Treatment of physiological phimosis at home. What you need to know about physiological phimosis in boys Physiological phimosis what health group

Often, during a preventive appointment with a pediatrician, boys are diagnosed with phimosis. This disease often occurs in infancy and is considered the absolute norm - this is due to the fact that all the baby’s structures are still developing. Therefore, there is no need to worry and take urgent therapeutic measures.

What is phimosis, what are the reasons for its development, how to treat it, and in what case should you consult a doctor? All parents who raise future men should know the answers. Untimely detection of pathology and treatment can lead to complications, problems with urination and sexual life in the future.

What is phimosis and why does it occur in boys?

Phimosis is a pathological condition in which the head of the penis is not completely exposed. This situation does not always indicate that the child has a disease, so there is no need to try to open the head on your own, because your actions can only cause harm.

Before reaching 6 years of age, the reproductive system in boys is still developing. If after this time the condition remains unchanged (the head does not appear, the baby complains of pain when urinating and discomfort in the intimate area), you should seek help from a specialist.

There are several reasons for the development of phimosis:

• congenital pathology resulting from disorders of intrauterine development;
• injury to the penis, causing narrowing of the prepuce or scar formation;
• inflammatory processes in the intimate area, including balanoposthitis;
• improper restoration of tissue structure after surgery on the genital organ;
• a small number of elastic connecting structures.

At what age can this problem occur?

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This condition is observed in the majority of newborn boys (almost 95%): the head of the penis comes out partially, since the foreskin is connected to it by synechiae. Therefore, phimosis in children aged 2-3 years is the absolute norm - this condition is called the term “physiological phimosis in boys.”

By the age of 4, many children return to normal without outside intervention. The skin surrounding the reproductive organ becomes mobile, and the head is completely exposed. It is believed that opening can take up to 6 - 7 years - this depends on the general physiological development.

Some experts do not advise starting treatment for phimosis before the age of 10, unless, in addition to the main symptom, other accompanying symptoms are observed (pain, itching, difficulty urinating, etc.). In any case, it is necessary to consult with a pediatrician to prevent complications from occurring and not to aggravate the child’s condition.

Classification and symptoms of pathology

Phimosis in boys is divided into 3 types - cicatricial, hypertrophic and congenital. Depending on the type of pathology, a treatment regimen is determined. The characteristics of the disease of each type are discussed in the table.

Forms of phimosis

Type of phimosis	Reason for development	Symptoms	Method of treatment
Scarred	the main factor provoking the appearance of cicatricial phimosis is neglect of the rules of personal hygiene; inflammation of the genital/urinary organs; congenital pathology.	With cicatricial phimosis, the foreskin is longer and prevents the free exit of the head. Cracks and scars appear on the skin, swelling appears, resulting in a narrowing of the genital opening. Carrying out hygiene procedures is almost impossible. Often the course of cicatricial phimosis is accompanied by inflammation of the area (paraphimosis).	Drug therapy or surgery.
Hypertrophic	There is only one reason for the occurrence of hypertrophic phimosis - excess weight, including obesity in the intimate area (the surrounding tissues in this condition have an excessive accumulation of fat cells).	The pathology occurs not only in young children, but also in adults. Due to the excess fat layer, the prepuce lengthens and a large amount of moisture accumulates under the skin. The foreskin is tightly wrapped around the head of the penis, which is why it cannot come out. Increased humidity contributes to the development of inflammation, so the child may experience pain.	If the disease is detected early, surgery can be avoided. Therapy can be carried out at home, but it is necessary to adjust the child’s nutrition.
Congenital	may occur for no reason; genetic predisposition; developmental pathologies during pregnancy.	Physiological phimosis manifests itself in a narrowing of the foreskin, due to which the head cannot extend beyond the boundaries of the surrounding skin. In some cases, fusion of the prepuce and the genital organ is observed.	Treatment is carried out after the boy reaches a certain age. Drug therapy is used; if it fails, surgery is indicated.

The main symptom of phimosis is the inability to open the head of the penis (narrow foreskin) or its complete closure (the photo shows what phimosis looks like).

Manifestations of pathology also include:

• problematic urination - small children often cry or are capricious, urine is released in droplets (a thin stream) with slight delays;
• pain during erection;
• radiating pain in the upper region of the penis;
• if phimosis is accompanied by an inflammatory process, then pus may ooze from the opening of the genital organ, body temperature rises, and the head of the penis swells and turns blue.

Diagnostic methods

The pathological condition is easy to detect by visual examination. An experienced urologist determines the degree and form of the disease by the appearance and complaints of the patient. Sometimes additional diagnostic procedures are required - ultrasound, Dopplerography, OAC, OAM. Based on all available information, an accurate diagnosis is established and a treatment plan is drawn up.

A urologist can diagnose phimosis after a visual examination

Features of treatment

Treatment can only be carried out after consultation with a doctor. The initial stage of phimosis is treated with medication and other methods; the specialist gives recommendations on changing the daily diet, if necessary.

