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Urinary and Genital Disorders (Children)

Penis pain due to constipation?

03/30/2011

Question:

Our 5 year old has been complaining that his penis tip bothers him all the time, and not during urination. He does clarify to us that it does not hurt, it "bothers" him all day and night. We took him to a urologist which diagonosed him with constipation and meatal stenosis (No infection and urinalysis negative). We agreed that it sounded like it could be constipation. We have been on laxatives and stool softerners for over three weeks now. We expected to see the "irration" reduce by now, but it seems to be worse. He is crying all the time (melt downs) and taking naps which he has not done since he was three. He is so out of sorts with this "irration". We need help, is there anything else we can do for him. (We have also tried motrin and tylenol with no relief). Thank you for your help!

Answer:

If there is any active inflammation and irritation at the tip of the penis at the opening of the urethra (called the meatus), the diagnosis is called "meatitis". This often responds to topical steroids (like hydrocortisone). For symptomatic meatal stenosis (small or narrow urethral meatus, a condition that can be acquired over time in circumcised boys), a simple operative procedure to enlarge the opening can often relieve the discomfort at the tip of the penis. It's called a "meatoplasty" and is performed in the operating room under general anesthesia, typically requiring less than 10 minutes. Generally a couple of small absorbable sutures are placed to keep the edges of the meatus everted during the healing process. Numbing medicine (typically lidocaine jelly) can be placed around the meatus at the conclusion of the procedure to help with any stinging with urination. A follow-up consultation with your pediatric urologist is recommended to re-examine your son and decide if a course of steroids is the first step or if surgery is indicated.

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Response by:

William Robert DeFoor, MD, MPH William Robert DeFoor, MD, MPH
Associate Professor of Surgery
College of Medicine
University of Cincinnati