin stays moist on the inside because like the vagina it is an internal mucous membrane so trying to keep it dry isnt going to work unless you really dry him out which is not good for his bodies flora.

[eepster]

Originally Posted by lari

I took him in and they rx'd an antifungal and an antibiotic. the Dr didn't try at all to retract and didn't swab him either, but he seemed pretty concerned and wants us to come back later today again to see how it's doing.

Unless the antifungal is meant to be prophylactic (I would not use anything strong enough for an rx with out very good cause,) then you would not combine it with an antibiotic. If it is a fungal infection, all you need is OTC monistat cream, and taking an antibiotic will make it worse.

If it truly is an infection, then it isn't going to get better in a couple of hours. Unless there is a major change (fever for example) I see no reason to see the Dr again so soon, unless you can talk him into doing the swab.

The Dr did check the base of the penis to make sure there wasn't a hair wrapped around it, yes?

[Mackenzie]

Originally Posted by kcparker

It's not putting a q-tip IN there, it is gently moving that extra skin a little ways up so that it is over the glans instead of hanging down in front of it. My son's foreskin hangs down about a centimeter beyond the tip of the glans, like if the foreskin is a turtleneck sweater, maybe most boys' glanses are inside the turtleneck part, but my son's is totally behind it, if that makes sense. So, I think that for my son, that extra flesh retains moisture and provides a harbor for bacteria, and it tends to get red and swollen a lot. It's like a tube of flesh that extends well beyond the tip of the penis, and we are NOT trying to expose the glans at all. I understand that the foreskin is likely still at least partially adhered to the glans. If you have other suggestions for how to keep it from getting red and infected, bring 'em on. DS bathes regularly, we don't soap it, I never even touched it most of the time, being so concerned about not retracting, but this has only bought my poor son a red, sometimes blistered foreskin, so I think we have to do something differently.

My older son's is long like that and I would be (well, would have been as he is 10 now and I really no longer have anything to do with his penis) very uncomfortable doing that... He was red sometimes, mostly from playing with it but we never had any real problems other than a freak accident involving a bathing suit...

[kcparker]

@Lari - sorry for hijacking your thread. I hope this is helpful for you too.

Originally Posted by thyra

When you say that you were too shy about cleaning that you didn't clean his penis EVER, or that you just didn't touch the foreskin?

When he wakes up with a heavy diaper, we do a sitz bath with baking soda, and he takes baths at night if he gets dirty playing during the day. But if you aren't supposed to manipulate the foreskin or use soap, I don't know what more cleaning we could be doing. I don't use soap on his penis, and when I do clean it, it has been using a with a downward wiping motion, not pushing up, and being very ginger with the foreskin. DS is basically potty-trained, so cleaning it during the day isonly an occasional issue, and he has thankfully not been pooping his pants for a looong time now. The episodes of redness didn't start until he was over 2 years old either. As a baby, he never had trouble like this.

So, y'all are of the opinion that drying out is not necessary. Hmm, now I return to being confused. What is up with him getting all red and puffy so often then? Just red is not so disturbing as the puffiness and blistering and him saying that his penis hurts when he wakes up in the morning. MCatLvr, I will try giving him probiotics and see if that helps matters.

[MCatLvrMom2A&X]

There is definitely something going on if he is having issues that often. It is so hard to figure things out sometimes. Could he be having issues with the diaper itself or maybe something is making his urine more acidic than it should be. I hope you get it figured out.