I'm looking for advise from those who have sons diagnosed with phimosis. I am not talking about just not being able to retract or ballooning during urination, which is normal, but the foreskin being hardened and white so that it won't retract and is painful.
My 6.5 year old has been complaining of pain during and after urination. We went to FP where urine cultures tested clear. As recommended, we used Lotrimin antifungal and boxers to treat possible yeast infection. We also take an oral probiotic, culturelle. After 2 weeks of that not working and pain worsening, we made an appointment with a pediatric urologist. He diagnosed my son with phimosis and said to try a steroid cream while gently stretching the foreskin 2 times a day for 6 weeks. If that doesn't work, he recommends circ., which we do not want to do. He said the tissue around the opening was scarred and hardened, prob from UTI (which I had never been aware of).
These are some interesting factors that makes me think there might be more to this. He used to be able to retract it, at least partially. He does not drink much, nor urinate much. We push water, but I can't always be there to remind him. I saw on nocirc.org that concentrated urine can cause phimosis. Another possiblilty is a yeast infection that can cause the hardening. I understand it can be difficult to treat. He has ADHD and sensory intergration disorder, and is on gluten-free, low sugar, low dairy diet. We use coconut oil as soap since my kids have KP and sensitive skin (they've also had ring worm). We also use Charlie's laundry soap. I mention these since they are possible irritants to cause the skin hardening.
Some of the questions I have are:
1. What can we be doing to help the pain? Drinking water does seem to help, but not always.
2. Other ways to treat phimosis other than surgery? The gentle stretching with steroid cream is making the hole a little bigger, pain is improving.
3. Ways to treat a possible yeast infection effectively? We're trying applying probiotic topically.
4. Who to go to for a second opinion? Is there a such thing is non-circ. happy urologist? Do we try a naturopathic doctor? Do we try a dermatologist?
Thanks in advance for your positive input and help!
Married to a wonderful woman since 2010. Baby boy C arrived in June 2013!
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I'm sorry you are both going through this. When reading your post, my initial thoughts were related to his overall health, his gut health in particular. I see that he has ADHD & sensory issues. Have you read about the lack of gut health impacting these things? How about healing diets (as much as some see improvement from going gluten & other things free, that's just a first step in making healing possible - healing diets work to get at the root of the problems)?
Have you contacted Marilyn Milos at NOCIRC? She's a nurse & she may be able to help you or help you find a doctor who will help w/o circ.
I see you're using culturelle - what's the CPU count on that? He may need higher count probiotics. You said you're applying probiotic topically. Again, you make need a higher count of these. There's a relatively new probiotic called Living Streams that I've been giving my childrne. It's a liquid. You may contact the company to see if it's supposed to be good for skin conditions. I know you can take it orally or on the skin, but I"m not sure if it's got bacteria in it that are supposed to be on the skin or not.
Yes, I think you may need an alternative med doctor or homeopath or somethng along those lines to work on healing his whole body vs. just this one part. If the steroid cream & stretching are working for now, then I'd say keep up w/ it as a temporary solution until you can find something that will address the root of the problem (gut healing).
I don't spend much time on my comptuer (& typing on a device is torture!) so this is more brief than what I'd thought about it all when I first read your post shortly after you posted it. Feel free to PM me w/ any questions. Or post them here.
They can try softening the scar tissue with steroid cream and stretching exercises. They can also do something called a dorsal slit, which just makes a slit in the foreskin to allow for retraction, but doesn't remove the foreskin.
I would follow everyone else's ideas about getting his whole system in balance so he doesn't have constant infections/irritation.
Many years ago (before the internet) my DS was diagnosed at age 11 with phimosis following examination by a doctor for an infection. I do not know if the infection was a UTI or balanitis. In any case, it was extremely painful for him to pee and he would pinch his penis or foreskin to let the urine out very slowly. This happened in the middle of the night and the next day we had him at the clinic where he was prescribed antibiotics that cleared it up in a day.
However, we were then referred to a urologist because of the "phimosis". Like your son, he had been mostly retractable by age 7, but then one night when retracting to swish in the tub he got a couple of tiny slits in his foreskin which stung and made him cry. Our Dr at the time said retraction was unnecessary and I doubt he ever did again. So now at age 11 it was observed that his foreskin was tight like a newborns and the urologist insisted that he must be circumcised. I got in a big argument based on my gut feeling that this was wrong, but had no factual evidence to support that. I refused to go back. Dw in the meantime felt that Ds did indeed have an issue and took him in to get circumcised. As soon as I got access to internet, a lifelong curiosity and desire to learn the facts gave rise to a lot of research. I was infuriated to learn that the average age of retraction in intact cultures is 10 1/2 and not being retractable at 11 is perfectly normal. That phimosis can often be cured through the application of Betamethasone cream and stretching. That if that fails there are several methods of preputioplasty that solve the issue without any loss of foreskin. Why had that urologist not been aware of any of this? I wanted to do serious physical harm to him!!
So now to address the problem that your 6 1/2 year old is having: First, has any one done a culture to determine whether he really does have a yeast infection? Yeast is easily cured by the same medications used by women, but if it is not yeast but something else, then that treatment will exacerbate the problem. Similarly, taking antibiotics will worsen yeast. A culture is required to determine the issue in order to prescribe the correct treatment.
From what I gather, it is not uncommon for a previously retractable foreskin to become tight again for a period of time. However you stated that the tip of his foreskin is hardened and white. That would indicate either scar tissue or possibly BXO. There is an article published in Australia that has pictures of both a normal tight foreskin and one that is scarred. I believe I saw it on the www.cirp.org website. There is a whole segment, followed by a ton of reference articles on treating phimosis at www.cirp.org/treatment/library/treatment/phimosis. The bottom line is that it is very rare for a phimosis to require a circumcision for resolution. Sadly circumcision is all many doctors in North America know! The one exception may be BXO, but I have seen articles claiming success in treating BXO with Carbon Dioxide laser treatment. You should also read : www.biomedcentral.com/1471-2490/8/6 which shows another treatment that preserves the entire foreskin. A PP mentioned the dorsal slit. While this does release the phimosis, it leaves a permanently retracted foreskin that is somewhat unsightly since it bunches up under the glans. What she/he was probably referring to was what is involved in preputioplasty, where several longitudinal slits are made in the constricted part of the foreskin which are then sutured transversely, thus widening the opening. There are good descriptions on the cirp website.
The challenge for you is to first determine precisely what the issues are in regard to your son's foreskin, and then to find someone willing and knowledgeable enough to use procedures that will solve those issues without amputation. If we only had access to European or Scandinavian doctors!!
I highly commend you for your efforts to keep your son whole. Keep us posted on your progress, and if we can help further, please ask. Good luck!!