Phimosis (from the Greek. phimosis - remove the skin, compression) is a narrowing of the foreskin that prevents the removal of the head of the penis. This state is the norm for the smaller of the representatives of the stronger sex, however, it becomes the pathology, persisting beyond the law of time. We will try to understand, where the border between the two states.
To understand the problem of the phimosis, let us recall the features of the anatomical structure of the prepuce of the "dignity of man".
The penis (or the penis consists of the body, the head and the root. The head of the penis hidden in the skin - the foreskin (prepuce), which the adult man is moved easily, revealing the glans. The foreskin consists of two jobs: outside, which does not differ from the skin of the majority of other parts of the body and interior, tender, and soft, reminiscent of mucus. Between the head and the inner leaf of the foreskin is no preputial space (another name - preputial of the bag). In this cavity stands out the secret of the glands under the foreskin and form a special lubricant (smegma), through which it facilitates the sliding of the head. Of the bottom surface of the penis the foreskin connects to the head flange foreskin - fold of skin, in which lie the vessels and nerves. In the head there is an outer opening of the urethra.
In newborns carrying the head of the penis spliced with prepuce, are a kind of points that do not allow the free exit of the crown. This feature is physiological - a kind of defense mechanism, to reduce the likelihood of infection in the preputial space and the development of inflammation and is called physiological phimosis. For children 3 to 7 years, the physiological phimosis is totally normal! Statistics show that the age of 1 year the head of the penis is opened 50% of the children, and 3 years of life - already in the 89 %. The frequency of phimosis 6-7 years of age is 8 %, and from 16 to 18 years of age of the young is only 1 %.
As the growth of the head of a member slowly pushing prepuce, physiological sinehii are destroyed. Well, and in the period of puberty, from 12-14 years of age, when activating male sex hormones that make the tissue of the foreskin is more elastic and extensible, the head opens completely.
Physiological phimosis does not require any treatment, but forces parents to pay close attention to the state of the external genitals of a child. The status of the head of the penis and foreskin preputial of the bag (the space) is easier to control for the time they spend cleaning, and then, when the baby is urinating. If the flesh of his foreskin is swollen and reddened, and the child of the thing extends handles in the causal place (and even more if it is difficult for the evacuation of the urine), it is necessary to consult with the child back, and if they do not, no child surgeon or urologist.
Upon phimosis as a medical diagnosis (that is to say, patalgico a narrowing of the foreskin) begin to talk in a while take out the head of the penis can not be the child after 6-7 years.
Phimosis, depending on the condition of the skin of the foreskin, which may be atrophic and hypertrophic. When atrophic phimosis the foreskin is very thin, and very susceptible to microtraumas, as a result of which scars are formed. When hypertrophic prepuce, on the contrary, quite fat, and in the form of "siphon" away protrudes from the edge of the head of the penis.
In addition, the phimosis is accepted to distinguish degrees. Depending on the severity of narrowing of the foreskin, distinguish 4 degrees of phimosis:
- 1 degree. In the quiet (relaxed) state of the head of the penis is naked without problems, and when it is erect it requires a little effort.
- 2 degree. When the erection of the head does not open fully, in a state of tranquillity - with the effort.
- 3 grade. The head of the penis, or does not open completely, or this is only possible with great effort and only in a state of tranquility in the penis, however, urinary problems phimosis does not occur.
- 4 grade. When you urinate first swollen preputial of the bag, and then the urine in a thin stream or drop by drop) separates out. The head of the penis is not yet able to disclose.
The main causes of phimosis are:
- The genetic predisposition to the formation of phimosis as a result of the shortage elastic component of connective tissue in the body;
- The injury to the penis, as a result of which it is possible to the formation of scar tissue leads to a narrowing of the foreskin;
- Inflammation of the foreskin of the penis, also leads to cicatricial changes.
It should be noted also, that the of phimosis is a factor in the development of narrowing of the foreskin. The case is that if there is even a small narrowing occurs continuous trauma work foreskin when you discover the head. This happened especially in the period of puberty and the onset of erections. When the erection occurs an increase in the size of the head and the body of the penis, which causes the extreme tension of the flesh and of the education in her micro-breaks. In the process of healing in places of micro-cracks will form in the scar tissue, not the traction, which leads to the progression of the phimosis.
That dangerous phimosis
Given that the phimosis several difficult body hygiene, when it is not enough to the thorough care of your baby, it is possible stagnation of smegma. Unfortunately, it is an excellent breeding ground for bacteria, which, in turn, may cause the development of inflammatory processes. In addition: the prolonged stagnation, it is even possible that the formation of dense formations - smegmatis (literally, "the stones of smegma").
Especially dangerous phimosis 4-degree, of which there are obstacles to the flow of urine. The increase of the pressure in preputial bag at the end of the act of urination, when reducing the pressure in the bladder, which leads to the return of the stream of urine and dissolved smegma by the canal of the urethra. This leads to a development of infectious complications in the urethra.
The complications of phimosis
In general, the main danger is not the phimosis, and its complications. The most terrible of them is paraphimosis - infringement of the head of the penis restricted to the foreskin in a violent opening. This can occur when the family or the child itself, which is called "got game" - have uncovered the head, and return the foreskin in place were not able to. Paraphimosis can also occur, and later in life, with sexual intercourse or masturbation. Violation leads to the swelling of the head of the penis, which at some point makes the reduction impossible. As a result of the decrease of the circulation head turns blue, and becomes sharply painful. And if you don't provide emergency assistance, may occur assumed by the mortification (necrosis) of the head, leading to the amputation.
