— Nancy, California Nancy, I understand your concern. What you describe does sound like a very significant and rapid enlargement. Testicular tumors are unusual in this age group, but they can occur. Your grandson’s condition certainly should be evaluated by a pediatrician or a pediatric urologist. To diagnose this swelling, the pediatrician will want to know about the history of the swelling: Is it painful, does it change in size with position, was there trauma to the area? On exam, the doctor will look for signs of inflammation, like redness, warmth, or tenderness. It is important to determine what exactly is enlarged: Is it the actual testicle or the scrotum? Painful scrotal swelling should always be examined as soon as possible. Causes such as a twisting of the testicle need to be treated urgently. A frequent cause of painless swelling in the scrotum is a hydrocele, or a collection of fluid in the scrotum. This can result from a variety of causes. Sometimes a hydrocele is present from birth. It may occur as an inflammatory response to an infection in the area, a tumor of the testicle, or a twisting of a small piece attached to the testicle called the appendix testis. Twisting of the appendix testis is reasonably common in this age group. Although it results in no actual damage to the testicle, it may cause impressive swelling and possibly some redness, warmth, and tenderness of the scrotum. An inguinal hernia can also present itself suddenly as swelling in this area, as can bleeding in the scrotal area after trauma. As I mentioned before, the best way to determine the cause of your grandson’s swelling is to have him examined by a pediatrician or pediatric urologist. Q2. My seven-year-old son has suffered from encopresis for several years. We have tried all traditional “cures” with little or no success. Are there any new surgical treatments for this condition? — Heather, New Jersey I do not know of any new surgical treatments for encopresis, also known as fecal incontinence, or the inability to control one’s bowel movements. Figuring out how to help your son recover depends on the type of encopresis he has. The most common form is associated with constipation. About 1.5 percent of children between the age of seven and eight suffer from encopresis related to constipation. This may seem counterintuitive, but constipation can cause the colon to dilate, which can lead to the leakage of fecal matter around any hard, constipated stools, causing soiling of the underpants. Children with this type of encopresis often won’t even know until later that they have soiled themselves. Treating the constipation is critical in curing this type of fecal incontinence. A high-fiber diet, laxatives, stool softeners, or enemas can help treat constipation, though this type of encopresis usually will resolve with time (certainly by the time a child reaches puberty). Another type of encopresis is not associated with constipation but rather with anxiety, stress, and behavioral problems. This type of fecal incontinence responds best to behavioral therapy that focuses on behavioral changes, like setting aside time for the child to spend on the toilet each day to encourage daily defecation. Less commonly, encopresis can be the result of a neurologic problem affecting a child’s continence. Hirschsprung’s disease, for instance, is a neurological disorder related to constipation encopresis. People with this disorder are missing nerve cells that are supposed to help with the movement of the colon. Hirschsprung’s disease and other neurological problems that lead to fecal incontinence can be treated with surgery, which involves resectioning of the distal part of the colon. All children with encopresis should have a thorough physical exam where you can discuss the history of your child’s problem. The physical exam should include an assessment of the anal sphincter tone to determine the type of encopresis and the best ways to manage it. If your son has not been seen by a pediatric gastroenterologist, you might consider making that your next step. Q3. I fell on a gate a month ago, and about two weeks later I began to have pain in my urethra, especially when I urinate. Other times I will have a shooting needle pain in the area. I feel like I have to go to the bathroom all the time. Could the accident have damaged something? — Dee, Delaware If you had injured your urethra, you would most likely have had immediate symptoms such as burning, bleeding, or other lower urinary-tract complaints. Shooting pain in the urethral area, combined with having to go to the bathroom all the time, suggests a urinary-tract infection. While it is possible that the accident could have damaged some of the urethral tissue, this would be less likely to cause the symptoms of urinary frequency. A visit to a health-care provider is in order. A history, examination of the urethra, and urinalysis would likely detect any significant underlying problem or infection. Learn more in the Everyday Health Healthy Living Center.
