Balanitis in children

Balanitis is when your child’s foreskin or head of the penis becomes inflamed, which can cause pain and redness in the genital area.

Inflammation of the foreskin often resolves itself in a few days, but occasionally it can become a recurrent problem. If you think your child is experiencing balanitis, our paediatric urology team are on hand to provide accurate diagnosis and treatment.

What is balanitis?

Balanitis is when your child’s foreskin or head of the penis becomes inflamed, which can cause pain and redness in the genital area.

Balanitis affects children of all ages, but it is particularly common in those under the age of four. It is also more common in children who haven’t been circumcised since it is much harder to keep the head of the penis clean when it is covered by the foreskin.

Inflammation of the foreskin often resolves itself in a few days, but occasionally it can become a recurrent problem. If left untreated, it can lead to issues such as pain, irritation and even scarring. There is also a risk that the infection could spread.

If you think your child is experiencing balanitis, our paediatric urology team are on hand to provide accurate diagnosis and treatment.

Types of balanitis

Balanitis is usually divided into two categories — ‘bacterial balanitis’, which refers to an infection that is caused by bacteria, and ‘candida balanitis’ which refers to a fungal infection similar to thrush.

Occasionally balanitis could be superimposed on BXO (Balanitis Xerotica Oblitrans), a progressive scarring condition of the foreskin which could lead to severe trouble with blockage of micturation.

How long does balanitis last for?

Balanitis usually goes away by itself within a few days.

However, if your child has recurrent episodes of balanitis, the symptoms don’t resolve themselves or get worse, you should schedule an appointment with a urology specialist for medical advice.

Balanitis and phimosis

Recurring balanitis in children has been shown to increase the risk of a condition called phimosis at a later age.

Phimosis occurs when the foreskin becomes too tight to retract. Depending on the severity of the condition, it could require surgery to correct it.

Balanitis symptoms in children

The most common symptom ofbalanitis in children is pain and discomfort affecting the penis. The type of discomfort can vary from itching, soreness and tightness, to a dull ache or more severe pain.

Other symptoms of a foreskin infections in children include:

• a tight, swollen foreskin that is difficult/impossible to retract
• redness
• difficulty passing urine
• pain when passing urine
• whitish spots on the penis
• itchiness
• an unpleasant smell
• a build-up of thick fluid

What causes balanitis in children?

Balanitis is very common in children who have intact foreskin and most of the the time is self limiting.

In most cases, this appears as mild redness that resolves itself quickly. However, true balanitis causes many more symptoms and is only prevalent in around 5% under the age of five.

It’s not always possible to determine what causes balanitis, but several factors are thought to make it more likely. These include:

• nappy rash
• poor hygiene, which can lead to a build-up of bacteria under the foreskin
• irritation caused by urine that hasn’t dried after peeing
• irritation from soaps, shower gels or other products
• bacterial or fungal (yeast) infections
• skin conditions, such as eczema or psoriasis
• diabetes

Diagnosing balanitis

Most cases of balanitis are mild and resolve easily, with little to no symptoms at all. However, if severe balanitis is left untreated, there is a risk that the infection can spread into the urinary tract system and cause further problems.

Fortunately, balanitis causes symptoms that are fairly easy to recognise. Your child may tell you that they are experiencing these symptoms, or if you are supporting them with things like toileting and bathing, you may be able to see symptoms yourself.

Our paediatric urology specialists can determine if your child is experiencing balanitis by learning about the symptoms your child is experiencing, along with an examination of their penis.

In some cases, a sample of urine or discharge may be taken so that it can be checked for signs of a bacterial or fungal infection. This will help determine which treatment will be recommended if any.

Balanitis treatment

The most straight forward way to treat balanitis is to improve the hygiene of the penis.

Depending on the age of your child, the responsibility may fall to you. The penis should always be kept as clean and dry as possible. Wash the foreskin in lukewarm water only — there is no need to use soap as even non-perfumed varieties can irritate. Teaching your child this habit could prevent them from developing balanitis and other issues as they get older.

It’s also useful to teach your child to dry the head of his penis gently after peeing. This helps to prevent moisture from becoming trapped under the foreskin, which could lead to irritation and soreness.

If your child’s balanitis is a result of a bacterial or fungal infection, they may be offered antibiotics or an anti-fungal cream. This should always be applied exactly as directed, and you should ensure that your child completes the entire course of treatment. This will help minimise the risk of the infection returning.

In some cases, if there have been multiple episodes of moderate to severe balanitis, circumcision surgery may be recommended. Circumcision isn’t only performed for religious reasons, it can also be an effective treatment to reduce the risk of balanitis coming back again.