Phimosis Diagnosis and a question...

[MrsHenderson]

My 4 year old boy was just diagnosed with phimosis. I read several threads here today and got a lot of helpful information - thank you! There is one thing that I have not seen addressed so I'm asking for a little additional insight. If he does have a medical problem that is going along with the unretracted foreskin, then what do I do? My son says after he pees he "drips" and not for just a minute or too, but 10 minutes later (this has been going on for 6 weeks). He's also started urinating frequentl, like every hour or half hour (3x's this morning between waking and leaving for the doc an hour later). I took him to the doc toady because I thought maybe he had a UTI (despite having no pain). That was ruled out and the phimosis diagnosis was given. I did research on the steroid creams that have been prescribed and it seems the majority do very well with the use of the cream so I'm hoping for the best. There is no way in hell I'm going to circ this kid. Thoughts?

[vachi73]

#1, I am so glad that circ is not an option for your son! You go, mama!

#2, I think that a phimosis diagnosis in a 4 year old is questionable. Others know far more about this than I do, but how can a foreskin that is appropriately fused to the glans be diagnosed as being fused?? That makes no sense.

From what you are telling us, I think your son has normal, physiologic phimosis, NOT pathologic phimosis. IMHO, I would not treat with steroid cream, I would just leave it alone. The purpose of that cream is to help teenagers and adults achieve separation to accommodate an adult-sized erection...probably not necessary for your son, unless he wakes every morning with an erection that is painful (unlikely, and you don't mention that as an issue).

#3, the frequency of urination is of greater concern to me. I would be concerned about a UTI, too. Did the doctor test for that, or just jump on the phimosis bandwagon immediately? You said it was "ruled out" -- just checking to see if there was actually a urinalysis. Any chance he was nervous?? When I am nervous, I can urinate literally four times in an hour, and it's nothing but nerves. OK, I am reaching here, but thought I'd ask. Unlikely that a 4yo could be that nervous!

#4, the "dribbling" -- hmmm. That's a new one to me, though I find that all the males in this house, circ'd and not, seem to "dribble" all the time. From the male dog, to my circ'd DH, to all four intact DSs. I am not sure if it is a cause for concern or not, nor what the fluid actually is (urine, seminal fluid, smegma, etc.) Is it at all associated with coughing or sneezing?? (Hey, I've had four kids, I am all over stress incontinence!! It would be unusual in a child, though.) Is it possible that he has some ballooning associated with normal separation, and that a little urine is retained between the glans and foreskin and then driblles when he relaxes? I would think that is normal, not pathologic, but I'm not a urologist.

I'll be very intersted to see what others offer up as other ideas. HTH, and hang in there!

[MrsHenderson]

Thanks for the quick reply!! I love how thoughtful the moms on this board are :)

To answer your question, yes, the did a urinalysis and a UTI was ruled out.

As for the the nervousness in my child, I wouldn't classify him as nervous and nothing has changed/happened to make him a nervous child so I'm going to rule that out with regard to urination frequency.

With regard to dribbling, I have a husband (circ'd) and a 6 y.o. son (intact) and neither "dribbles". And no, his dribbling is not related to coughing or sneezing. I was waiting it out to see if it was a technique thing, but it has continued now for 6 weeks.

We do have a large jacuzzi tub that the kids take bubble baths in almost daily so the redness at the tip of his penis may have to do with that... and maybe the other symptoms? 

Honestly, this doc was in and out quick. She asked me what was going on, inspected my sons penis quickly (without trying to retract the foreskin unnecessarily, or I would have thwacked her!), told me her diagnosis (phimosis), explained it in a sentence, wrote the scrip, didn't ask me if I had any questions and left the room. I had to chase her down to ask her if this would stop the dribbling to which she replied, "Yes." Ah, medicine in America.

So, there's some additional info. Looking forward to more insight. I don't want to use the cream, but if it will help "loosen up" the skin and stop the dribbling, maybe this is not that big of a deal. At least she didn't start talking about circumcision, that would have had me fuming!

[Galatea]

I see people of two opinions on the steroid cream.  One, that it is not necessary, and just to wait for normal full retraction.  Another, that if using the cream prevents an unsure parent from circumcising, then good.  Personally, I would avoid the steroid cream b/c it is not necessary for what is likely a temporary laundry issue.  Could it be that your son's foreskin has not fully separated yet, so that there are pockets of separation and pockets that are still adhered, and the urine takes a bit longer to work its way out of the pockets?  If so, that is normal for the foreskin to not separate all at once, but it will.  Perhaps you could teach him to sort of pinch the foreskin out after urinating from the shaft down to the tip to squeeze the pee out.