If the disease is advanced, then surgical intervention is indispensable. Physiological phimosis, as a rule, goes away on its own, but sometimes it is necessary to eliminate the problem promptly.

Surgery with before and after photos

Surgical intervention is indicated only when conservative therapeutic methods are ineffective. The operation is carried out in several ways:

• traditional - the surgeon makes axial incisions in the foreskin, then stitches it together (thus increasing the diameter of the pulp ring);
• Shkloffer operation - a zigzag dissection is performed, after which the edges of the wound are connected with sutures (local anesthesia is required before the procedure);
• circumcision - complete removal of the skin around the head of the genital organ (the result is in the photo).

Circumcision result

One alternative to surgery is laser removal of the foreskin. This method has a number of advantages - absolute painlessness, absence of blood, quick recovery.

Therapy at home

Phimosis in children is eliminated in several ways, which, as a rule, are combined. During the treatment period, you need to monitor the child’s hygiene; doctors recommend taking baths with the addition of herbal decoctions (chamomile, celandine, calendula, etc.), manganese solution or sea salt.

After bathing, the upper skin of the genital organ is lubricated with cream or a special ointment and stretching movements are made (with two fingers, the tissues are spread apart). You cannot do this too quickly and sharply - manipulations should not cause pain to the child. This method allows you to achieve good results within two months. It takes 10 minutes a day to complete the procedure.

Doctors also often prescribe corticosteroid ointments - Betamethasone, Triderm, Diprosalik, Budesonide, Clobetasol and others. They have antimicrobial and antibacterial effects, promote rapid healing of scars and microcracks.

Corticosteroid ointment Triderm

If the use of ointments is contraindicated, you can replace them with Vaseline. Any medications should not be used without a doctor's prescription.

Possible complications

In addition to possible discomfort and difficulties during hygienic procedures, additional problems and pathologies often appear that require immediate treatment. These include diseases:

• Balanoposthitis is an inflammatory process that occurs in the foreskin and the end of the penis. Occurs due to poor hygiene. The patient develops the following symptoms: itching, discharge of purulent accumulations, hyperemia, pain.
• Paraphimosis occurs when parents try to expose the head of the penis on their own. Sudden and incorrect movements lead to forced stretching of the foreskin and subsequent compression of the genital organ. Blood vessels and tissues suffer from this. The patient experiences severe pain, the tip of the penis increases in size and swells. If the disease is not treated in time, necrosis or gangrene of the genital organ may develop. The way out of this situation is amputation of the affected area.
• Fusion of the foreskin and the head occurs if no measures are taken for a long time to eliminate phimosis - synechiae (fusions) gradually form (we recommend reading:). In this condition, it is impossible to fix the problem on your own.

Prevention of phimosis in children

The physiological form of phimosis does not require therapy. To prevent the development of the disease in boys, it is enough to carefully monitor the regular implementation of hygiene procedures and visit a pediatrician for preventive examinations. If a child is prone to obesity, then it is necessary to adhere to a special diet.

Every boy is born with physiological phimosis. Many mothers are scared when they hear this diagnosis from a doctor. In fact, physiological phimosis is not dangerous. This problem disappears on its own as children grow older. Moreover, some boys may no longer have phimosis at the age of 6, while others still have it at 14.

With physiological phimosis, the help of a doctor is not required. You should contact a specialist only when the child has problems with urination and inflammation begins. A doctor's consultation is also required if the head of the penis is not exposed by the end of puberty. Let's find out what phimosis is in children and how parents can help their child.

What is phimosis called?

All newborn boys have a foreskin covering the head of the penis. This mucocutaneous membrane is immobile. It serves as a kind of protective “cap” that protects the head of the penis from contamination with feces and exposure to urine. The inability to expose the head of the penis is called phimosis.

This condition comes in two types:

• physiological;
• pathological.

The first type of phimosis is an absolutely normal phenomenon. The head of the child's penis begins to open gradually. By the end of puberty, it is completely exposed in almost all children.

Phimosis may also be pathological. The doctor makes this diagnosis when there is pronounced narrowing of the foreskin. The causes of phimosis in children lie in the individual characteristics of the connective tissue and the presence of microtraumas. The following symptoms may appear, indicating the presence of a pathological narrowing:

• urination is impaired;
• the child is straining and worried;
• the foreskin fills with urine (a ball is formed);
• urine comes out through the hole in drops or a thin stream;
• the skin turns red.

What to do with physiological phimosis

This is a question many parents ask. Some doctors advise mothers and fathers to gradually retract the foreskin and try to expose the head without waiting for the end of puberty. In fact, if a child has phimosis, there is no need to follow this advice, since such actions can cause harm to the baby.

The International Association of Pediatricians does not recommend that parents do anything when diagnosing physiological phimosis in a child. Careless impact on the foreskin can lead to the appearance of microcracks. As they heal, a more pronounced narrowing will form.

Physiological phimosis in most cases goes away on its own:

• during the newborn period – in 4% of boys;
• upon reaching one year of age – in 50%;
• at 3 years – 90%;
• at the age of 5–7 years – 92%;
• at 12–13 years old – 97%;
• at 14–17 years old – 99%.

