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Children's Health

2 Year 11 Month Old Boy in Pain Holding Penis

11/30/2010

Question:

My son screams in acute pain and rolls around on the sofa holding the area of his penis. He`s in nappies and can`t yet talk. He`s not potty trained. He has been on movicol because it was thought he was constipated but his abdomen shows no signs of retention. He only poos at night in his sleep. The penis/scrotum area isn`t red or inflamed. Any ideas please?

Answer:

This is certainly a distressing situation for you and your child! I would recommend first checking to see if there is thread or a strand of hair wound around your son's penis such that it is restricting urine flow or causing pain from constriction of the tissues. If you are using bubble bath or any bubbling bathing product in his bath water, stop using it. Perfumed bathing products are frequent causes of urethral (the tube that carries urine from the bladder to the external opening of the penis) irritation causing burning and pain with the passage of urine.

Testicular torsion is an emergency condition in males of all ages. It may come and go. In this condition, the testicle twists on the spermatic cord and pinches off both the nerves and blood flow to the testicle. Exquisite pain, nausea and vomiting often mark this problem. It is essential that males receive prompt surgical care to untwist the spermatic cord and save the testicle.

A painful but non-emergent condition is torsion of the appendix testis, a small area of tissue lying on the top of the testicle on each side. The small bit of tissue may twist on itself. Because it serves no useful function, the tissue is allowed to die off and is eventually absorbed away. No treatment is needed other than pain relief. The pain usually subsides in about three days.

A bowel problem called intusussception, a condition in which a section of small bowel is trapped inside the large bowel restricting blood flow to the trapped bowel segment, may also come and go and produces acute pain which may be referred to the groin and scrotum. The pain is acute causing children to draw up their knees and this pain may also be referred into the groin and genitalia. Non-surgical reduction is successful for over 90% of affected children. Failure to treat may cause widespread infection in the abdomen and lead to loss of large parts of the bowel.
 
Of course, a urinary tract infection (UTI) also causes pain with urination. Males who are not circumcised are at greater risk for a UTI than are circumcised males. This is a condition easily treated with antibiotics. 

As you can see, the possible causes of acute pain in the genital area for your son range from the minor to the emergent. Thus, the best action to take is a visit to the child's doctor for a thorough exam. If you observe any swelling or discoloration over his testis on either side or if he passes jelly-like red stool, it would be best to take him immediately to the nearest children's hospital for possible surgery to correct a significant problem.

I hope this information is helpful and that the problem resolves soon and safely.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University