How effective is hydrocortisone for phimosis

Constriction of the foreskin

Constriction of the foreskin(Phimosis): Acquired or congenital disease of the penis in which the foreskin is so tight that it causes discomfort.

About 3% of all boys are affected. Foreskin constriction is the most common cause of foreskin inflammation in childhood.

Leading complaints

  • Discomfort when urinating, "ballooning" of the foreskin, thin stream of urine
  • Pushing back the foreskin is difficult or impossible
  • Recurring foreskin infections.

When to the doctor

On occasion if

  • You suspect your son's foreskin is too tight.

In the next few days if

  • your son's foreskin puffs up like a balloon when urinating or the urine stream seems very thin to you.

The illness

Disease emergence

In male babies, the foreskin is glued to the glans and cannot (and should not) be pulled back. With this trick, nature protects the sensitive glans during the "diaper phase" from the effects of the rather aggressive urine. By around the third birthday this bond loosens slowly, but not in every case completely.

In individual cases, the complete solution takes considerably longer, and some boys are only able to slide the foreskin behind the glans without problems when the first sex hormones loosen the foreskin at the onset of puberty. This is not a disadvantage: the full mobility of the foreskin is only required during sexual intercourse, and regular cleaning of the glans is also necessary at the onset of puberty at the earliest, as the sebum-like smegma then forms on the foreskin.

Sometimes, however, the foreskin is so tight that it can hardly or not at all be pulled back behind the glans even in pubescent boys. This leads to pain or difficulty urinating - recognizable by the fact that the foreskin puffs up like a balloon when you pee.

causes

Congenital phimosis results from an opening in the foreskin that is too narrow or from adhesions between the foreskin and glans.

Acquired phimosis is caused by scarring of the foreskin caused by repeated inflammation or certain skin conditions.

Complications

The narrowing of the foreskin also promotes the development of painful inflammation of the foreskin and the glans, as bacteria easily get under the foreskin. Balanitis can be recognized by the fact that the tip of the penis is red, and it is extremely painful and slightly swollen. If pus accumulates under the foreskin, the boy will have severe and burning pain even when urinating. One speaks of an inflammation of the foreskin and glans if the glans is also affected.

Pathological phimosis. Attempting to forcibly push back the foreskin on a young boy to speed up the dissolution process or to wash the glans should never be attempted, as this is not necessary in children. This leads to tears and as a result to scarred constrictions of the foreskin. The pathological phimosis also occurs as a result of recurring inflammation under the foreskin (balanitis), especially if the boy has previously suffered from purulent balanitis.

Paraphimosis. If the foreskin is very tight, there is a risk that it can just be pushed behind the glans, but not back. This paraphimosis, also known as the "Spanish collar", must be treated immediately by a doctor, as the resulting ring interrupts the blood supply to the glans.

Urinary retention (Urinary retention, urinary retention). Here it is no longer possible for the boy to urinate. Such urinary retention is an emergency and requires admission to the children's clinic.

Diagnostic assurance

In general, a foreskin examination should only be carried out by a pediatrician. In doing so, he checks whether the foreskin can be pushed back completely or at least partially over the glans and whether a lace ring may form.

treatment

Only pathological phimosis needs to be treated. Otherwise, the following applies: If the boy has no complaints, it is best to wait. No treatment is necessary for babies. The rule mentioned earlier, that you should wait until your third birthday, is not scientifically proven: Usually, a tightness in the foreskin that still exists afterwards resolves by itself until puberty - but no later than the age of 17.

Conservative treatment

If the phimosis is disturbing and there is only a narrowing without complications, the doctor relies on conservative therapy. Here, the foreskin is carefully widened by daily stretching exercises.

A cortisone-containing ointment may be applied to the area of ​​the glans that is now exposed. Then the foreskin is pulled forward again. This treatment works for most boys. However, the likelihood that the foreskin will narrow again later is not all that small. Then the treatment is repeated, in each case with the application of an ointment containing cortisone.

Operative treatment

If the treatment of the phimosis with the cortisone-containing ointment is unsuccessful, if it is a paraphimosis or a pathological phimosis, or if the following problems occur, surgical therapy is necessary:

  • Obstruction of the flow of urine, recognizable by a balloon-like inflation of the foreskin when urinating
  • Bloody urine
  • Recurring foreskin infections
  • Frequent pain.

The operation - usually under general anesthesia - consists of circumcision, i.e. circumcision. H. removal of the foreskin. The foreskin is partially or completely removed. With a partial circumcision, there is a risk that the remaining foreskin will narrow again after a while. If the foreskin is completely removed, the glans is then exposed, which means that there is no further phimosis. In uncomplicated, non-scarred cases, minimally invasive surgical procedures are increasingly preferred. The foreskin is largely preserved, as it is only incised and then sewn lengthways.

Treatment complications

Nowadays, circumcision is a routine procedure, but around 2 out of 100 people subsequently suffer from symptoms that may require follow-up treatment:

Bruising. Often bruises develop on the penis after the operation, but these are harmless and usually go away on their own after a while.

Bleeding or inflammation of the surgical wound. These complications usually make follow-up treatment necessary.

Renewed narrowing of the foreskin. If the foreskin is partially removed, there is a risk that it will narrow again after a while. A second and then complete removal is necessary here.

Your pharmacy recommends

What you can do as a parent

Patience.

If you have phimosis, you should be patient because it sometimes lasts well into puberty. As long as your son has no complaints: wait - and a visit to the pediatrician is not necessary either!

Authors

Dr. med. Herbert Renz-Polster in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections "Description", "When to see the pediatrician", "The disease", "Confirmation of diagnosis", "Treatment" and "Your pharmacy recommends": Dagmar Fernholz | last changed on at 16:12


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.