Caring for the circumcised baby or child

• Bleeding control:
  After circumcision a diaper can be tied provided that bleeding control is done frequently. A small amount of bleeding at the surgical site or on diaper is normal. The operation site must be checked as soon as arriving home. If it is bleeding, you will need to apply mild pressure to the operation area. Usually, five minutes of pressure will be enough to control bleeding. If bleeding does not stop, pressure is applied for 10 minutes more. In case of persistent bleeding, the doctor must be called immediately. An intervention may be needed.

In the Nerve Sparing Esthetic Technique of circumcision (NES) a serious bleeding is not seen as only capillary vessels are cut.

• Appearance
  

After the first day of circumcision, the operation site may be red, swollen, and bruised. This is considered as normal.

Encrustation and of glans penis may ocur. It is because of peeling on the glans penis while prepucium is seperated from it or drying of glans mucosa after circumcision. It usually lasts 7-10 days after operation.

In the Nerve Sparing Esthetic Technique of circumcision (NES) there will be a ring- shaped puffiness on the incision line. It is because of spared tissue containing superficial nerves, nerve corpuscles and vessels.  The appearance will be better about two weeks after surgery.

• Dressing:
  

Dressing is usually removed at the first or second day after operation by the direction of doctor. If the dressing falls off, you do not need to replace it.

You can remove the sticked dressing by soaking it in a warm bath, unless otherwise instructed. If  penis does stick to diaper, it can be soaked the diaper off in the tub.  A petroleum jelly (Vaseline) is applied to the glans penis and inside of diaper for four-five days so that his penis does not stick to the diaper.

Parents are asked to push down on the skin at the base of the penis with their four fingers to completely expose the glans and apply petroleum jelly onto penis each after diaper changes for the next two weeks. This will help to prevent penile skin adhesions which can sometimes occur after the circumcision.

Do not use soap for one week after the procedure as it may cause burning.

To prevent adhesions between glans and shaft skin (reattachment of the skin), penile skin must be retracted forcefully towards to the base of penis with the fingers of both hands. This will fully expose your baby’s penis. This maneuver must be done fearlessly every time while changing the baby’s diaper.

For the first couple of days, the diaper on the baby must put loosely to lessen pressure on the wound.

A complete healing occurs nearly in ten days.

• Pain Management:
  

Some analgesics such as paracetamol (acetaminophen) or ibuprofen for comfort after operation.

Pain is caused by some substances released from tips of nerves which is cut. As the superficial sensorial nerves are not cut in Nerve Sparing Esthetic Technique of Circumcision (NES), analgesic usage and  the possible side effect of them in the postoperative  period is quite less. ^1,2

• Restriction of activity:

For three-four days after operation the baby must not be kept upright position and he must be lied down as much as possible to prevent bleeding and edema.

Parents  can continue to use a car seat three-four days after circumcision.

If he is a child,  he may not ride straddle toys (bikes, walkers, swings) for 2 full weeks after surgery. He can return to school usually within 3-5 days. The doctor will tell the parents when he may return to gym class or sports such as swimming.

• Bowel Movements:

Circumcised child should have regular bowel movements. He must be given juices, fruits, and vegetables to prevent constipation and bleeding due to straining. If he does not have a bowel movement within 24 hours after surgery, a pediatric glycerin suppository or syrups containing lactulose may be given

• An urgent call must be done in case of experiencing any of the matter following

If any signs of infection is seen (increased edema, reddishness on the operation area,  and foul smelling drainage from incision line).

Worsened or unrelieved pain by analgesics (acetaminophen).

Bleeding from the incision that does not stop after pressing on it for ten minutes. (A small ooze of blood from the incision the first day or two is normal.)

A temperature of 101.5°F by mouth or 102.5°F rectally.

If parents have any questions or concerns.