What to Know About Meatal Stenosis

Your baby wears a diaper all day, every day. Sometimes, the diaper doesn't fit tightly enough.

"In newborns who are circumcised, the most common cause [of meatal stenosis] is irritation from the diaper constantly rubbing against the exposed tip of the penis," says Scott D. Miller, MD, MBA, urologist and medical director at Wellstar Urology and Wellstar Robotic Surgical Services in Roswell, Georgia. "This irritation can cause inflammation, and over time, the opening can shrink."

To lower your baby's meatal stenosis risk, follow your doctor's aftercare instructions. It can help prevent inflammation.

But certain skin conditions can inflame and narrow the opening, too. Lichen sclerosus is a chronic autoimmune skin problem on your genitals. Balanitis is a common but treatable rash on the head of your penis, which usually happens when you're uncircumcised.

These skin problems can irritate your penis. The chronic inflammation can scar your meatus.

Surgeries or procedures

Medical procedures or surgeries can come with risk. Sometimes, they can scar or narrow your meatus and lead to meatal stenosis. These procedures include:

Vaginoplasty. This surgery repairs or creates a vagina. It's used in gender-affirming surgery. Problems can happen when your surgeon turns your penis into a vagina. And meatal stenosis happens in about 1 to 6 out of every 100 gender-affirming vaginoplasties.

Glans ischemia. If the head of your penis doesn't get enough blood or oxygen, ischemia can happen. It's called ischemia of the glans penis. This is a serious but rare problem. Your penis can swell and you can get meatal stenosis. 

If you think you have symptoms of this medical condition, get medical help right away.

Meatal Stenosis Symptoms

If you have meatal stenosis, the opening at the tip of your penis is smaller. A narrower pee hole can block your urine flow. 

Here are some symptoms you may notice:

• Pain or burning when urinating
• A sudden urge to pee
• A spray instead of a single stream of pee
• Needing to pee a lot more than usual
• Not being able to aim when peeing
• Straining to pee
• A drop of blood at the tip of the penis after urinating

For children, you might not notice problems until they use the toilet. It's often noticed during toilet training, when you can usually see how your baby pees.

"If your son has been circumcised and you notice changes in how he pees — like a strong stream that sprays, dribbles, or discomfort — it's a good idea to talk to your pediatrician," Miller says.

In most cases, your doctor can perform an exam. They'll often find a partly blocked pee hole. The lower part is often stuck together. If your doctor sees a smaller hole and you can't control your urine stream, you may have meatal stenosis.

But the narrow hole can sometimes be hard to diagnose. Some studies report a detailed physical exam is needed to find it.

"A simple physical exam is often enough to make the diagnosis," says Miller. "But in some cases, further tests like a urine flow study might be needed."

If you think your child has meatal stenosis, ask for a second opinion. Your doctor may ask you about other symptoms, too. They'll review the tests before they confirm the diagnosis.

"Sometimes, it can be as simple as a parent observing their son's stream," says Miller.

Is Meatal Stenosis Serious?

Because your penis plays an important role in your body, meatal stenosis can be very serious. Your penis helps you get rid of waste (urine). It also helps you have babies (reproduce). 

Your penis carries urine and sperm out of your body through the urethra. If it gets blocked, these can't exit your body.

The meatus normally appears as a vertical slit at the tip of your penis. It's about 5.4 mm long for children. But the slit is about 8 mm in adults. A narrow meatus can significantly affect your quality of life. 

You'll likely need to find a bathroom more often. And you may have problems such as leaking pee (urinary incontinence), too.

"For adults, don't ignore changes in urination or discomfort. The key is not to be embarrassed — urologists deal with this all the time," says Miller. "And getting checked out can make a big difference in comfort and quality of life."

When the meatus narrows, it can stop your normal urine flow. If your opening is too small, some urine may be left in your bladder. This can cause urinary tract infections or kidney problems. But if you catch it early, it isn't dangerous. Most of the time, it's quite treatable.

Meatal Stenosis Treatment

While meatal stenosis can potentially be a problem, it often doesn't need treatment. 

"Only 1%-2% [of children] need treatment," says Miller. "[Circumcision] often doesn't require treatment.” But if your meatal stenosis is chronic or causes problems, your doctor can treat it. Treatments for meatal stenosis include:

• A device to stretch your pee hole (meatal dilator)
• Surgery to open your meatus (meatoplasty)

A meatal dilator can stretch your meatus. Your doctor will guide you on how to do this. They'll check your progress, too. 

But the device can also scar your opening. Some people try to expand their penis tip at home. It's dangerous and can tear, scar, or further narrow your opening. If scars form, it can get blocked again.

Surgery is often the choice for treating meatal stenosis. The surgeries to open your meatus are called meatotomy and meatoplasty. Your doctor will make a small cut to widen the tip of your penis. Surgery can help make peeing more comfortable. It's safer, and you'll typically recover after a week.

If you have more serious narrowing, your doctor may suggest urethroplasty. This surgery can open the meatus and repair or rebuild your urethra (urinary tube).

Meatoplasty

If you're having chronic issues with meatal stenosis, you may decide on surgery. You can get a meatoplasty or meatotomy. A meatoplasty is done under general anesthesia (while asleep). But a meatotomy is a minor surgery done while you're awake. It's done in your doctor's office with numbing cream.

