Hydrocele, which literally means water sac, is what happens when the scrotum fills with fluid and this fluid collects in the thin tissue surrounding a testicle.

This medical condition is actually quite common among newborns and usually the issue is resolved without any treatment by the time the boy reaches one year old. Sometimes the hydrocele lasts longer, and when it does, your physician will want to check to make sure that the testicle or testicles are not infected. Rarely, older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.

When a baby boy is still in the uterus, his testicles initially develop in his abdominal cavity. As the baby develops, the testicles move from the abdominal cavity into the scrotum. Sometime soon before the child’s birth, or soon after he is born, the testicles typically drop into the scrotum. In some cases, though, one or both testicles may take a little while longer to move into the correct position. This is very common and no cause for alarm. 

It is even more common among baby boys that are born prematurely. This is understandable since the testicles need a little more time to develop normally. When the child is brought in for regular check-ups during the first year of life, healthcare providers keep close watch over the proper growth and development of the child. Checking to make sure that a boy’s testicles are healthy and in the correct position is a regular part of an early childcare examination.

Symptoms of hydrocele

Usually, a hydrocele usually isn’t painful or harmful; it likely is only a swelling of one or both testicles. If any type of scrotal swelling lasts too long, or when there is pain, your healthcare provider is likely going to want to do some tests to rule out other causes or potential issues.

Sometimes hydroceles are described as “simple,” which means that the swelling remains the same. When the swelling of the scrotum gets bigger or smaller, it is called a communicating hydrocele.

A communicating hydrocele can form in the testicle or testicles at any age but as previously mentioned in this article, this is much more common in babies. This type of hydrocele shows as a swelling that changes size, caused by fluid flowing through a tube from the abdomen into the scrotum. This occurs when the tube has not fully or properly developed and does not close as it should. This type of hydrocele may grow larger when a person is physically active and may shrink when the body is at rest.

Causes of hydrocele

Certain underlying diseases or conditions can cause hydroceles to develop. A hydrocele can also develop as a result of inflammation within the scrotum. Inflammation might be caused by an infection in the penis, testicles, or in other parts of the reproductive system.

Testicular torsion and hydrocele

Hydrocele can occur for a number of reasons, making it difficult to diagnose. The signs and symptoms of hydrocele can be linked to a number of conditions, including testicular torsion, which is blocked blood flow in a twisted testicle. Testicular torsion is a rare but serious condition that needs to be treated right away.

Testicular torsion is when something happens to twist the cord supplying blood to the loose bag of skin—scrotum—beneath the penis. This may occur after vigorous exercise or after injury to the testicles. This twisting causes severe pain and hydrocele in the testicle. Surgery is required to restore blow flow. When this condition is treated promptly, the testicle usually is restored to health and the hydrocele disappears when blow flow resumes.

Hydrocele and STIs

Infection, including a sexually transmitted disease (STD) can also be the cause of a hydrocele. 

Orchitis is a condition caused by bacteria or viruses, in which one or both of the testicles are inflamed and the result might be a hydrocele. Inflammation of the epididymis, the tube along the back of the testicle that carries and stores sperm, can be caused by STDs such as chlamydia and gonorrhea. Both infections are easily treated with antibiotics and can even be treated with a single dose if the infections are diagnosed early. Once the infection is treated with the antibiotics, any hydrocele associated with the sexually transmitted disease usually resolves quickly.

Hydrocele and lumps 

In cases of swollen testicles, many sexually active men first assume it is a symptom of an STD, but there are other related conditions. There are multiple reasons why the testicles may become swollen or inflamed, such as a cyst or tumor. If the cyst or lump is benign, these conditions can still cause a reduction in sperm production or function.

Hydroceles are sometimes found among men with an enlarged prostate, especially for people who are 60 years of age or older. Usually, an enlarged testicle or a small lump or area of hardness are the first signs of testicular cancer. Any lump, enlargement, hardness, pain, or tenderness should be evaluated by a doctor as soon as possible. Other symptoms of testicular cancer usually do not appear until after the cancer has spread to other parts of the body.

If cancer tests are positive, there are options and a number of modern treatments that can have significant success.

Hydroceles and other conditions

It doesn’t happen very often, but contact allergy from something that has directly touched the skin, such as soap, lotions, irritating plants, or an insect bite can also cause hydrocele. If you suffer from chronic allergies from foods or medications, it may cause a reaction in any part of the body. Edema, which is fluid retention, is a symptom of congestive heart failure, which can lead to system-wide edema with scrotum swelling also. There are also rare parasitic worms which can migrate into the scrotum, especially in third-world countries. Make sure that you give your medical healthcare provider your full medical history when you visit. If you have known reactions to any environmental conditions or medications, make sure to document that for your physician. If you often travel or have recently visited any foreign country, you’ll want to mention that also.