Only 1% of children require specialist help. If physiological phimosis does not go away by the age of 14–17, then you will need to consult a doctor. He will prescribe medical or surgical treatment. Surgery is required in very rare cases. According to statistics, only 1 boy out of 2 thousand children needs surgical treatment.

What to do with pathological phimosis

If there is severe narrowing and problems with urination, you should consult a doctor. A surgeon may not be needed. First of all, non-drug conservative treatment of phimosis in children is used. Drug therapy may also be prescribed.

At the end of the last century, specialists developed methods for conservative elimination of pathology. They are still used today. When diagnosing pathological phimosis, doctors choose the method of gradual stretching of the flesh. They recommend doing special exercises daily aimed at exposing the head of the penis. However, you must follow certain rules:

• regarding the use of techniques for gradual stretching of the foreskin, you should consult a doctor;
• stretching should be gradual (you cannot suddenly expose the head, all actions should not cause pain);
• manipulations must be regular.

Can give good effect drug treatment pathological phimosis. Doctors use corticosteroid therapy. A child suffering from pathological phimosis is prescribed an ointment based on glucocorticosteroids, which increase skin elasticity, reduce inflammation and swelling, and also accelerate the healing of small cracks. For example, a doctor may prescribe Prednitop. The use of ointment is combined with mechanical action on the skin of the foreskin (the head is gradually exposed). In this way, phimosis in a child is treated without surgery.

Pathological narrowing of the foreskin can be eliminated thanks to surgical intervention . However, currently this method of treatment is used in very rare cases (when drug therapy has not given the desired result). In case of cicatricial changes in the foreskin, specialists perform partial or complete circular excision.

Be careful - paraphimosis!

Some parents, having heard a diagnosis of “phimosis” from a doctor, try to rid their child of the problem on their own. They begin to try to expose the head of the penis and train it. Violent, inept actions of inexperienced mothers and fathers lead to the baby developing paraphimosis.

This pathological condition is very dangerous. With paraphimosis, the head of the penis swells due to the fact that it is pinched by the ring of the foreskin. The child needs urgent medical attention. Paraphimosis can lead to the development of congestion in the glans penis, its necrosis (cell death), and amputation.

If the head of the penis is pinched, then you need to immediately go to the surgeon. You can try to correct the situation yourself. To do this you need:

• gently squeeze the head of the penis with your fingers;
• apply something cold to the penis.

Thanks to physical impact and cold, the swelling will instantly subside. The foreskin can be returned to its place.

Features of hygiene for boys

It is impossible to prevent the occurrence of physiological phimosis, because it is an absolutely normal condition. But the appearance of a pathological form can be completely avoided. To prevent symptoms of phimosis from appearing in a child, parents just need to carry out hygiene procedures.

Moms and dads need to keep their child's genitals clean. It is recommended to wash the baby daily in the evenings with clean warm water. The rest of the time you can use wet wipes. The use of foam for bathing is not recommended. These products contain chemicals that irritate the delicate skin of the penis.

You can use baby soap to wash the genitals externally. Under no circumstances should you try to expose the head and soap it or pour soap foam under the foreskin for better cleansing. The product may cause irritation and inflammation.

With physiological phimosis, there is no need to expose the head of the penis while swimming. If a child develops inflammation due to dirt accumulated under the foreskin, then it must be removed from there as follows:

1. Draw 10 ml into a syringe without a needle. clean warm water or ectericide solution (furatsilin can be used instead).
2. Pull the foreskin upward so that the head of the penis is hidden rather than exposed.
3. Insert the syringe into the gap that has formed between the foreskin of the penis and its head (this procedure is more convenient to carry out together).
4. Release the liquid, thus washing away accumulated dirt.
5. Repeat this procedure 1 or 2 more times.
6. Drop 2-3 drops of olive or Vaseline oil into the gap between the foreskin of the penis and its head (you can use oil solutions of vitamin A, E).

It is imperative to change diapers for a small child more often. Thanks to this, there will be no prolonged contact of the head of the penis with feces and urine. The inflammatory process will not occur.

In conclusion, it is worth noting that you should not be afraid of the diagnosis of “phimosis”. For little boys it is the norm. This is how a child’s body works. Pathological phimosis is also not scary. It can be easily gotten rid of without any consequences thanks to drug treatment. Surgery can also be performed for phimosis in children. It will not affect your health and will not affect your future sex life.

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Most parents raising a boy hear the phrase “physiological phimosis” from doctors. How dangerous is this condition and what should be done in this case?

Physiological phimosis is not a disease, but a temporary condition. It is characteristic of 95% of newborn boys, often persists in early and middle childhood, and sometimes in teenagers. This term is used when they mean the fusion of the foreskin with the glans penis by adhesions, or synechiae, that occur during fetal development. With age, this deficiency disappears: the epithelium gradually peels off and the head is released.

Attention! Desquamation takes quite a long time. It is prohibited to artificially accelerate this process, so as not to cause undesirable consequences that could worsen the health of the child’s genitourinary system.

