# Phimosis Diagnosis and a question...



## MrsHenderson (Jul 25, 2005)

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 (Mar 26, 2009)

#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 (Jul 25, 2005)

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 (Jun 28, 2004)

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 (Jul 25, 2005)

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 (Sep 20, 2006)

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 (Jul 25, 2005)

Quote:


> 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.
> 
> ...


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 (Nov 18, 2004)

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 (Jun 4, 2006)

Quote:


> 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 (Oct 8, 2006)

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 (Apr 5, 2004)

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 (Jul 25, 2005)

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 (Sep 20, 2006)

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 (Nov 9, 2006)

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 (Jun 13, 2006)

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 (Jul 25, 2005)

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 (Sep 20, 2006)

Quote:


> 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 (Jul 25, 2005)

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 (Nov 18, 2004)

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 (Jun 4, 2006)

Quote:


> 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.
> 
> ...


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


----------



## A&A (Apr 5, 2004)

Quote:


> Originally Posted by *myfairbabies*
> 
> Quote:
> 
> ...


I agree, as well.

Mama, here is the phone # for Dr. Paul Fleiss, a pediatrician in Calif. who has written an anti-circ book:

*(323) 664-1977*

*I've met him in person, and he's very nice. I'm sure he'd be happy to talk to you.*


----------



## MrsHenderson (Jul 25, 2005)

Thank you everyone. I need a ped who supports my gut feelings. He's still having this issue of feeling like he has to pee often, usually every hour, which is not typical of him and started about 10 days ago. Something is not quite right, but I don't think removing his foreskin is the answer. Thx for the tip on Dr. Fleiss. I moved here from So. Cal so I know him, although he was not our pediatrician. I'll see if a call to his office yields some answers. Thank you for that


----------



## littlemizflava (Oct 8, 2006)

have him pee in a clean clear glass jar let it sit a few min and see if you see any thing floating in it or if it looks cloudy. i know this is a way of looking for a uti or bladder infection. you could start giving him pure cranberry juice to flush out a infection.


----------



## AllMyChildren (Jan 9, 2011)

I agree with others. It is impossible to diagnose true phimosis in a young boy. If that were the case, there are sure a lot of intact boys with phimosis. I dont see any need for the steroid cream either. His foreskin is not meant to retract at this time. I second the cranberry juice. Maybe try that for a day or two and see if there is any improvement. Hope everything works out soon for you and your son.


----------



## MrsHenderson (Jul 25, 2005)

The urine infection was ruled out in a visit to first pediatrician.


----------



## MCatLvrMom2A&X (Nov 18, 2004)

So the main concern right now is him having to use the bathroom really often? My ds went through something like that and about the time I started to worry it stopped. He never had any signs of a UTI and didnt complain of pain. Is he drinking something that he hasnt had much access to before now? More kool aid or even a different brand of water? I ask because if I change even brands of water it increases my need to go to the bathroom. I just have really sensitive kidneys when it comes to things like that. It can last for a few hours to days sometimes depending on what it is I was drinking.


----------



## MrsHenderson (Jul 25, 2005)

Yes, he's going to the bathroom every 45 min. to an hour. And this is a kid with a steel bladder who never went to the bathroom at pre-school from Aug. to Dec. (He was in school from 8:45 to 12:45, or 1:45 depending on the day.) We drove to Disneyworld on 12/28 and he said he had to go pee 10 min. after we got in the car. No pain so I treated it like NBD. Then after 4 days on our trip, distracted by all the Disney craziness, he would still ask to go pee at a lot, just as a show would start, or just as we were getting on a ride after waiting in line for an hour. Clearly something is up with the frequent peeing. He only drinks milk or water, and we haven't changed brands. His teacher was excited, thinking he's become comfortable enough to use the bathroom at school, but then I asked her how often he went and she said 3 x's day one back, and 4 x's day two - that's when I took him to the doc last week to rule out UTI. I'm calling another doc tomorrow to address this issue.


----------



## MCatLvrMom2A&X (Nov 18, 2004)

Make sure to mention diabetes testing. I hope you can get it figured out and hope that this Dr. dosnt start in on the foreskin because frequency of urination has nothing to do with that.


