Baby Care After Circumcision at Gentle Procedures Perth
Baby Care After Circumcision at Gentle Procedures PerthPerth Clinic2020-02-06T04:25:30+11:00
Common Post Circumcision Concerns and Questions
We understand that parents will have concerns and questions in the days after a baby boy’s circumcision. Please see the detail below for information on how to care for your baby post-circumcision, and do not hesitate to contact us with any concerns that you feel require Dr. Newton’s attention.
How to care for your son in the first 24 hours following the circumcision:
Keep your son snugly swaddled (especially his legs). The more he kicks his legs, the less comfortable he may be. After the first day, you no longer need to swaddle him but can continue to do so if he finds it comforting.
This image shows initial application of the gauze with Vaseline. Replace it if it falls of in the first 24 hours. The image also shows the long gauze and bandage around the penis that will be removed in 24 hours, or if it falls off earlier you may leave it off.
There will be a square white gauze with Vaseline placed over the head of your son’s penis. Leave the gauze in place and remove it only after 24 hours. If it has fallen off, replace it with a fresh 3×3 dressing with some Vaseline on it and put it over the penis then close the nappy.
Please check your baby’s nappy every hour for the first 24 hours to look for any abnormal bleeding.
If the white gauze over the penis is soiled with urine don’t worry just leave it alone. If it is soiled with stool, remove the gauze gently and rinse his bum with warm water and replace the gauze with Vaseline on it.
There will also be a long piece of gauze wrapped around your son’s penis. Leave this gauze in place for 24 hours as well. If it falls off earlier, don’t worry just leave it off. If it is dry or stuck when you are trying to remove it after 24 hours, you may need to pull slightly harder and expect that there may be a little bleeding when you do this. This is normal and you may need to apply some direct pressure on the head of the penis as we taught you in the clinic. You may use some warm water to wet the dressing to help remove it. If there is some bleeding, maintain firm pressure for 3-5 minutes.
No gauze bandages are required after the first 24 hours, just ointment.
For the following weeks after circumcision, put a generous amount of Vaseline on your finger and rub it over the incision site placing a thick layer of ointment over the entire head of the penis.
Here you see a part of the mucosa attaching to the head of the penis. This is an example of “bridging” that requires a simple adjustment by our doctors.
It is important to push the skin down off the head of the penis if it has moved up a little to ensure it heals properly just behind the back rim of the head. Do not do any pushing on the skin for the first two days because it will be swollen from the surgery. It is important to avoid mucosal adherence (see image) and skin bridging, which results from the mucosa and skin, respectively attaching to the head of the penis. If you are unsure of the appearance of your son’s penis, bring him to see our doctor, and we will adjust the skin for you if required.
Most babies like to nurse in a quiet environment following the circumcision. A baby who cries for more than a few minutes is usually suffering from air swallowed during the circumcision and needs to be burped.
Most babies sleep quite well following the circumcision. The best sleeping position for your baby is on his side, supported by a blanket roll.
Healing is promoted by keeping the area clean and dry. Warm water and a cotton-ball or washcloth are preferred for cleaning the area around the penis. Avoid moistened towelettes, alcohol, powders, and lotion since these may irritate. Don’t bath your son before the doctor has said that it is ok to do so (generally after 3 – 4 days).
Disposable nappies are strongly recommended for the first week since they tend to be less irritating, and they help keep the area dryer and cleaner.
It is better both before and for about three days following the circumcision to restrict the handling of your baby to just a few people. Also, avoid unnecessary travel as car seats can be irritating to the new circumcision.
Healing Post Circumcision
Healing is usually rapid and occurs in several stages. Remember that a circumcision is like any other cut. There are many factors that influence healing; but most importantly, every child heals differently.
First, the cut edge seals and bleeding ceases within minutes, hours, or even over an entire day. The area just behind the glans (mainly the underside) will become swollen. This inflammation will subside within a week or two. In the first two days, there may be an off-white or yellowish, patchy appearance of the glans. These patches are a type of scab and are associated with healthy healing.
After a few days, the area where the skin was cut look green and yellow. This is NOT pus. It is healing tissue. It can look this colour for up to two weeks after the circumcision.
You will notice yellow patches on the head of the penis as it heals. This is a normal part of healing.
The head of the penis can often be purple, blue or red after circumcision. This is normal.
Circumcision Scar? – The appearance of the Baby’s Penis
A common concern for parents is aesthetics. Remember that penises come in all shapes and sizes. While most penises “look normal” within days of the circumcision, some do not take on a “completely normal appearance” until after the penis starts to grow. Furthermore, although the penis may appear smaller after circumcision, it is not! This appearance is mostly due to the relaxation of skin surrounding the penis, which before circumcision, holds the penis more erect.
After a few days to a week, some parents notice swelling of the mucosal tissue behind or under the head of the penis and believe it looks “like a blister.” This type of swelling is typical. It is not a blister, and it will gradually subside. Scarring from infant circumcision is rare, even if there is swelling in the first week.
You will notice a mucosal ring at the base of the penis head. Sometimes it is more prominent on one side than the other. This is normal and no cause for concern.