Physiological phimosis should be distinguished from acquired phimosis, which is less common and occurs after inflammatory diseases of the penis or urethra, trauma, resulting in loss of tissue elasticity.

Physiological phimosis normally occurs without any pathological symptoms - redness of the foreskin, glans, pain, urination problems.

Attention! If the boy’s head of the penis has already opened, and then the foreskin has narrowed, then they talk about pathology. Late elimination of phimosis is sometimes associated with disturbances in the hormonal system.

Some ethnic groups are predisposed to physiological phimosis even after reaching puberty. The phenomenon is considered common, for example, among residents of the southeastern region of Asia.

Interestingly, narrow foreskin was considered beautiful by men in ancient Greece. They even learned to artificially lengthen this area using kinodesma - a special leather whip, the other end of which was encircled around the waist.

Physiological phimosis can turn into pathological when the head does not open even during puberty. Scientists still cannot clearly explain why this happens. One of the most popular versions is genetic predisposition and insufficient production of connective tissue. Along with physiological phimosis, cryptorchidism (failure of the testicle to descend into the scrotum) or hypospadias (pathology of the urethra) can sometimes be diagnosed. This indicates an anomaly of the paramesonephric duct, which occurs during the period of intrauterine development under the influence of infection or intoxication.

Why is phimosis dangerous?

Is phimosis a health problem if for many peoples it is the norm? This violation is dangerous because the head is constantly closed. If you do not adhere to the rules of hygiene, infections may develop due to residual urine and secretions that accumulate in the preputial sac. The secretion consists of pheromones, bactericidal components, lipids, and is the basis of smegma. Normally, this substance protects the mucous membranes of the penis and foreskin from drying out, and also serves as a natural lubricant during intercourse. At the same time, this is a favorable environment for the development of pathogenic microflora, especially if hygiene procedures are difficult.

Phimosis can provoke balanitis, balanoposthitis. Scientists have also found that with prolonged stagnation, carcinogens are formed in smegma, causing cancer in both men and their partners.

Treatment of phimosis

As a rule, with physiological phimosis, treatment is not required - the child is only observed. The condition normalizes by 6–7 years, and for some representatives of the stronger half even later, in adolescence. In the latter case, this is facilitated by changes in hormonal levels, under the influence of which the skin softens and stretches.

Hygiene rules

Parents often take a wait-and-see approach, hoping that their son will “outgrow it.” Then you must strictly observe the rules of hygiene. So, after each urination it is necessary to rinse the perineum with clean water.

Attention! Soap for washing is used once every three to four days, not more often. Care must be taken to prevent soap suds from getting into the preputial sac.

For daily treatment, the doctor may additionally recommend such pharmaceutical products as Chlorhexidine or Miramistin. The use of these drugs will prevent the development of pathogenic bacterial flora.

If unpleasant symptoms nevertheless arise - itching, redness - they may prescribe additional procedures, for example, rinsing Furacilin or Ectericide. To do this, take a warm solution of one of these drugs into a disposable syringe without a needle, pull off the skin without exposing the head, and insert the nose of the syringe into the formed gap. Then the liquid is released under pressure to wash away the secretions.

The procedure is carried out several times if necessary. Then the following drugs are instilled there:

• Vaseline, olive oil;
• vitamin A in oil.

If a child is diagnosed with hypersensitivity to any product, discomfort is caused by allergens that are excreted in the urine. Then they minimize contact with substances that provoke a painful reaction in the body.

Attention! When carrying out hygienic procedures, you should not displace the foreskin, as this is fraught with unpleasant consequences. So, if this area of ​​skin is fused to the head of the penis, then there is a possibility of erosion and inflammation, which will cause secondary phimosis to develop.

There is also a risk of strangulation of the head, disruption of the blood supply to the organ and necrosis. This condition requires urgent medical attention. In the first hours, reduction is performed; in the later stages, the ring is cut and the foreskin is trimmed.

Video - Phimosis in a boy: normal or pathological?

Drug therapy

As part of conservative treatment, hormonal ointments are used and herbal baths are prescribed. These products help increase the elasticity of the skin, and also relieve swelling and inflammation, if any, and heal wounds. Additionally, the foreskin is stretched. But this technique does not always give results. In addition, such manipulations increase the likelihood of strangulation of the head and infection of the genitourinary tract. The use of hormonal drugs causes side effects.

Surgical treatment

The surgical operation is called circumcision, or circumcision, and is performed under local anesthesia, in some cases under general anesthesia. The intervention consists of completely or partially excising the preputium. The entire manipulation takes only 20 minutes. There are bloodless techniques that do not cause swelling, which use laser and radiosurgical treatment. Then a sterile bandage is applied to the penis, which is removed after 48 hours. During this period, the child should not be bathed. There are no other restrictions. Side effects are rare. Plastic surgery can be performed to eliminate phimosis, but partially preserve the foreskin.

After surgery, sexual functions are not affected: in the future, a man can have children, the composition of sperm does not deteriorate, unless there are other pathologies. Whether the baby needs surgery or can do without it, only the doctor decides.