----------



## eepster (Sep 20, 2006)

The sudden change in frequency may well be nothing more than a growth spurt, but it really could be a symptom of a problem that needs treatment. The foreskin seems to be posing such a distraction to the Drs you've gone to that they are ignoring the fact that you DS's symptoms point to something either going on with his kidneys or bladder and not his penis. You need to get the Drs to look into things that might be causing his kidneys to work faster (such as diabetes) or his bladder to feel full when it isn't (such as gas in his colon pressing against it.) The way they are ignoring what is areal concern that needs to be addressed and focusing on what is a non-issue is a serious problem.

You need to force them to focus on the real concern here (change in urinary frequency.) I would start by simply stating that you want them to test for diabetes, and go from there. Don't mention the dribbling, I think it is what is causing them to look at the penis and forget that it is just the end of and extensive urinary system that starts with the blood.


----------



## MrsHenderson (Jul 25, 2005)

Quote:


> Originally Posted by *eepster*
> 
> The sudden change in frequency may well be nothing more than a growth spurt, but it really could be a symptom of a problem that needs treatment. The foreskin seems to be posing such a distraction to the Drs you've gone to that they are ignoring the fact that you DS's symptoms point to something either going on with his kidneys or bladder and not his penis. You need to get the Drs to look into things that might be causing his kidneys to work faster (such as diabetes) or his bladder to feel full when it isn't (such as gas in his colon pressing against it.) The way they are ignoring what is areal concern that needs to be addressed and focusing on what is a non-issue is a serious problem.
> 
> You need to force them to focus on the real concern here (change in urinary frequency.) I would start by simply stating that you want them to test for diabetes, and go from there. Don't mention the dribbling, I think it is what is causing them to look at the penis and forget that it is just the end of and extensive urinary system that starts with the blood.


I agree!

Found another doc who's not too far who's foreskin friendly. Calling today because he's peed three times this morning already. Def. something up.

Thx everyone for checking back and offering helpful advice


----------



## MrsHenderson (Jul 25, 2005)

Met with Doc #3 yesterday and things went very well - yay! She listened, took notes and agreed that the urinary frequency was unrelated to the foreskin, which she also agreed was a non-issue. She didi a urine test for UTI - neg. And a blood test for diabetes - also neg. She asked a lot of questions and in the end thought I should consider urinary frequency syndrome. It's basically a non-medical explanation for urinary frequency in post toilet-trained kids (avg. age 3-7). Usually, due to some trauma, kids feel an urge to pee as often as every 5-10 minutes. (Not there is any trauma I can explain, unless a road trip to Disneyworld is considered traumatic, and to a kid who prefers the home toilet, it may very well be!). So, on the way to school today, I explained to my son nothing was medically wrong with him and that if he had to go pee, ok, but there was no reason behind it; that his penis, his bladder, his blood, etc we're all ok. He only peed twice at school today so I think it's just a matter of him growing out of it, which is usually the case, although it can take anywhere from 6 weeks to 18 months! So my efforts paid off, I've found a new ped, and I wanted to also say how much I appreciate all the support from this board







- thank you!


----------



## MCatLvrMom2A&X (Nov 18, 2004)

I am so happy you found a ped. who was willing to listen and help you figure things out. I am really glad your ds's tests came back OK as well.







Sometimes you have to kiss a lot of frogs to find a prince







as the saying goes.


----------



## eepster (Sep 20, 2006)

I'm really glad it wasn't a serious medical problem, but I'm also really glad that your new Dr actually checked for those things.


----------



## TigerTail (Dec 22, 2002)

Er, yeah, I would skip the steroid. My kids are 8 & 10 & don't retract yet. No worries. (Is that poll still around I started like in 2005, where the average age of first retraction was?) It's not their fault that the medical textbooks are so outdated in this country (though they really ought to research for themselves. I mean, if we can...) Anybody have a European medical database, for the Dr's to have a peek at?


----------



## TigerTail (Dec 22, 2002)

Sorry I missed the update! Yay, you!


----------

