A hydrocele is a fluid-filled sac surrounding a testicle that causes swelling in the scrotum. Hydrocele is common in newborns and usually disappears without treatment during the first year of life. Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.
A hydrocele usually isn’t painful or harmful and might not need any treatment. However, if you have scrotal swelling, see your doctor to rule out other causes.
Usually, the only indication of a hydrocele is a painless swelling of one or both testicles.
Adult men with a hydrocele might experience discomfort from the heaviness of a swollen scrotum. Pain generally increases with the size of the inflammation. Sometimes, the swollen area might be smaller in the morning and larger later in the day.
If you or your child experiences scrotal swelling, you may have a suspicion of presence of hydrocele. It’s important to rule out other causes of the swelling that might require treatment. For example, a hydrocele might be associated with a weak point in the abdominal wall that allows a loop of intestine to extend into the scrotum (inguinal hernia).
A baby’s hydrocele typically disappears on its own. However, if your baby’s hydrocele doesn’t disappear after a year or if it enlarges, you should ask your child’s doctor to examine the hydrocele again.
Get immediate medical treatment if you or your child develops sudden, severe scrotal pain or swelling, especially within several hours of an injury to the scrotum. These signs and symptoms can occur with a number of conditions, including blocked blood flow in a twisted testicle (testicular torsion). Testicular torsion must be treated within hours of the beginning of symptoms to save the testicle.
A hydrocele can develop before birth. Normally, the testicles descend from the developing baby’s abdominal cavity into the scrotum. A sac accompanies each testicle, allowing fluid to surround the testicles.
Usually, each sac closes and the fluid is absorbed. However, fluid can remain after the sac closes (noncommunicating hydrocele). The fluid is usually absorbed gradually within the first year of life.
Sometimes, however, the sac remains open (communicating hydrocele). The sac can change size or, if the scrotal sac is compressed, fluid can flow back into the abdomen. Communicating hydroceles are often associated with inguinal hernia.
A hydrocele can develop as a result of injury or inflammation within the scrotum. Inflammation might be caused by an infection in the testicle or in the small, coiled tube at the back of each testicle (epididymitis).
Most hydroceles are present at birth. Between 1 and 2 percent of newborns have a hydrocele. Babies who are born prematurely have a higher risk of having a hydrocele.
In men, hydroceles mostly affect men over the age of 40. Risk factors for developing a hydrocele later in life include:
- Scrotal injury
Infection, including sexually transmitted infections (STIs)
A hydrocele typically isn’t dangerous and usually doesn’t affect fertility. However, it might be associated with an underlying testicular condition that can cause serious complications, including:
- Infection or tumor. Either might reduce sperm production or function.
Inguinal hernia. The loop of intestine trapped in the abdominal wall can lead to life-threatening complications.
Your doctor will start with a physical exam, which will likely include:
- Checking for tenderness in an enlarged scrotum.
- Applying pressure to your abdomen and scrotum to check for inguinal hernia.
- Shining a light through the scrotum (transillumination). If you have a hydrocele, transillumination will indicate the presence of clear fluid surrounding the testicle.
After that, your doctor might recommend:
- Blood and urine tests to help determine if you have an infection, such as epididymitis
- Ultrasound to help rule out hernia, testicular tumor or other causes of scrotal swelling
Treatments and drugs
For baby boys, hydroceles typically disappear on their own within a year. If a hydrocele doesn’t disappear after a year or if it continues to enlarge, it might need to be surgically removed.
For adult males, hydroceles often go away on their own within six months. A hydrocele requires treatment only if it gets large enough to cause discomfort or disfigurement. Then it might need to be surgically removed.
The procedure can be performed on an outpatient basis during general or regional anesthesia. An incision is made in the scrotum or lower abdomen to remove the hydrocele. If a hydrocele is found during surgery to repair an inguinal hernia, the surgeon might remove the hydrocele even if it’s causing no discomfort.
After hydrocelectomy, you might need a tube to drain fluid and a bulky dressing for a few days. To ease discomfort, your doctor might recommend:
- A scrotal support strap
- Ice packs to help reduce swelling
Your doctor is likely to recommend a follow-up examination because a hydrocele might recur.