Buzz
A hydrocele is a fluid-filled sac within the scrotum of a male — essentially an accumulation of fluid around one or both testicles. This condition is quite common, affecting approximately 5% of newborn boys. It can also develop in older children or adult men due to infection or injury to the scrotum. In most cases, hydroceles are not harmful and tend to resolve on their own, without treatment, but scrotal swelling should always be evaluated by a medical professional to rule out other causes. Curing a persistent hydrocele typically requires surgery, although some home remedies may also provide relief.
Important Information
- Symptoms of a hydrocele include painless swelling around the scrotum. As the swelling worsens, the hydrocele can become painful.
- To prevent hydroceles, use condoms to prevent infection and/or wear a jockstrap when engaging in sports.
- Consult your doctor if the hydrocele persists for at least 6 months or if it causes significant discomfort.
- Treatment options include draining the hydrocele fluid with a needle or surgically removing the entire sac.
Steps to Follow
Understanding and Coping with Hydroceles
Try a soak in Epsom salt. If you notice painless swelling in your testicle(s)/scrotum, immerse yourself in a very warm bath with several cups of Epsom salt added. Relax in the tub for 15 – 20 minutes with your legs slightly apart, allowing the water to surround your scrotum. The warmth can promote fluid movement, potentially alleviating blockages, while the salt may draw out fluid through your skin, reducing swelling. Epsom salt, rich in magnesium, can also relax muscles and alleviate discomfort.
- If your hydrocele causes pain, exposure to warm water or heat might exacerbate inflammation.
- Avoid excessively hot baths to prevent burns and limit your time in the tub to prevent dehydration.
Recognize symptoms. The primary indication of a hydrocele is painless swelling or enlargement of the scrotum due to fluid accumulation around one or both testicles. Babies typically experience no complications from hydroceles, which usually resolve on their own before age 1. In contrast, men with hydroceles may eventually experience discomfort as the scrotum enlarges, potentially affecting mobility.
- Pain or discomfort associated with a hydrocele generally corresponds to its size — larger hydroceles tend to cause more noticeable symptoms.
- Hydroceles are often smaller in the morning and increase in size throughout the day, especially with exertion.
- Premature babies have an increased risk of hydroceles.
Fun Fact: Hydroceles come in 2 main types: communicating and noncommunicating. In communicating hydroceles, fluid flows between the scrotum and abdominal cavity, causing the size of the hydrocele to fluctuate. In noncommunicating hydroceles, fluid originates from scrotal tissues, resulting in relatively stable fluid levels throughout the day.
Practice patience with hydroceles. In most cases, hydroceles in infants, adolescents, and men resolve spontaneously without specific treatment. Blockages or congestion near the testicles typically resolve, allowing the hydrocele to drain and be absorbed by the body. Therefore, if you notice scrotal enlargement without pain or functional impairment, allow time for resolution.
- For infants, hydroceles usually resolve within the first year of life.
- In men, hydroceles often diminish within 6 months, depending on the underlying cause. Larger hydroceles may take longer, but medical intervention should not be delayed beyond 1 year.
- However, in children and adolescents, hydroceles can result from infection, trauma, testicular torsion, or tumors, necessitating evaluation by a physician.
- Hydroceles are akin to fluid-filled ganglions near joints, which gradually disappear over time.
Prevent Injuries and STDs. The exact cause of hydroceles in infants remains unknown, although it's believed to result from fluid backup due to fetal positioning. However, in older males, trauma to the scrotum or infection is usually responsible. Trauma can occur during activities such as wrestling, martial arts, cycling, and various sexual practices. Infections in the testes or scrotum are often associated with sexually transmitted diseases. Therefore, safeguard your scrotum from injuries and practice safe sex.
- Always wear an athletic supporter with a protective cup during contact sports to shield your scrotum from injury.
- Use a new condom each time you engage in sexual activity to significantly reduce the risk of infection. While STDs don't always affect the testicles, it's not uncommon either.
Know When to Seek Medical Care. If your baby boy's swollen scrotum persists beyond a year or continues to enlarge, seek medical attention. Similarly, men should consult a doctor if a hydrocele persists for over 6 months or causes significant pain, discomfort, or deformity.