Also, bubble baths are bad for everyone's genitals, boy or girl.  Plain water is best.  For the dribbling, perhaps some padded trainer underwear?

[MrsHenderson]

Loving all the advice - thanks! I examined both boys penis' tonight and they look exactly the same! My older son is 6.5. I am beginning to think there is nothing wrong and that it is just a matter of technique after urinating. His undies are never wet so I'm not even sure what he's talking about. We had a talk about it tonight and I'll show him again in the morning. Hopefully that will do the trick. Haven't filled the prescription yet. Def. thinking I need a new pediatrician!

[eepster]

Excessive urination is one of the first symptoms of diabetes.  Your Dr needs to test his blood sugar, and I'm very surprised she didn't do it right away.

The dribbling could also be a symptom of constipation.

Not being retractable at 4 yo is normal, not pathological, and requires no treatment.  Dribbling isn't a symptom of phimosis.

[MrsHenderson]

Originally Posted by eepster 

Excessive urination is one of the first symptoms of diabetes.  Your Dr needs to test his blood sugar, and I'm very surprised she didn't do it right away.

The dribbling could also be a symptom of constipation.

Not being retractable at 4 yo is normal, not pathological, and requires no treatment.  Dribbling isn't a symptom of phimosis.

Hmmmm... no diabetes in the family, but I will call the doc tomorrow. 

Have not heard this... "The dribbling could also be a symptom of constipation."  Is that true?

I totally agree with your last sentence :-)

THX!

[MCatLvrMom2A&X]

If he is starting the retraction process then that can cause ballooning where urine goes under the foreskin and makes it puff outward. The urine could get trapped in there and continue to run out for a bit after. If that is the case then simply taking toilet paper and squeezing the penis will push the urine out.

I cant think of anything else that might be causing the dribbling.

Like others have said at his age phimosis isnt a diagnosis it is how he should be. True phimosis cannot be diagnosed until well into puberty. I wouldnt use the cream because it is a steroid and because once you stop it if his body isnt ready for retraction it will go back to being non retractable.

[myfairbabies]

Originally Posted by MrsHenderson 

Loving all the advice - thanks! I examined both boys penis' tonight and they look exactly the same! My older son is 6.5. I am beginning to think there is nothing wrong and that it is just a matter of technique after urinating. His undies are never wet so I'm not even sure what he's talking about. We had a talk about it tonight and I'll show him again in the morning. Hopefully that will do the trick. Haven't filled the prescription yet. Def. thinking I need a new pediatrician!

So, his undies are never wet, and it sounds like you are saying you've never seen the "dribbling", correct? I don't think there is anything wrong, maybe he is getting erections or something else is going on and he doesn't know how else to describe what he is feeling. Does he pee a lot each time or is it just a tiny bit? For diabetes, he would probably be drinking a lot more and peeing a lot more, sudden bed wetting is also common.

[littlemizflava]

i see the dribbling in my ds4 he dont shake or wait he pees and runs off so it is still dripping a little. for the record he is not retractable at all. if i took him to the dr i bet i would have the same diagnosis  for my ds. trust me when i say that a tight foreskin is not a problem to worry about. if he is having problems retracting when he is a older teen then that would be the time for him to do the streching and maybe the cream. as a child and a young teen i would not worry unless he is having pain.

[A&A]

It can take up to age 17 for some boys to be fully retractable.  I would NOT use the steroid cream....I think that's totally inappropriate for a 4 year old.  I'd contact Marilyn Milos of NoCirc (she's a very friendly nurse and intactivist.)

[MrsHenderson]

Unbelievable that this is the state of medical care in this country. I didn't want to take him to the doctor, but he wants the dribbling to stop and he kind of insisted (I think he thinks doctors fix everything). I've not seen the dribbling, his undies aren't we, my gut is saying (was saying) it's a technique thing. As for qty., he doesn't pee a lot when he pees... I'll give it another few days with his new technique and see if things improve. 

[eepster]

If it isn't a lot volume wise, then probably no diabetes.  I would still want to check into it, though since it's hard to be sure that isn't what a 4 yo meant, and it's such a simple test.

Constipation would cause dribbling from the straining, when he is trying to pass a difficult/hard bowel movement.  If he is backed up enough, it could also make him feel like he needs to pee more often b/c the full colon is putting pressure on the bladder (kind of like when one is pregnant.)

[buckeyedoc]

My 6-year-old has a long, apparently non-retractable foreskin. I would not worry about that and would not accept a diagnosis of phimosis (at least not pathologic phimosis) and would try to avoid the steroid cream in fear of it allowing adhesions to form later.

Is the dribbling just because he has a little separation underneath, so urine accumulates and trickles out for a few minutes?