Both surgeries are usually done by a urologist, a doctor who specializes in the urinary system. They'll make a cut to increase the length of your meatus. It's often kept in place with glue or stitches that dissolve. You won't need to remove them later.

After surgery, you'll recover at home. Your penis will likely heal in about two to three weeks. Try to stay hydrated. Drink plenty of fluids. Follow your doctor's instructions for cleaning your penis. It will help prevent further problems. 

Your doctor will instruct you on how to gently treat the meatus. They'll likely tell you to use antibiotic cream or jelly. Watch out for pus or more pain than usual. If this happens, get medical help.

What to Expect During Surgery for Meatal Stenosis

A meatotomy is done in your doctor's office. Your doctor will use numbing cream. They'll make a small cut to widen your opening. It won't need any stitches because it's so small.

"The most common treatment is a minor surgical procedure called a meatotomy, where the opening is gently widened," says Miller. "It's usually quick and done under local or light anesthesia."

Another option is a meatoplasty. This surgery can widen your pee hole. Your surgeon may also repair or rebuild your meatus. 

Here are some general meatoplasty steps:

• Your surgeon first puts medicine in your IV (through your vein).
• After you're asleep, they'll make a V-shaped cut at the bottom of your penis.
• The cut is below your meatus to open your penis tip to help widen it.
• Your doctor can also repair the end of your penis (meatus).
• Next, they'll use surgical glue or stitches to close the tissue.
• They'll also check to make sure there isn't any other narrowing.
• Then, your surgeon may put in a catheter to help you pee.

A meatoplasty and meatotomy are usually permanent fixes. "Most kids and adults do well afterward," says Miller. "Complications are rare, but can include some bleeding, discomfort during healing, temporary spraying, or the opening narrowing again over time."

When to call your doctor

Watch out for problems or signs of infection after your surgery. Get medical help right away if you:

• Get a fever of 100 F or more
• Have heavy bleeding
• Have increased pain
• Vomit three or more times a day
• Have a hard time urinating

Also seek medical help if you notice your child's diaper is dry (that they aren't peeing).

Preventing Meatal Stenosis

If you choose not to circumcise your baby, it can lower their risk of meatal stenosis. But not being circumcised may slightly raise their chance for STDs and penile cancer.

If you decide to circumcise your child, follow your doctor's aftercare instructions. Change your baby's diaper often. If possible, allow your baby to go diaper-free, as it can also help with healing. 

Proper care during and after the procedure can help lower inflammation and swelling. This helps prevent scarring and narrowing, too. 

It is your choice to consider circumcision. Before making the decision, talk to your doctor. Ask about the benefits and risks involved.

Meatal stenosis can also occur after long-term urinary catheter use. If your doctor recommends a urinary catheter, ask these questions:

• How long should it stay in?
• How often will it be reinserted?
• Are there other options?
• Are there certain care instructions to lower my chances for meatal stenosis?

Injuries, such as saddle injuries, can also cause meatal stenosis. When you play sports, try to wear protection, such as a cup. Protecting this area and your penis can help prevent injury and scarring.

Some people are born with meatal stenosis. Although congenital meatal stenosis can't be prevented, it can be treated. Talk to your doctor about the best treatment for your baby.

Meatal Stenosis in Adults

The chances of getting meatal stenosis as an adult are a lot lower. Some studies report about 0.6% of men get urethral strictures. That means they have narrowing of their urinary tube, which includes meatal stenosis.

"[Meatal stenosis is] less common [in adults] than in children," says Miller. "But the causes are usually different and often relate to chronic irritation or injury. It is not typical after a circumcision performed as an adult."

Trauma to the penis and urethra can cause meatal stenosis, too. It can include saddle injuries, surgery, or procedures. And inflammatory skin conditions can also narrow the opening.

"In adults, meatal stenosis can happen after trauma, infections, long-term [urinary] catheter use, or even repeated inflammation," says Miller. "[It's] sometimes related to other health conditions."

Takeaways

Meatal stenosis is a narrowing of your pee hole, which can cause pain or discomfort when you urinate. Injury, inflammation, or surgery can cause it. If you have chronic problems, talk to your doctor about surgeries, such as meatoplasty or meatotomy, to help widen your opening.

Meatal Stenosis FAQs

How rare is meatal stenosis?

Meatal stenosis is fairly common. About 8 to 10 out of every 100 men have it. It's more common in children after circumcision. 

In fact, some reports say up to 23 out of every 100 children get it. But other studies report 2 to 10 out of every 100 children get meatal stenosis.

What age does meatal stenosis occur?

It most commonly occurs in early childhood between ages 3 and 7.

How do you fix meatal stenosis?

Surgery can fix meatal stenosis. Your doctor may suggest meatotomy. It's done in their office with numbing cream. Or you may get a meatoplasty. You'll be asleep during this surgery.

Can meatal stenosis correct itself?

Meatal stenosis doesn't correct itself. Talk to your doctor about the best treatment for your health.

Is meatal stenosis surgery painful?

After your surgery, it may take a few days to feel better. Your doctor will likely prescribe pain medication to help. They'll also give you other steps to help improve your comfort. 

Your doctor may suggest a warm bath. You can also try applying skincare ointment. The jelly can help your penis tip heal.