16303 Communicating Hydrocele

Overview

A communicating hydrocele is a build-up of clear fluid around a testicle that happens when a small channel between the belly and the scrotum stays open. This channel normally closes before birth. When it stays open, fluid can move down into the scrotum, causing it to swell.

Yes, hydroceles are one of the most common causes of scrotal swelling in newborn boys, and communicating hydroceles are the most common type in children.

It most often affects newborn boys, especially those born prematurely. It can also appear later in life, but in older boys and men it more often develops due to another cause such as injury, infection, or a problem with fluid drainage.

Symptoms

Common symptoms

• Soft, painless swelling in the scrotum
• Swelling that feels like a water-filled balloon
• Size changes throughout the day - smaller in the morning, larger by evening
• May be small or large enough to feel heavy

Symptoms in children

• A bulge or swelling in the scrotum or groin that may only appear when the child cries, coughs, or stands
• The swelling may disappear when the child lies down and sleeps
• Usually painless, and the child seems well

Symptoms in older adults

• A gradual or sudden swelling in the scrotum that may feel heavy
• Usually painless, but may cause discomfort during activity
• If it appears quickly after surgery, injury, or as part of another illness, it should be checked

Causes

Main causes

• An open channel between the belly and the scrotum that fails to close before birth - this is the cause of communicating hydrocele.
• Fluid from the belly trickles down this channel into the scrotum while the baby is in the womb or after birth.
• In older males, a hydrocele can be communicating if the channel has reopened or if there is a rise in belly pressure (for example, from ascites or after a surgical drain).

Risk factors

• Being born prematurely
• A family history of hydrocele or undescended testicle
• Conditions that raise pressure in the belly, such as persistent coughing, straining, or fluid in the belly
• Previous surgery or injury in the groin area

When to see a doctor

See a doctor urgently if:

• If you or your child have sudden severe scrotal pain, redness, or a hard, tender testicle - call your local emergency number or go to an emergency department right away.
• If a known hydrocele becomes painful, very large, or the skin over it turns red, get urgent medical help the same day.

Book a routine appointment if:

• Any painless swelling in the scrotum in a child or adult should be checked by a doctor to confirm what it is.
• If a baby has a scrotal swelling that does not disappear by 12 months of age, book a routine review.
• If an adult has a new scrotal swelling that persists for more than a few days, see a doctor.

Diagnosis

A doctor will ask about when the swelling began, whether it changes, and whether there is any pain. They will then examine the scrotum while you or your child lies down and stands. They may shine a small torch through the swelling to see if it glows (transillumination), which suggests it is fluid-filled.

Tests that may be done

• Clinical examination and transillumination test
• Ultrasound scan of the scrotum - often done if the diagnosis is not clear or to check the condition of the testicle
• Urine test if there is pain or fever, to check for infection

What to expect at your appointment

The diagnosis is usually quick and does not cause pain. The doctor will check that the testicle is normal and make sure there is no lump or hernia. If an ultrasound is needed, it is painless and uses sound waves - no dye or needles.

Treatment

Treatment depends on age, size, and whether there are other symptoms. Many communicating hydroceles in babies close naturally in the first year. If it does not close or if it causes problems, a minor operation can seal the channel and drain the fluid.

Self-care at home

• For babies, no special care is needed - just leave the swelling alone and keep the nappy area clean.
• For older children and adults, comfortable underwear or supportive briefs can reduce the heavy feeling.
• Avoid straining during bowel movements or heavy lifting, as this can push more fluid down.
• Keep an eye on the size and let your doctor know if it grows quickly or becomes tender.

Medical treatments

There is no medicine that closes the channel or removes the fluid. In most cases, the only way to fix a communicating hydrocele that does not close by itself is a surgical procedure called a hydrocelectomy. A surgeon makes a small cut in the scrotum or groin, closes the open channel, and drains the fluid. The operation is usually done as a day case, meaning you go home the same day.

When is surgery considered?

Surgery is usually recommended when a communicating hydrocele has not resolved on its own by around 18 months to 2 years of age, or if it becomes painful, very large, or is associated with a hernia. In adult men, surgery is often the definitive treatment because communicating hydroceles in adulthood rarely close on their own.

Living with this condition

For most people, a communicating hydrocele is easily managed. Babies and children can play, bathe, and live normally. Adults can continue work and exercise, but may find supportive underwear more comfortable. The main thing is to watch for any change in size or pain.

Lifestyle tips

• Wear supportive underwear if the swelling feels heavy.
• Avoid prolonged heavy lifting or straining while waiting for treatment.
• Keep the scrotum clean and dry to prevent skin irritation.
• After surgery, follow the surgeon's advice about bathing, activity, and returning to work or school.

Diet and exercise

No specific diet is needed. Drinking plenty of water and eating a diet rich in fibre helps prevent constipation and straining, which can increase pressure in the belly and worsen a communicating hydrocele. Gentle exercise is fine, but avoid intense activity that causes pain or discomfort until a doctor gives the all-clear.

Mental health and emotional wellbeing

Living with a scrotal swelling can feel embarrassing or worrying, especially for teenagers and adults. It is completely normal to feel that way. Remember that a hydrocele is not a sign of poor health or something you caused. Talking to a doctor, a partner, or a trusted friend can help. If worry becomes overwhelming, ask your doctor about counselling or support groups.

Prevention

In most cases, communicating hydrocele cannot be prevented because it happens while the baby is developing in the womb. However, you can reduce the chance of making it worse by avoiding excessive straining - for example, by treating constipation and a chronic cough. There are no proven ways to stop a communicating hydrocele from forming.

Screening programmes

There is no national screening test for hydrocele. It is usually found during a routine newborn check or when a parent or doctor notices a scrotal swelling.

Complications

If left untreated

• In an infant, an untreated communicating hydrocele that does not close may slowly get larger and can be associated with an inguinal hernia, which can become strangulated (a medical emergency).
• In an older child or adult, an untreated hydrocele can cause discomfort, a heavy feeling, and, rarely, pressure on the testicle that could affect blood flow.
• Rarely, a hydrocele can become infected, causing pain, redness, and fever, which needs urgent medical care.

Long-term outlook

The outlook is excellent. Most baby hydroceles disappear without any treatment. For those that do need surgery, the operation is simple, safe, and generally very successful. After recovery, the scrotum usually returns to a normal size and shape, and the testicle works normally. You or your child can expect to return to ordinary activities within a week or two, with no long-term problems.

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