Prepuce is the Skin surrounding the edge of the penis. In normal circumstances the fore skin can be retracted and thereby exposes the external urethral meatus. In such situations the urine flow would not be hampered nor would it cause much difficulty for the baby.

The problem occurs when the Retraction of the skin does not happen and most often the skin and the surface layers of the penis is attached tightly resisting against the retraction. The outcome of this would be a tight and relatively small meatus at the edge of the urethra.

The last line of treatment and the most effective of all would be to separate the two layers of skin and excise the excess skin thus allowing the urethral meatus to be full exposed as well as relieve the resistance towards skin retraction. Prior to arriving at a decision to do the circumcision as it is called, several methods will be used in order to relieve the narrowed prepuce. Some of them are,

Applying gentle pressure:

This should be done very carefully and can be done at times when the baby is given a bath. The technique is to gently retract the foreskin of the penis and expose the tight ring. Once the ring is exposed gradual, sustained though gentle pressure should be applied without causing any discomfort to the baby. Once or twice a day would help in slowly separating the layers and allow full retraction of the fore skin.

Steroid cream:

This will gradually make the adhesions between foreskin layers dissolve and gradually ease the retraction. The application can be done once or twice a day according to the advice given by a paediatrician and can continue to be applied for about 2 weeks before a result can be seen.

The downside of applying these kinds of creams would be its effect of making the skin thin at the site. This would in rare instances lead to ulceration of the site and much more distress to the baby than the narrowing of the prepuce.

Antibiotic ointments:

When narrowing of the prepuce is present there can be collections of dead cells, urine and other substances within the tight ring and the foreskin adhesions. This can give rise to perfect culture medium for the bacteria to grow. If this happens the baby will suffer recurrent urinary tract infections and even kidney damage. To prevent this from happening, the paediatrician, if indicated, will recommend to use a antibiotic ointment to be applied to the narrowed prepuce and the fore skin.

In any of the above instances, when the fore skin retraction is done always remember to pull the skin back to what it was earlier.

Keeping the area cleaned:

If narrowing of the prepuce is present, it is always best to give fullest attention to cleaning the area with soap and water when ever the child passes urine. This will prevent the organisms from getting collected as well as urine to remain at the site.

Although these methods can be tried, in some instances the outcome might not be that positive. It's always best to follow your paediatrician's advice and never try various methods of unproven benefit by yourself.