- A testicular infection differs from a hydrocele but can lead to one secondarily. Testicular infections are extremely painful and should be promptly treated to reduce the risk of infertility. Seek medical attention if you experience scrotal swelling accompanied by fever.
- Consult your doctor if the hydrocele affects your mobility or causes discomfort during physical activities.
- Hydroceles do not directly affect fertility.
Medical Assistance
Visit Your Doctor for Evaluation. If the hydrocele persists or causes symptoms, schedule an appointment with your family physician for an examination. While hydroceles are generally benign, your doctor will want to rule out other potentially serious conditions with similar presentations, such as an inguinal hernia, varicocele, infection, benign tumor, or testicular cancer. Surgical intervention is typically required once a hydrocele is diagnosed, as medications are ineffective.
- Your doctor will perform a physical examination to check for tenderness or signs of a hernia. They may utilize diagnostic ultrasound, an MRI, or a CT scan for better visualization of the scrotal area.
- Transillumination can reveal whether the fluid inside the scrotum is clear (indicating a hydrocele) or cloudy, suggesting the presence of blood or pus.
- Blood and urine tests may be conducted to rule out infections such as epididymitis, mumps, or various STDs.
Remove the Fluid. Once a hydrocele is diagnosed, the least invasive treatment option is aspiration, involving draining the fluid from the scrotum using a needle. After administering a local anesthetic, a needle is inserted into the scrotum to access the hydrocele, and the clear fluid is withdrawn. If the fluid appears bloody or purulent, it may indicate injury, infection, or possible cancer. This procedure is brief and requires minimal recovery time, typically just a day or so.
- Needle drainage of a hydrocele is not frequently performed because the fluid often reaccumulates, necessitating further treatment.
- In some cases, the needle may need to be inserted through the groin area if the hydrocele is located higher in the scrotum or partially outside of it.
Undergo surgical removal of the entire hydrocele. The most common and effective approach to addressing a persistent or symptomatic hydrocele is through hydrocelectomy, wherein the hydrocele sac and fluid are surgically removed. This procedure greatly reduces the likelihood of the hydrocele recurring, typically with only a 1% chance. Hydrocelectomy surgery can be performed using either a scalpel or a laparoscope equipped with a small camera attached to a long cutting instrument. The surgery is usually conducted on an outpatient basis under general anesthesia. Recovery may take up to a week or longer, particularly if the abdominal wall requires incision.
- For infants, surgeons often make an incision in the groin (inguinal region) to drain the fluid and excise the sac, with stitches used to reinforce the muscle wall—similar to hernia repair surgery.
- In adults, incisions are typically made in the scrotum to drain the fluid and remove the hydrocele sac.
- Following hydrocelectomy, a temporary drainage tube may be inserted into the scrotum to eliminate excess fluid for several days.
- In certain cases, surgical repair may be advised to reduce the risk of hernia in the area affected by the procedure.
Take precautions during the recovery period. Recovery from hydrocele surgery is generally swift for most individuals. Healthy patients typically return home within a few hours post-surgery, with overnight hospital stays being rare. Children should restrict their activities and receive additional bed or couch rest for approximately 48 hours following surgery. Adults are advised to follow similar precautions, including refraining from sexual activity for up to a week as a precautionary measure.
- In the majority of cases, normal activities can be resumed 4 to 7 days after hydrocele surgery.
- Potential surgical complications to watch for include adverse reactions to anesthesia (resulting in breathing difficulties), persistent bleeding within or outside the scrotum, and the risk of infection.
- Symptoms of bacterial infection may include groin pain, swelling, redness, unpleasant odor, and possibly a mild fever.
Useful Tips
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Hydroceles may sometimes coincide with inguinal hernias, but these can often be addressed simultaneously through a single surgical procedure. An inguinal hernia occurs when an abdominal organ protrudes into the inguinal canal, a narrow passageway connecting the abdomen to the scrotum.
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Regularly perform self-examinations of your scrotum without hesitation. This practice can aid in the early detection of issues like hydroceles before they progress into more severe conditions.
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While uncommon, hydroceles can develop due to infection with filarial worms (parasitic) in the testes, leading to significant swelling and the condition known as elephantiasis.
Caution
- Seek immediate medical attention if you experience sudden and severe swelling accompanied by pain in the scrotum.