So far, doctors have not come to a consensus at what point should phimosis be considered a pathology. Some experts consider this to be the norm even before the age of 17.

There are no specific recommendations for preventing the anomaly. However, this puts forward standard requirements for a pregnant woman: a woman must lead a healthy lifestyle, protect herself from infections and not self-medicate.

Boys and girls from birth have certain physiological characteristics and differences. Diseases of the genital area always cause parents real confusion. One of these diseases is phimosis.

What it is?

Phimosis in boys is a pathological condition in which it is impossible to slightly open the head of the penis due to the presence of a narrowing of the opening of the foreskin. Typically, this pathology is manifested by an increase in the size of the foreskin and some urination disorders. The incidence of phimosis in boys is quite high.

It is important to note that it decreases with age. Thus, in children 7-9 years old, the incidence of phimosis does not exceed 10%. In adolescents, it is less than 2%.

A newborn boy has his own physiological characteristics that distinguish him from an adult man. Normally, all born babies have a connection between the head of the penis and the inner lining of the foreskin. These structural components are interconnected. It was no coincidence that nature provided this feature. This helps prevent infection from reaching the delicate tissue of the external genitalia, and therefore reduces the risk of developing secondary infection.

As a child grows up, various physiological changes occur in his body. Every second boy by the age of 1 year, the head of the penis opens. By 2-3 years this value is already 90%. In some cases, deviations still develop. They lead to the development of various diseases in children, including phimosis.

Typically, boys' reproductive system is formed before the age of 6. If a child has any deviations in reproductive health, they try to treat them conservatively or use “observational” tactics.

In many children who have various pathological conditions in childhood, by adolescence they completely disappear without treatment. In any case, you should definitely monitor your baby and monitor any changes in his health.

Causes

There is currently no single cause that leads to the development of the disease. Many andrologists and pediatric urologists are still arguing about what contributes to the development of phimosis in children. They identify several reasons that can cause this pathological condition in boys. In some cases, the development of the disease can be caused by exposure to several causative factors simultaneously.

This pathological condition is caused by:

• Disorders of intrauterine development. Exposure to unfavorable environmental factors or chronic diseases in a pregnant woman contribute to the formation of various pathologies during pregnancy. In the fetus, the stages of organogenesis are disrupted, which contributes to the onset of various diseases in the future. Typically, clinical signs of phimosis in this case appear in a child under one year of age.
• Traumatic effects. The external genitalia in boys are quite easily damaged. Especially in young children. A blow to the intimate organs, a fall, or independent attempts to open the head of the penis can cause significant injury to the child. The consequence of this, as a rule, is the formation of persistent phimosis.

• Infectious and inflammatory pathologies in the area of ​​the external genitalia. A child's body, due to the fact that it has reduced immune resources, is easily exposed to any infectious agents. Usually they become a wide variety of viruses and bacteria. Getting into the intimate area through the bloodstream or through contact and household contact, they can cause severe inflammation in the child. The consequence of this, as a rule, is the formation of persistent andrological pathologies.
• Complications of urological operations. An incorrectly chosen surgical procedure in most cases leads to the formation of various long-term complications. One of them is phimosis. Damage to the tissue of the glans penis or foreskin contributes to the formation of pathologies and acquired anatomical defects in this area.
• Insufficient number of connecting structures. This feature is individual and occurs only in children who have a special predisposition to this.

Kinds

Doctors distinguish several forms of this pathological condition. This classification is necessary in understanding the essence of the disease, as well as for drawing up examination and treatment tactics in the future. Thus, phimosis can be congenital, hypertrophic or cicatricial.

A large number of cases of cicatricial phimosis occur due to violation of personal hygiene rules. This leads to the fact that infection easily penetrates into the area of ​​the external genitalia and an inflammatory process develops.

Much less often, cicatricial stenosis is a congenital pathology. This pathological condition is characterized by a fairly long foreskin, which prevents the glans penis from fully opening. Due to severe inflammation, various cracks appear on the skin and scars form.

In this case, it becomes extremely difficult to carry out hygiene procedures. If inflammation intensifies, then phimosis can even develop into a very dangerous condition - paraphimosis. The treatment strategy for cicatricial phimosis is the prescription of conservative therapy or surgery. The choice of treatment tactics remains with the treating urologist. The prognosis of the disease is favorable. The risk of complications is average.

According to statistics, most often the development of a hypertrophic form of phimosis is caused by the child being overweight. In this case, obesity is most dangerous in the lower abdomen and groin area. The abundance of fat cells in the reproductive area makes it easy for fat folds to appear there. It is important to note that this form of the disease occurs not only in the youngest patients, but also in adult men.

Large accumulations of adipose tissue lead to the head of the penis is slightly compressed. The skin begins to get wet, which causes the formation of various macerations and irritation. Compression of organs located in the reproductive zone by adipose tissue leads to the fact that the foreskin of the penis begins to tightly cover its head. This significantly aggravates the course of the disease. Pronounced moisture in the skin leads to various irritations appearing on the skin, which become an excellent environment for the development of pathogenic bacteria.