On occasion, a poor aesthetic result occurs when too little or too much skin is removed, or more likely when the cut edge of the skin attaches too high or too low along the length of the penis. The latter is sometimes caused by the presence of a hydrocele or penile erections. In nearly all these cases, the penis will heal properly, and, in time, take on a normal appearance. If you are concerned in any way about the appearance of your son’s penis, please call our Perth clinic to consult with Dr. Newton immediately.
The Pollock Technique™ is associated with excellent cosmetic outcomes. Scarring on the penis is very uncommon, but do share any concerns you have in the weeks after your boy’s procedure.
Frenulum – Band of skin underneath the penis
Sometimes parents come to us worried about a band on the bottom of the penis, fearing that it needs to be cut. This band is called the frenulum, which carries the frenular artery and is normal (see image).
It is similar to the band under the tongue (the part that is cut in some babies with tongue-tie).
You may notice a band on the bottom of the penis after circumcision. This is normal and no reason for concern.
It is not unusual for your son to sleep 6-8 hours after the procedure and to miss a feeding. Some babies will be irritable for a number of minutes to hours afterwards. Behaviorally, most babies are relatively normal after a day or two.
It is normal to use some force to pull off the gauze bandage. To make this easier, you can soak the gauze with warm water and Vaseline before pulling it off. In the end, you just may have to pull a little more firmly to get it off. Remember the direct pressure method if you observe any bleeding. See detail below.
A small amount of bleeding is normal. Take some gauze with Vaseline on it and squeeze the bleeding area of the penis with your fingers for 3-5 minutes. Repeat if necessary. Call Dr. Newton directly at the clinic if bleeding persists despite pressure.
Visible scarring on the mature penis is very rare with our circumcision method. It is normal for there to be swelling and discoloration in the week after surgery and the penis will likely take on a normal appearance over time.
For newborns, our physician will let you know at your follow-up when you can start giving your baby a full bath where he goes under water.
Post-Circumcisions Issues and Treatments
Circumcision is associated with few and infrequent complications, although with any surgical procedure there are occasional problems. For example, bleeding. In almost all cases, bleeding is controlled by direct pressure. The frequency of complications after infant circumcision varies with the skill and experience of the physician, amongst other factors.
Even though complications are rare, do not hesitate to consult Dr. Newton at our Perth clinic if you have any questions about the appearance of the penis. Remember, early treatment (if any is needed) is always best.
Keep in mind the following things:
If your child has any medical problems or significant jaundice, discuss this with Dr. Newton before giving him more Tylenol.
If you want, you can sponge bathe your baby following the circumcision, but do not submerge him in water for four days after his surgery.
If you have any other comments or questions, do not hesitate to call the office. In case of an emergency, call Dr. Newton.
Please check your baby’s nappy for any bleeding every hour or so for the first 24 hours after the circumcision. If the baby is sleeping, you can look at the front edges of the nappy from the outside. If it is not discoloured, he is likely not bleeding abnormally. When you open the nappy, it is normal for the covering gauze to be a little red from bleeding. You need to remove the gauze to check for active bleeding only if the whole gauze has become soaked with fresh, red blood. You treat active bleeding from the penis the same as you would for the tip of a finger:
Apply pressure to the penis for 3-5 minutes; no less. Do this by grasping the penis between your thumbs and two fingers using a piece of gauze with some Vaseline to prevent sticking.
After applying pressure, inspect the area for continued bleeding and repeat step one if necessary.
Once the bleeding has stopped, apply a fresh gauze square with Vaseline and close the nappy. Recheck the nappy after 10 minutes for any signs of more blood on the gauze.
It is reasonable for you to try the pressure technique twice, for 3-5 minutes at a time, before calling Dr. Newton as most bleeding will stop with this.
If the penis is dripping any blood, and you cannot stop the bleeding with the pressure technique that we have demonstrated to you, call us.
When the length of the penile shaft is no greater than its diameter or when there is a good amount of pubic fat, the penis will tend to retract inward. This is normal. This characteristic is only a concern for the first month or two since the healing circumcision can adhere to the surrounding skin resulting in a “concealed penis.”
If your son fits this profile, you can reduce the chance of concealed penis by applying a very thin layer of Vaseline to the entire glans, once a day, until the glans takes on a healed appearance (about 1-2 months). To expose a glans that has retracted inward, place gentle downward pressure on either side of the base of the penis.
Consult Dr. Newton if the penis cannot be fully exposed, or if any connecting skin bridges form between the shaft skin and the head of the penis.
Although rare, there have been reported cases of infection. Common signs of infection include a pus-like discharge, a foul smell, excessive swelling or redness, local warmth, a fever, or a rash anywhere in the area of the penis. With any of these signs, or if your son has not urinated in over 12 hours, consult Dr. Newton at our Perth circumcision clinic immediately.
There will be a long gauze strip (1/2×8 inches) wrapped around your son’s penis. This strip may fall off within the first 24 hours. If it falls off early, do not worry, this is normal, leave it off. You can place the small gauze given to you at our office (with some Vaseline on it) on the penis for the remainder of the 24-hour period. If, after 24 hours, the gauze strip is still in place, it will have to be removed.
To remove the gauze strip:
Apply Vaseline liberally and completely over the stuck surface.
Close the nappy and allow 10-15 minutes for the bandage to soften.
Gently peel away surfaces that are no longer stuck. Repeat the process as necessary. It is okay to do this a little at a time over the day – it always comes off.