What is a hydrocele?
A hydrocele is a sac filled with fluid that forms around a testicle. Hydroceles are most common in babies.
Nearly 10 percent of males are born with a hydrocele. However, they can affect males of any age.
Hydroceles generally don’t pose any threat to the testicles. They’re usually painless and disappear without treatment. However, if you have scrotal swelling, see your doctor to rule out other causes that are more harmful such as testicular cancer.
What causes a hydrocele?
Towards the end of pregnancy, a male child’s testicles descend from his abdomen into the scrotum. The scrotum is the sac of skin that holds the testicles once they descend.
During development, each testicle has a naturally occurring sac around it that contains fluid. Normally, this sac closes itself and the body absorbs the fluid inside during the baby’s first year. However, this doesn’t happen for babies with a hydrocele. Babies born prematurely are at a higher risk for hydrocele, according to the Mayo Clinic.
Hydroceles can also form later in life, mostly in men over 40. This usually occurs if the channel through which the testicles descend hadn’t closed all the way and fluid now enters, or the channel reopens. This can cause fluid to move from the abdomen into the scrotum. Hydroceles can also be caused by inflammation or injury in the scrotum or along the channel. The inflammation may be caused by an infection (epididymitis) or another condition.
Types of hydroceles
The two types of hydroceles are non-communicating and communicating.
A non-communicating hydrocele occurs when the sac closes, but your body doesn’t absorb the fluid. The remaining fluid is typically absorbed into the body within a year.
A communicating hydrocele occurs when the sac surrounding your testicle doesn’t close all the way. This allows fluid to flow in and out.
What are the symptoms of a hydrocele?
Hydroceles usually don’t cause any pain. Usually, the only symptom is a swollen scrotum.
In adult men, there may be a feeling of heaviness in the scrotum. In some cases, the swelling might be worse in the morning than in the evening. It is not usually very painful.
Seek medical treatment if you or your child has sudden or severe pain in their scrotum. This could be the sign of another condition called testicular torsion. Testicular torsion occurs when the testicles become twisted, typically due to an injury or accident. Testicular torsion isn’t common, but it’s a medical emergency because it can lead to blocked blood supply to the testicle and ultimately infertility if untreated. If you think you or your child has testicular torsion, go the hospital emergency room right away or call 911. It needs to be evaluated and treated immediately.
Diagnosis of hydroceles
To diagnose a hydrocele, your doctor will perform a physical exam. If you have a hydrocele, your scrotum will be swollen, but you won’t have any pain. Your doctor won’t be able to feel your testicle well through the fluid-filled sac.
Your doctor may check for tenderness in the scrotum and shine a light through the scrotum. This is called transillumination. It allows your doctor to determine if there’s fluid in the scrotum. If fluid is present, the scrotum will allow light transmission, and the scrotum will appear to light up with the light passing through. However, if scrotal swelling is due to a solid mass (cancer), then the light will not shine through the scrotum. This test does not provide a definite diagnosis but can be very helpful.
Your doctor may also apply pressure to the abdomen to check for another condition called inguinal hernia; your doctor may also ask you to cough or bear down to check for this. This can occur when part of the small intestine protrudes through the groin due to a weak point in the abdominal wall. While it’s usually not life-threatening, a doctor may recommend surgery to repair it.
They may take a blood or urine sample to test for infections. Less commonly, your doctor may administer an ultrasound to check for hernias, tumors, or any other cause of scrotal swelling.
How to treat a hydrocele
If your new infant has a hydrocele, it will probably go away on its own in about a year. If your child’s hydrocele doesn’t go away on its own or becomes very large, he might need surgery by a urologist.
In adults, hydroceles typically go away within six months, according to the Mayo Clinic. A hydrocele usually only needs surgery if it causes discomfort or if it’s a communicating hydrocele, which can lead to hernias.
Surgery to remove a hydrocele is performed under anesthesia. In most cases, you’ll be able to go home within a few hours of the surgery.
A small cut is made in the abdomen or scrotum (depending on the location of the hydrocele) and the hydrocele is surgically removed. Your surgeon will most likely apply a large dressing to the site of your incision. Depending on the location and size, you may also need a drainage tube for a few days.
Risks associated with anesthesia include:
- allergic reactions
- breathing difficulties
- heart rhythm disturbances
Risks associated with this procedure include:
- blood clots or excessive bleeding
- scrotal injury, including nerve damage
Ice packs, a support strap for your scrotum, and plenty of rest will ease discomfort after the surgery. Your healthcare provider will likely recommend a checkup exam because a hydrocele can sometimes reoccur.
Another option for hydrocele treatment is to drain it with a long needle. The needle is inserted into the sac to draw out the fluid. In some cases, a drug may be injected to prevent the sac from filling again. Needle aspiration is commonly performed on men who are at high risk for complications during surgery.
The most common side effects of needle aspiration are temporary pain in your scrotum and the risk of infection.
What to expect after surgery
Whether your hydrocele goes away on its own or requires surgery, the outlook is excellent.
If you have surgery, the pain will probably go away in about a week. Your doctor may prescribe pain medication if you find it necessary. You probably won’t return to normal activities for a few weeks. This includes avoiding anything involving straddling, like riding a bike, for at least three weeks. Other strenuous activities should also be avoided during that time.
Stitches at the incision site usually dissolve on their own, but your doctor may want to check them after a few weeks. Keeping the area clean using showers or sponge baths will help prevent infection.
- Hydrocele. (n.d.).
- Mayo Clinic Staff. (2014). Hydrocele:
- Non-cancer causes of testicular or scrotal symptoms. (2015).