In the treatment of hypertrophic obesity, normalizing the daily routine and prescribing a therapeutic hypocaloric diet are very important. For such children, the necessary physical training regime must be selected. Therapy for hypertrophic phimosis in most cases is conservative.

Doctors of several specialties simultaneously take part in the treatment of the child.

Congenital forms of phimosis are quite common. Many doctors agree that the cause of this pathological condition is congenital anomalies of intrauterine development and genetic predisposition. In some cases, specialists cannot identify a specific cause that caused the baby to develop adverse symptoms. Congenital phimosis is characterized by the presence of a pronounced narrowing of the opening of the foreskin, which is manifested by the impossibility of exiting the head of the penis. Quite often, such conditions are accompanied by the presence of multiple synechiae in the baby.

Doctors do not actively treat congenital phimosis in infants. Basically, they choose a wait-and-see approach, which allows them to monitor the course of the disease and predict the outcome of the disease in the future. Pediatric urologists treat congenital forms of phimosis.

If the doctor, during an examination of the child, finds signs of illness, then he “puts” the baby on the dispensary register. In this case, you should visit the doctor at least 1-2 times a year.

During examination, doctors diagnose some children with “proboscis phimosis.” This pathological condition is hypertrophic. It is characterized by excess skin formation in the area of ​​the glans penis, which creates a “proboscis”. The tactics in this case are the same as for other forms of the disease. If conservative treatment is ineffective, surgery is performed.

Symptoms

The clinical signs of this pathological condition are associated primarily with impaired dilation of the glans penis due to pronounced narrowing of the opening. This symptom is the most characteristic. As a rule, parents notice it during regular hygiene procedures.

Some dads and moms make an extremely unacceptable mistake. They try to independently “open” the head of the penis through overcoming effort. This should absolutely not be done! Such self-medication can contribute to injury to the baby. This pathological condition should only be treated by a pediatric urologist. Self-reduction is unacceptable!

In addition to the main symptom of the disease, there are other clinical signs of the disease. These include:

• Painful urination. This symptom does not always occur, however, it significantly aggravates the baby’s well-being when it appears. The mild course of the disease is not accompanied by urination problems. More severe and complicated forms of the disease contribute to the appearance of disturbances in urinary diversion. The baby may feel pain when urinating or even severe pain.
• Urinary disorders. In some babies, especially with quite severe phimosis, urine may be released with some “interruptions” or flow in a thin stream. If this symptom is accompanied by pain, the child’s well-being is sharply disrupted. The youngest patients usually show this by crying. Older children begin to be capricious and run to the toilet more often to urinate.
• Soreness in the groin area. Typically, this symptom appears when the inflammatory process spreads throughout the intimate area. If phimosis is complicated by a secondary bacterial infection, then the child develops additional adverse symptoms. These include: suppuration from the opening of the glans penis, swelling and swelling of the foreskin, marked increase in body temperature and swelling of the testicles.

The severity of symptoms may vary. Milder variants of the disease, as a rule, are practically asymptomatic.

The main clinical sign in this case is a narrowing of the opening of the head of the penis and the inability to fully open it.

The severe course of the disease is accompanied by the appearance of numerous symptoms that require conservative treatment. When the first signs of phimosis appear, your child should immediately consult a pediatric urologist.

What does it look like in newborns?

In all boys born, the glans penis and foreskin are fused. As the child grows older, this situation changes. There is no need to rush into surgical treatment. Physiological phimosis completely disappears in almost 90% of children by the age of three. Doctors only recommend carefully monitoring the youngest patients, as well as providing proper regular hygienic care.

Often, parents of boys independently discover certain physiological characteristics in their child. The skin of the foreskin of newborn babies is very delicate and easily vulnerable. It is tightly fused with the head of the penis. When trying to expose the head on their own, the child feels pain, begins to be capricious and even cry.

The skin of the foreskin secretes a special substance - smegma. It has a white color and a specific smell. With age, its quantity and composition changes somewhat. The formation of smegma is a completely physiological process. It is necessary for the inner layer of the foreskin to “peel off” from the head of the penis. This physiological situation helps improve the opening of the head.

If too much smegma is formed or its composition changes significantly due to chronic diseases, then the process of normal development of intimate organs is disrupted. Also, this situation can lead to the baby developing clinical signs of a wide variety of infectious diseases. Smegma is an excellent nutrient medium for microorganisms. Carrying out thorough hygienic care for a newborn baby is necessary as a prevention of diseases of the intimate area.

Diagnostics

The appearance of the first unfavorable signs of the disease should motivate parents to consult a doctor. The doctor will conduct the necessary clinical examination, as a result of which he will be able to establish the correct diagnosis. In some cases, phimosis is accompanied by other pathological conditions that require careful monitoring or adequate treatment.

Diagnosing phimosis is usually not a significant difficulty for doctors. To establish a diagnosis it is quite A clinical examination is sufficient. Additional diagnostics may be required only in complex cases or with a complicated course of the disease. For this purpose, the following are prescribed: general blood and urine tests, biochemical examination (if there are complications), ultrasound examination, Doppler sonography and other methods as indicated.

