Help! painful urination in 2yo toddler boy- update

This weekend my son suddenly started complaining that it hurt when he urinates. He doesn't have a fever, the urine in his Pull-Ups doesn't smell unusual, and it isn't darker in color than normal. He hasn't been sick recently, moods seem pretty good and overall is eating normal ( for a 2yo anyway...[L])

He isn't circumcised and we did notice some white discharge around his penis and in his Pull-Ups. I took him to the Ped. and she said the discharge was normal - something called "Smegma" that isn't unusual to uncircumcised boys. His urine sample came back normal.

So here's the problem - he still screams and cries when he pees. Tonight he kept wanting to go to the bathroom and then would get pee shyness because he knew it would hurt. Finally, after an hour and three aborted attempts I was able to get him to pee while sitting in a tub of warm water. He cried and shook the entire time.

I know he's experiencing pain - a 2yo doesn't know how to "fake" this sort of thing. I also think the Ped. is wrong - something HAS to be going on here. Has anyone experienced this before? Any suggestions or ideas that I can point out with the Ped? We're going back to the doctor's tomorrow morning at 8am to try again.

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Hmm, no fever, and no other symptoms .... It could be a UTI, but I think it's also at least faintly possible that your DS has some adhesions breaking (either as part of the natural separation process or from past retraction), and the urine on the raw spots is really stinging. (That could explain all the smegma you've noticed lately, too.) I've heard my ILs talk about my circ'ed DH developing adhesions as a toddler -- he was in such terrible pain at times that the only way he could pee was when he was soaking in a tub of warm water with some kind of special soap. I couldn't help but think of that whenever I read your description.

A yeast infection is also a possiblity, although I'd think you'd notice other signs as well. [shr] I can definitely understand why you're taking him back to the ped -- I think I'd get them to at least re-do a clean-catch urine sample to check, and a culture of any discharge, if possible. I hope they can do something to make him more comfortable, at any rate. [hug][#]

Update-

Monkeysee - you were pretty close. There's still no sign of UTI, after a second look the Ped. decided that we were probably looking at a sore spot under the foreskin that developed after the eruption of smegma (he likened it to something like the sore spot that develops after a pimple erupts). That in itself can cause some pain, but with some additional observation we noticed that the tip of my son's penis swelled some before he was able to pee. Also, he'd try to go and sometimes only a drop or trickle would come. These things led to the theory that he may be dealing with phimosis as well. After talking to the Ped I believe I understand that an aspect of phimosis can include a foreskin that's too tight to let urine flow easily through the tip of the penis.

Apparently phimosis isn't unusual for uncircumcised infants/toddlers. By itself it's not much to be too concerned about - naturally over time the foreskin retracts on its own - typically by 5 yo is what I think I was told. For many children it isn't even noticeable by parent or child.

When we combined the sore spot under the foreskin with the possible phimosis an infection probably developed leading to the pain every time he urinated (my guess is that because the flow of urine was slowed due to the tight foreskin/smaller hole urine may have been able to come in contact with the sore spot because it sort of "backs up" as it slowly is expelled.)

My son is now on antibiotics and Motrin and the pain has lessened and the swelling when he pees has decreased. We have to continue to watch for swelling and pain. If it continues we'll go see an urologist.

[hug][hug] poor little guy - glad you got some answers!

I agree with Em. Phimosis is normal and expected in a child of that age -- it keeps things like poop out of the foreskin. Smegma doesn't really erupt just out of nowhere -- it is always there, even if you're just seeing it now, and is very healthy and wouldn't cause a sore.

What I'm guessing has happened is that he is starting the separation process and a normal adhesion released, causing a slightly sore spot that should resolve itself, but might sting a tad when urine touches it. Sounds like a normal part of the separation process to me and I'm guessing it will be fully resolved in a couple of days.

I'd wonder if the only peeing a drop or two might be related to him being afraid to go due to the stinging. I'd do some extra baths. You wouldn't see the first sign of truly problematic phimosis randomly at this time, I think, and I'm told you'd expect to see external signs of an infection, unless it was a UTI. Seeing the smegma for the first time may be another indication of an adhesion releasing -- sometimes smegma "pearls" work to the surface and the foreskin could have released enough for it to be visible for the first time. [hug]

Thanks for the additional information. We're continuing to keep a watchful eye....

I know this is an old thread, but I just wanted to know the outcome of your situation.  My son is 2 1/2 and he has had the same exact issue for 14 days now.  We're on our 5th doctor, who is a Urologist, and we still don't have an answer.  We're now waiting for our appointment to have an ultrasound on his kidneys and bladder, but I don't think the issue is there and it is killing me that he is still having this issue! 

I know this is an old thread, but my 2YO DS is going through the same thing, I think.  For the last two days his penis is swollen and red, with lots more smegma than usual, and the foreskin will hardly retract at all.  It doesn't seem to be bothering him (yet) and he's peeing just fine, but he doesn't like me to touch it at all.  I'm putting vaseline around the tip to keep it from rubbing on his diaper.