Hydrocele from injury

Any type of game or sport that involves physical contact has the potential to cause injury. Football often tops the list as the most dangerous sport for young people and adults, but there are many other sports with risk for causing minor or major injury that could lead to the development of hydrocele. Lacrosse, baseball, boxing, soccer, basketball, wrestling, hockey, gymnastics, diving, weight lifting and even performing stunts for stage or film has the potential to cause injury to the scrotum. 

Wearing protective equipment under clothing while participating in sports is very important. Whether there is an observable hydrocele or not, injuries to the scrotum can be serious and may require immediate emergency treatment. Certainly you should visit your healthcare provider if any of the following conditions are present, especially following participation in a sports event:

• Any injury or damage done to the scrotum, even if protective equipment was worn
• Any pain in or near the scrotum
• Any swelling in or near the scrotum
• Feeling nauseous or vomiting
• Any bruising in or near the scrotum
• Certainly if there is any difficulty urinating or if there is blood in the urine

If any of these symptoms are present, you should visit your healthcare provider right away and be checked for injury and treated.

Hydrocele and hernia

A hydrocele and hernia are two different medical conditions, but are often related to each other. A hydrocele may occur at the same time that a hernia develops. A hernia is when part of the intestine goes through a hole in the lining of the abdomen. This happens when there is a weakness or defect in the muscular wall that keeps abdominal organs in place. This defect allows organs and tissues to push through, or herniate, producing a bulge or a lump. Depending on exactly where the hernia is located, the scrotum may sometimes also be affected and a hydrocele develops. When a hydrocele is associated with a weak point in the abdominal wall that allows a loop of intestine to extend into the scrotum, it is called an inguinal hernia.

Adult men with a hydrocele might experience discomfort from the heaviness of a swollen scrotum. It may be difficult to get dressed in the morning, and if exercise is part of the everyday routine, the hydrocele may make the workout a challenge. Pain in any part of the scrotum generally increases with the size of the inflammation.

Diagnosis and treatment options

Your healthcare provider will ask about your swollen scrotum, document your medical history, and examine you carefully first.

Tell your caregiver about any injury to your scrotum as well as any medications you are taking. The healthcare provider will apply gentle pressure to your scrotum to check whether the hydrocele shrinks. 

There are a number of tests that help physicians more accurately diagnose the possible cause or causes for any swelling of the scrotum. These tests include transillumination and ultrasound.

Transillumination is a simple test that shines a bright light on your scrotum. This helps the healthcare provider see the fluid inside your scrotum. Transillumination can also help identify the presence of other problems, such as cysts, tumors, or hernia.

An ultrasound uses sound waves to show pictures of your scrotum on a monitor. An ultrasound can help confirm the presence of a hydrocele and identify any other problems with the scrotum.

Treatment options

There are a variety of treatment options for hydrocele. In cases where the cause is simple such as extreme or prolonged exercising, there are a number of natural remedies that men may find helpful and comforting as the body heals.

• Saw palmetto is one herb that benefits the prostate. The prostate is a gland in the male reproductive system that’s about the size of a chestnut. It surrounds the part of the urethra (the tube that empties the bladder) just below the bladder and above the muscles of the pelvic floor.
• Eucalyptus is another herb identified with male reproductive health.
• Pumpkin seeds aid prostate health with vitamins and minerals. Pumpkin seeds contain zinc, which reduces inflammation.

While your hydrocele is healing, take bed rest. Wear a scrotum supporter. Take few cubes of ice in a towel and place it over the painful testis for a few minutes. Avoid strenuous physical activities and sexual intercourse. Eat a healthy nutritious diet of whole foods and for a while, avoid alcohol.

Surgeries used to treat hydrocele

If your healthcare provider determines that your hydrocele is more serious, surgery may be suggested for your condition.

Hydrocelectomy is surgery to remove your hydrocele. The surgeon will make an incision in your scrotum or groin. During surgery for a simple hydrocele, a small incision is made, and the fluid is removed. During surgery for a communicating hydrocele, the surgeon use stitches to close the tube. The stitches stop the flow of fluid from the hydrocele to the abdomen. 

Needle aspiration is when the physician drains the hydrocele. After the area is numbed with pain medication, the fluid is drained from the scrotum through the needle. This procedure is quick and usually done on an outpatient basis. If more tests have been recommended, the fluid may be sent to a lab for testing.