Complications

The prognosis for phimosis is conditionally favorable. Usually the disease proceeds without the development of long-term negative consequences. However, phimosis can also be dangerous. Especially in weakened children or children with immunodeficiency conditions or concomitant chronic diseases. Treatment of all complications is carried out only in a hospital. For this, the baby is hospitalized in the urology department.

A fairly common complication of phimosis is paraphimosis. This pathological condition is characterized by the appearance of infringement of the glans penis by the foreskin. Most often it occurs during attempts to forcefully open it. Quite often recorded in children aged 7-10 years.

Paraphimosis is accompanied by the appearance of severe pain, which brings significant discomfort to the child. This pathological condition requires emergency treatment in a hospital setting.

Organs in the intimate area are very sensitive to any infections. The spread of the inflammatory process leads to the inflammation spreading to neighboring anatomical formations. A fairly common complication in this case is urethritis. This pathological condition occurs due to the fact that bacteria enter the mucous membrane of the urinary tract. Urethritis is accompanied by the appearance of various unfavorable symptoms: difficulty urinating, pain when going to the toilet, pain in the groin area and lower third of the abdomen.

It's important to note that physiological phimosis does not affect conception. This pathological condition goes away on its own by school age.

Only complicated variants of phimosis can cause difficulties in conceiving a child in the future. However, this happens extremely rarely. Treated phimosis does not pose problems in the future for planning children.

Treatment at home

Self-therapy should be carried out only under the close supervision of specialists. Typically, such home treatment comes down to following all medical recommendations, as well as proper hygiene procedures. All manipulations must be carried out in a fairly gentle manner. Daily hygiene should be monitored from the very first days of a child’s birth. It is also worth gradually accustoming your baby to this.

Some doctors practice a method of gradually opening the head of the penis. This is done gradually, no more than 0.5 -1 mm per day. All movements should be smooth and of low intensity. They are usually performed after a warm bath, when the pelvic floor muscles are as relaxed as possible. As an auxiliary therapy, various ointments are used that were prescribed by a doctor.

You can add various ready-made antiseptic solutions and decoctions of medicinal herbs to the bath that is carried out before the procedure. The following are ideal remedies: chamomile, calendula, a weak solution of potassium permanganate, sage and others. Such baths are prescribed 2-3 times a week for 10-15 minutes. The water temperature should be pleasant and not cause discomfort to the child.

After the procedure, the foreskin should be lubricated with a special medicinal ointment, which will be prescribed by the doctor. These medicines have good wound healing and regenerative properties. Such home treatment should be carried out only with the mandatory supervision of the treating pediatric urologist.

Drug therapy

To eliminate adverse symptoms, doctors prescribe various medications. According to their mechanism of action, they can be different: anti-inflammatory, wound healing and regenerating, improving blood circulation, analgesic. The choice of treatment regimen depends on the pediatric urologist. In children under 6-7 years of age, active therapy is not carried out. Preference is given to conservative methods performed in gentle ways.

Doctors prescribe various ointments and creams as local treatment. They are usually applied to the skin in the foreskin area after a hygienic bath. “Diprosalik”, “Miramistin”, “Levomekol”, “Akriderm” help prevent secondary infection and promote rapid tissue healing. These agents have an excellent antiseptic effect, which is necessary to prevent complications of phimosis. Hormonal ointments and products containing antibiotics must be prescribed by a doctor according to strict indications. Independent use of such drugs without consulting a doctor will help to significantly aggravate the course of the disease, since these drugs have a number of side effects with long-term use.

Typically, tetracycline ointment is used to treat pathological conditions. The dosage, frequency and duration of use of this drug is determined by the attending physician. All antibacterial drugs are prescribed as a course of treatment. During treatment, strict monitoring of the effectiveness of the prescribed therapy is required.

Hormonal drugs are prescribed for cicatricial phimosis, as well as in cases where previous therapy is ineffective.

Hydrocortisone ointment and Fluorocort have a pronounced anti-inflammatory effect, heal small wounds and cracks in the skin, and also help improve the exposure of the glans penis. Hormone therapy is also used in a course. With long-term use of medications, adverse systemic and local side effects may occur.

In children under 6-7 years of age, in most cases, only conservative therapy is performed. As a rule, it helps to improve the condition and reduce adverse symptoms. This treatment leads to cure in more than 90% of cases. In situations where conservative therapy is unsuccessful, various invasive techniques and even surgeries are used.

Surgical treatment

Today, there are several methods of surgical treatment of phimosis. These include both very common methods and those used only in some countries. In some states, a number of operations are not carried out for ethnic and spiritual reasons. In any case, the choice of treatment tactics remains with the attending physician and must be agreed upon with the baby’s parents.

Operations can be carried out in the traditional way. In this case, the surgeon incises the foreskin and makes axial cuts on it. All excess skin is removed. The doctor then stitches the foreskin sections together. This contributes to a pronounced expansion of the opening of the glans penis. It is easily exposed without pain. This operation is performed under anesthesia.

