16294 Hydrocele

Overview

A hydrocele is a fluid-filled sac that forms around a testicle in the scrotum (the pouch of skin below the penis). It causes the scrotum to swell and feel heavy, but it is usually not painful. Hydroceles are often harmless and can sometimes go away on their own.

Yes, hydroceles are fairly common. They affect about 1 in 10 newborn boys. In adult men, they become more common with age, but many men never notice them.

Hydroceles can affect males of any age. They are most often seen in newborn babies and in men over 40. Premature babies have a higher chance of having one.

Symptoms

Common symptoms

• Swelling in the scrotum that may be on one or both sides
• A feeling of heaviness or dragging in the scrotum
• A soft, painless lump that feels like a water balloon
• The swelling may stay the same size or slowly grow larger
• Usually no pain, but a very large hydrocele can cause discomfort

Symptoms in children

• A swollen scrotum in a baby boy
• The swelling is usually painless and can appear at birth or in early infancy
• The swollen area may get smaller or larger over time
• In most babies, the swelling goes away on its own by age 1

Symptoms in older adults

• Gradual swelling in the scrotum that may increase over months
• A feeling of heaviness or pressure in the groin area
• Skin on the scrotum may feel stretched but is usually not red or hot

Causes

Main causes

• In newborn babies: a tunnel between the belly and scrotum that has not closed properly, letting fluid flow down
• In older males: inflammation or injury in the scrotum that causes too much fluid to form
• An infection in the testicle or epididymis (the tube that stores sperm)
• Rarely, a growth or tumor in the testicle that causes fluid buildup
• Sometimes the cause is unknown

Risk factors

• Being born prematurely
• History of injury to the scrotum
• Infection in the testicle or epididymis
• Prior surgery in the groin or scrotum
• Radiation therapy to the pelvic area

When to see a doctor

See a doctor urgently if:

• If you have sudden, severe pain in the scrotum
• If the swelling becomes painful, red, or hot
• If you have a fever with scrotal swelling

Book a routine appointment if:

• If you notice any new swelling or lump in the scrotum
• If swelling does not go away after a few weeks
• If a hydrocele keeps growing
• If you have discomfort or heaviness in the scrotum

Diagnosis

A doctor will ask about your symptoms and examine your scrotum. They may shine a light through the swelling (called transillumination). If light passes through easily, it is likely a hydrocele. If not, other tests may be needed.

Tests that may be done

• Physical examination of the scrotum and groin
• Transillumination (light test)
• Ultrasound of the scrotum – a safe imaging test that uses sound waves to look at the fluid and the testicle
• Urine test or blood test if an infection is suspected

What to expect at your appointment

The doctor will check whether the hydrocele is smooth and fluid-filled. An ultrasound is often done to make sure the testicle is normal and to rule out other issues. The whole visit is usually quick and painless. You will get clear advice about whether you need treatment or just monitoring.

Treatment

Treatment depends on the size of the hydrocele, your age, and whether it causes symptoms. Many hydroceles in babies go away without any treatment. In adults, small painless hydroceles may only need monitoring. If a hydrocele is large, painful, or does not go away, there are other options.

Self-care at home

• Wearing supportive underwear or a jockstrap may reduce pulling or discomfort.
• Apply a cold pack wrapped in a cloth to the area if it feels sore (do not put ice directly on skin).
• Rest and avoid heavy lifting if the hydrocele is uncomfortable.
• Keep the area clean and dry to prevent skin irritation.
• Do not try to drain the fluid yourself – see a doctor.

Medical treatments

Your doctor may treat an underlying infection with medicines if one is present. For a hydrocele caused by inflammation or injury, treating the cause may allow the fluid to settle. In some cases, a doctor may use a needle to drain the fluid (aspiration), but this is often a temporary fix because the fluid can come back. The most lasting treatment is a minor surgery called a hydrocelectomy, where the surgeon drains the fluid and closes off the sac to prevent recurrence.

When is surgery considered?

Surgery is usually recommended if the hydrocele is large enough to cause discomfort, if it interferes with daily activities, or if it does not go away on its own. This is a common and safe procedure. Most men go home the same day and recover within a few weeks.

Living with this condition

Most people with a hydrocele live normally without any restrictions. If you have mild swelling, wearing supportive underwear can help. You can still work, exercise, and carry on with your usual activities unless your doctor says otherwise.

Lifestyle tips

• Keep your scrotum supported during physical activity.
• Protect the area from injury, for example in contact sports.
• If you have a hydrocele, check the scrotum regularly for changes in size or new pain.
• See your doctor if the hydrocele gets bigger or becomes uncomfortable.

Diet and exercise

There is no special diet for a hydrocele, but eating a balanced diet and staying active are good for overall health. After surgery, follow your doctor's advice about when you can return to exercise and heavy lifting – this is usually after a couple of weeks.

Mental health and emotional wellbeing

Having a swollen scrotum can be embarrassing or worrying. It is normal to feel concerned, but remember that a hydrocele is usually harmless and treatable. If you feel anxious about your body or the condition, talk to your doctor or someone you trust. You can also ask for support from a counselor or local health service.

Prevention

Many hydroceles cannot be prevented, especially those in newborns. In adults, you can reduce the risk by protecting the scrotum from injury and getting prompt treatment for any infection in the groin or testicles. If you notice swelling early, seeing a doctor can help manage it before it becomes large.

Screening programmes

There is no routine screening for hydrocele. Regular self-checks of the testicles can help you notice any new swelling or lumps. If you notice anything unusual, see a doctor.

Complications

If left untreated

• A hydrocele rarely causes serious problems if left alone.
• In some cases, a large hydrocele can become uncomfortable or painful.
• If the hydrocele is caused by an infection or underlying condition, that condition might need treatment.
• In rare cases, an untreated hydrocele could mask a more serious problem like a hernia or a tumor, which is why a medical check is important.

Long-term outlook

The outlook is very good. Most hydroceles in babies resolve on their own. In adults, treatment is safe and effective, and surgery usually cures the problem. Even if you do nothing, a small hydrocele may remain small and cause no trouble. With proper medical care, complications are uncommon and the condition is not life-threatening.

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