As you know, to provide assistance in this case, can only physician. Immediately call the "ambulance"! The delay, as an attempt to tackle this problem yourself, which lead to loss of valuable time and serious consequences.
Dangerous complication of phimosis can be balanoposthitis - inflammation of the foreskin and the glans of the penis. Develops l when the breach of the genital hygiene and infection preputial space. The possibility of getting sick the balanopostitisom increases in children with less immunity or in the background of other infectious diseases. Inflammation of the foreskin is characterized by swelling, redness (hyperemia), pain, discharge, purulent of preputial space. The result of the inflammation can be the scar to the rebirth of the skin of the foreskin and, as a consequence, the development of phimosis. Balanoposthitis is a disease that require urgent medical assistance. The doctor inserts the special of the probe between the head of the penis and the skin of the foreskin, gently separate the sinehii, so that the conditions are created for the outputs, trapped pus.
Another complication of phimosis, requires an immediate treatment to a doctor - acute urine retention. This condition is more common in young children and carries reflector nature, as a reaction to the pain. The child for a long time unable to urinate, is restless, complains of pain in the belly and above the vagina, where detectable increased the bladder. In the process of treatment baby give painkillers to the pain, do a cleansing enema (bowel full of faeces, it is also not to be missed, and not difficult to the flow of urine), and then make a good bath with potassium permanganate, during which the child tries to urinate. If this does not work, the urine sample with the help of a catheter.
A complication of phimosis 3 and 4 grade, can also be the increment of the foreskin to the head. As a general rule, first when this adheres to a small plot, and then size of the adhesions and expands, and finally the flesh of his foreskin adheres to the head of his penis in all its extension. When I try to open the head accompanied by cutting pain and blood. This situation is not urgent, but to run what should not be. The increase of the foreskin is only possible surgical treatment. But, since when a large parcel adhesions intervention can be difficult, the sooner the problem, the easier it will be to resolve the problem.
The treatment of the phimosis
In the treatment of phimosis can be applied as conservative and surgical.
Conservative treatment phimosis
When hypertrophic phimosis, if there are no complications, it is possible to conservative treatment, which consists in the gradual improvement of the resistance to the traction of the foreskin. Manipulation can be performed by parents at home. Three times a week during the bathing with decoctions of herbs (succession, chamomile) is performed to move the foreskin up to the time of onset of the child's pain, after that in the preputial space is introduced a few drops of sterile vaseline oil. The duration of treatment is several months. The procedure should be performed with extreme care to avoid paraphimosis. The success depends on the perseverance of the parents and of the expressiveness of the phimosis.
In recent years, is used correction of phimosis hormonal ointments, they put in preputial space. Facilitate the traction of the tissues. The treatment is done by the parents when mandatory supervision of a physician.
When atrophic (scar) phimosis, conservative treatment, little efficacious. In this case, apply the surgical techniques.
The surgical treatments for phimosis
The indications for surgery are the paraphimosis expressed rubtsovie changes prepuce, the reiteration of the repetition of balanoposthitis, the violation of urination.
The fastest and most effective way for the treatment of phimosis is an operation under the name of circumcision, or the circumcision. In this procedure the foreskin is removed, which completely eliminates any problem with the exposure of the head of the penis. This operation lasts from 10 to 15 minutes, and is usually performed under general anesthesia. The foreskin cut circular (in a circle), with the conservation of the horseshoe. Outer and inner leaves of the foreskin sewn catgut (suture material, which does not require the removal of the suture, as that by itself is reabsorbed). After the operation is applied to the bandage with vaseline oil. A few hours after the surgery, the child can walk, it will be retrieved independent of urination. Circumcision is shown with any degree of phimosis.
The contraindications for the operation of circumcision are balanoposthitis, and paraphimosis.
Longitudinal dissection of the skin of the foreskin
This operation is used when the full of the circumcision is impossible. As a general rule, your help is directed to the two types of complications phimosis - acute balanoposthitis and when paraphimosis. In the first case, the longitudinal of the extreme section of the meat turn by the fact that for the opening of the inflammation of the head of the penis, you can't go to the circumcision, as the infection can lead to the insolvency of the seams. What Paraphimosis, when an acute violation of the circulation of the blood cannot pass the full of the circumcision, of the longitudinal dissection of the skin of the foreskin is still the only form of "to separate" the ring, tightening the head of the penis.
By the way, and in another case, at the end of the acute period (that is to say, when the worst has already happened), doctors may recommend circumcision, which is going to have as non-medicinal and cosmetic value.
Prevention of phimosis
The development of phimosis in large part by a genetic predisposition, therefore, radical measures of prevention of this disease, medicine can not provide. But we can speak about the prevention of complications related to phimosis. Here the first and most important hygiene.
In the period of the childhood of the proper hygiene is limited to diary of a excellent swimming pool annexed to the child and cleaning up after the baby will stain the diaper or diapers. During the bath, under the foreskin falls in the water, which naturally washes accumulated secret. Not less than once a week you should wash the penis and scrotum with soap and water. To do this, it is best to use the baby soap or special children's tools for the bathroom. Not recommended for the daily application of germicidal soaps or gels. If it is frequently used can alter the normal balance of the microbial, necessary for the health of the skin.