Another fairly popular method of surgical treatment is considered Shkloffer operation. In this case, the foreskin is excised in a zigzag manner. Then the edges of the wound are sutured. This technique also allows you to excise excess areas of skin that significantly interfere with the movements of the glans penis. This operation is usually performed under local anesthesia.

Circumcision is a fairly common procedure around the world. The prerequisites for its implementation are usually not only medical. Circumcision of young boys is also carried out for spiritual and ethnic reasons. This procedure is painless if performed on very young patients. In older children, it must be carried out with mandatory preliminary anesthesia.

One of the most minimally invasive procedures today is excision of excess skin using a laser. This technique is quite safe and can be used even in pediatric urological practice. During this procedure, the child experiences virtually no complications.

The laser allows you to minimize blood loss, reduce the risk of developing postoperative scars and long-term adverse effects.

In outpatient settings, pediatric urologists resort to excision of various adhesions using probes. This technique will have a positive result only when carried out in children with mild forms of uncomplicated phimosis. No type of anesthesia is usually used for this procedure. The doctor inserts a special medical metal instrument - a probe - into the space between the foreskin and the glans. By making movements of small amplitude, the probe “opens” the anatomical zone.

In the first month after surgery, all active physical activity is limited. Special restrictions are imposed on sports where there may be injuries. Walking in the fresh air is a good option for physical activity in the first month after surgery. Active games can also be present in the baby's daily routine. The expansion of the physical regime is carried out systematically, under the supervision of the attending physician.

To quickly heal damaged tissues, doctors prescribe various anti-inflammatory ointments. They are usually used topically 2-3 times a day. They are applied to the skin of the foreskin, and in some cases to the head of the penis, after daily hygiene procedures.

To improve the absorption of medications, leave the medications on the skin for a few minutes until completely absorbed.

Prevention

The main task with phimosis is to prevent various infections from getting under the skin of the foreskin and on the head of the penis.

Prevention of secondary infection is an important goal in this pathological condition.

To do this, you should use the following tips:

• Carry out regular hygiene procedures. For this purpose, special children's cosmetics are suitable that do not contain alcohol or aggressive perfumes that can cause severe allergic reactions in a child. A child should be taught to use the toilet every day from a very early age. To maintain reproductive health for many years, such hygiene procedures should be carried out 2 times a day: in the morning and before bed.

• Change diapers promptly in newborns and infants. Wearing diapers for a long time can cause various macerations or inflammation on the child’s skin. Wet skin becomes an excellent breeding ground for the development of the most dangerous microorganisms.
• Get checked regularly by a urologist. If your child has urological diseases, visit the doctor at least 2 times a year. Be sure to discuss with a specialist the tactics for future treatment and monitoring of the baby.
• Avoid complications of chronic diseases. Concomitant diseases of internal organs can significantly aggravate the course of pathological conditions in the intimate area. Compliance with the recommended regimen, optimal healthy nutrition and active physical activity contribute to the baby’s good health and strengthen his immunity.

To learn what phimosis is in a boy, see the following video.

By the time of birth, the boy’s genital organ is in an immature state. The development and growth of the penis continues until puberty.

A newborn baby’s foreskin is long and has a narrow tip, that is, signs of congenital hypertrophic phimosis in newborn boys are normal (does not require treatment).

Retraction of the tip is impossible due to the fact that a sufficiently narrow opening may not allow the head of the penis to pass through, and the mucous surface inside the foreskin is fused with the mucous membrane of the head outside. This phenomenon may be misdiagnosed as phimosis.

The foreskin, fused to the glans, usually separates by age 5, sometimes this process is delayed and does not end even by puberty.

By the time a boy becomes a man, the opening of the foreskin widens and the penis becomes larger. The membrane connecting the glans to the foreskin dissolves, causing them to separate from each other. The head is easily removed, and the foreskin becomes mobile.

Fusion of the foreskin with the glans penis - a phenomenon normal for newborns.

Achieving mobility of the foreskin does not need to be forced; everything will happen by itself by the time of puberty.

How does maintaining hygiene help?

Maintaining hygiene during phimosis can reduce the risk of inflammatory processes which can lead to scarring.

The cause of inflammation is the accumulation of particles of urine and smegma between the head of the penis and the inner surface of the foreskin. If hygiene is not maintained, this area becomes an excellent breeding ground for bacteria.

Therefore, it is so important to maintain intimate hygiene in boys with phimosis correctly:

• do not abuse medications and various solutions for washing;
• carry out hygiene procedures regularly: at least once a day;
• when washing the boy’s genitals, do not stretch the foreskin too much;
• change the child’s panties every day, wash clothes with special baby powders or soap, be sure to iron them on both sides;
• immediately after bathing, lubricate the genitals with zinc-containing ointment for prevention.

How are intimate organ allergies and phimosis related?

Allergies to intimate organs can occur due to:

• exposure to intimate hygiene creams that irritate the skin;
• improper hygiene;
• reactions to washing powder used to wash children's clothing.

Allergic reactions can lead to inflammatory processes in the glans penis and, as a result, to phimosis.