Expert Advice: My baby son has very tight foreskin!

Find out how this common condition in little boys, which may cause infections and other complications, can be treated.

The word “phimosis” means “muzzle” in Greek and refers to a common condition in young boys whose foreskin cannot be retracted to expose the head of the penis.

If this condition is left untreated, it may potentially cause an infection, difficulties urinating and other complications, which may then require medical attention.

As the foreskin covers the head of the penis at birth, this is a normal occurrence in uncircumcised babies and boys under age 4. Thomson Medical’s paediatric surgeon Dr Nidhu Jasm answers questions relating to phimosis.

What causes this condition and can it be prevented?

This could be the result of previous infection or is simply redundant foreskin. Very often, the cause is unknown.

While it may not be possible to prevent this condition, the problem is essentially treated before it occurs for babies who are circumcised at birth.

“On average, for about 50 per cent of boys it takes about four years for the foreskin to loosen… Only about 1 per cent of newborn boys have foreskin that can retract.”

How common is this condition among babies and kids?

In newborn boys, it is normal for foreskin to cover the head of the penis. This gradually loosens until it is possible to pull back the foreskin to expose the penis head. On average, for about 50 per cent of boys, it takes about four years for the foreskin to loosen. By age 16, only about 1 per cent of boys still have persistent tight foreskin. Only about 1 per cent of newborn boys have foreskin that can retract.

What are the signs/symptoms of this condition and when should the parent seek help?

If phimosis interferes with urination or is accompanied by other symptoms such as pain, infection, collection of urine under the skin, itchiness or even bleeding, you should bring your child to see the doctor.

How is this condition diagnosed and how severe can it get?

Parents often notice when their sons have an infection of the area. Your doctor can also check if their foreskin can retract. Other symptoms of phimosis include pain, bleeding or complete inability to pass urine.

If left untreated, it can cause scarring, painful erection, balanitis and balanitis xerotica obliterans, but rarely cancer of the penis. It can also worsen into paraphimosis, in which the foreskin gets stuck behind the glans, preventing normal blood circulation in the penis. This is an emergency and will require immediate treatment.

What treatments are there for this condition?

Medical treatment of phimosis involves first treating the infection, and thereafter, using steroid ointment to stretch the foreskin. This process usually takes place over a few weeks.

Surgical treatment involves removing the foreskin surgically by circumcision.

Is there an ideal age for the child to undergo the surgery?

If you decide to circumcise your son, it is best that your child undergoes this procedure as early as possible. Apart from treating phimosis, circumcision is known to offer other benefits, as stated by the American Association of Pediatrics.

Medical treatment of phimosis involves first treating the infection, and thereafter, using steroid ointment to stretch the foreskin. This process usually takes place over a few weeks.

Any risks associated with the procedure?

An important risk is if the medication doesn’t work when your child is being treated for the condition, which leads to a worsening of his symptoms while undergoing medical treatment.

The risks of circumcision are:

* Infection: Transient. Usually happens the week after the procedure. Antibiotic ointment is given for aftercare. Occasionally, oral antibiotics may be required.

* Dysuria: Pain and difficulty passing urine for several days: Transient.

* Bleeding: Spots of blood are common and tend to resolve without any intervention. Occasionally, children can bleed profusely and require a return to the theatre to stop the bleeding.

* Meatal stenosis [narrowing of the opening on the tip of the penis in circumcised males]:  Low incidence and tends to present many years later, and may require steroids and dilatation. This applies only to children still using diapers when they are circumcised.

How is the procedure carried out and how long does it take?

Circumcision is a day surgery under local or general anaesthesia, depending on the child’s age.

Your son will be given a short anaesthetic to keep him comfortable. The penis and surrounding area will be cleansed before the surgeon trims the foreskin. Afterwards, the penis will be covered with an antibiotic ointment, and wrapped loosely with antiseptic gauze. The procedure generally takes about 20 minutes.

What is the recovery period and how should the parent care for the wound?

It takes about two weeks for the child to recover, following the circumcision. Children whose foreskin is scarred will require a longer recovery period, compared to others who undergo circumcision without a history of an earlier infection.

Clean the wound with normal saline, apply antibiotic solution and offer pain relief. Sometimes, oral antibiotics may be required.

What are the signs of a problem with wound healing ― when should parents seek help?

Parents should come back to see the doctor if there is profuse bleeding (usually in the first 24 to 48 hours) or an infection, which is usually transient.

Dr Nidhu notes that she follows up with the child a week after the procedure.

For more info, call Thomson Surgical Centre at 6846-6766 or email surgicalcentre@thomsonmedical.com.

This article was first published on SmartParents.