The parents in younger children may notice this or the older ones may be able to vocalize and tell their parents. The boy may be straining to pass urine, have a thin stream of urine, which may fall close to his feet. The child may cry when passing urine, may pull at the penile skin after passing urine, or have a habit of rubbing the penile tip skin off and on. During the course of the day, the parents may notice that the child continuously has his hand on his penis. All these are signs of irritation, infection, inflammation of the preputial skin, which is long standing. The parent may notice a ballooning of the preputial skin before the urine stream comes out.

All these are signs of long standing infection and Phimosis: That is inability to retract the preputial skin back over the penis. The child should be shown to a Pediatric Surgeon. Once the diagnosis is confirmed, the treatment for this condition is Circumcision: This is a delicate and sensitive area that requires gentle and precise handling and suturing to give minimum pain and good result. This operation is done under general anesthesia and the child is sent home the same day. Since this a sensitive area, the boy will not be able to wear his pants or underwear for about 10 days. Healing takes only 4 days but the boy will be normal only after 15 days depending on the age at which the surgery is done. The older the child, the longer the time for total recovery. This should ideally be planned in vacation time in school going children.

Sometimes, these same symptoms may mislead you and actually point towards a more serious problem. The boy may be straining to pass urine, have a thin stream even after the prepuce is partially retracted. This could be due to an obstruction not in the terminal penile skin, but in the urinary passage or urethra. The common obstruction is caused by valves or leaflets in the urethra commonly the Posterior urethral valves.

These valves are like 2 doors, which close when the child attempts to pass urine and allow only minimal amounts of urine to pass out, the remaining is held back in the bladder. These boys need a careful and thorough investigation and evaluation before specific therapy is recommended. If the boy does not have a severe renal problem, then these valves can be seen by putting in a scope through the urethra and with special instruments, the valves can be cut without any external surgery being done. This procedure is even possible in newborns with this condition.