If he had a urinalysis, urine glucose might have been checked to rule out diabetes.

[Anastasiya]

Fwiw, I just did a Google search on dribbling after peeing and the first few things that came up said it was common in kids with juvenile diabetes, like a pp said. Hopefully that's not it, though.

I'm wondering, if he drips ten minutes after a pee, how his undies aren't wet?

[MrsHenderson]

We're heading to a foreskin friendly doc today for a consult and 2nd opinion. I'll update later. 

As for the dribbling and not wet undies, this is why I agree it's probably just urine in the foreskin and it needs to be squeezed out after peeing which I've instructed my son to do. We'll see what happens over the next week.

[eepster]

Originally Posted by MrsHenderson 

We're heading to a foreskin friendly doc today for a consult and 2nd opinion. I'll update later. 

As for the dribbling and not wet undies, this is why I agree it's probably just urine in the foreskin and it needs to be squeezed out after peeing which I've instructed my son to do. We'll see what happens over the next week.

If possible, don't mentiom the phimosis dx or the px for steroids.  It's better to start with a blank slate, so s/he doesn't feel a need to go along with what the other Dr said, Drs understandably dislike contradicting each other.

[MrsHenderson]

Finally saw a "foreskin friendly" physician this morning. I've been upset all day though after he confirmed the diagnosis of phimosis. I understand WAY more now about the foreskin and how it's supposed to function after doing a lot of reading online (no thanks to these docs!). What I am confused about, and I asked the doctor about this, is how it's possible there is something "wrong" when my older son (6.5) looks exactly the same. My older son has no problems, but the younger one has the dribbling issue (which seems to be "cured" by squeezing the foreskin dry after peeing) and is still going to the bathroom more frequently than is typical of him. So I've decided to use the steroid cream and hope this loosens up the foreskin enough at the tip that his is as "normal" as my older son. The 2nd doc didn't think the steroid cream would do anything and told me not to see a urologist because they will "just want to cut it off". He said to wait a year or year and a half and then do the circumcision if my son had not retracted (which doesn't seem likely given the physical state of my 6.5 y.o.). I am so upset about all of this. I believe both my boys will eventually retract because everything I've read says that it can take into the teens for some boys. I've noticed a smegma pearl on the older boy so I think he's starting to separate. I found a more holistic doctor that I'm going to call next week just to see if I can find someone who can support my view. The more I read about circumcision, the stronger I feel about how wrong it is to ever cut off any foreskin. I am amazed at how blindly people do it ("I want him to look like me.", "I let my husband decide.") and how ignorant people are about it's value (20,000 nerve endings can't be wrong!). Ugh!

[MCatLvrMom2A&X]

I am sorry you where unable to find a Dr. to help you out. It really is awful how ignorant Dr's are on the subject. For the Dr. to tell you that he would even consider circ on a 6yo for being not retractable that right there tells you he dosnt know about the normal development of the intact penis.

If the dribbling is fixed by squeezing out the urine after going then I can about guarantee it is separation relation and nothing is wrong. Once the sphincter at the tip starts to loosing the dribbling will stop as well.

I am curious though if you realize nothing is really wrong why are you still looking for a Dr? Unless you just want who knows about the intact penis for future issues I wouldnt bother going to Dr's over this and just giving them more money to tell you things you know are not true.

About the steroid cream if you use it it might help now but once you stop if his body isnt ready to retract then it will go right back to its original state once you stop. So you will have put steroids on him for no real reason. Also with the cream it must be used along with stretching for it to work properly and I would be very uncomfortable messing with my ds's penis like that.

[myfairbabies]

Originally Posted by MCatLvrMom2A&X 

I am sorry you where unable to find a Dr. to help you out. It really is awful how ignorant Dr's are on the subject. For the Dr. to tell you that he would even consider circ on a 6yo for being not retractable that right there tells you he dosnt know about the normal development of the intact penis.

If the dribbling is fixed by squeezing out the urine after going then I can about guarantee it is separation relation and nothing is wrong. Once the sphincter at the tip starts to loosing the dribbling will stop as well.

I am curious though if you realize nothing is really wrong why are you still looking for a Dr? Unless you just want who knows about the intact penis for future issues I wouldnt bother going to Dr's over this and just giving them more money to tell you things you know are not true.

About the steroid cream if you use it it might help now but once you stop if his body isnt ready to retract then it will go right back to its original state once you stop. So you will have put steroids on him for no real reason. Also with the cream it must be used along with stretching for it to work properly and I would be very uncomfortable messing with my ds's penis like that.

I agree with everything she said. You are the mother. You know your sons are normal. Trust yourself.