What on earth is a Hydrocele?

In short, Hydroceles are fluid-filled sacs that develop around the testicles, causing swelling in the scrotum. They may or may not be painful and oftentimes don’t cause any issue at all; but if you have a Hydrocele that is painful I want you to know there is help and there are options for dealing with it.

Causes and Risk Factors

First, how do these Hydroceles develop? There are primary and secondary causes. Primary causes include anything that starts before you were even born. Secondary causes occur as the result of an underlying condition (for instance, an infection). 

To explain primary causes of a Hydrocele let’s use a plumbing analogy: if the plumber who worked on your home was supposed to divert a bathroom drain to the sewer, but instead diverted it to your basement you would end up with water where it shouldn’t be….

The Proccesus Vaginalis (“I got a Vagina down there?” No, you don’t. Remember, all medical speak is caveman latin. “Vagin-” merely means “sheath” or “covering”.) is a sheath of tissue that allows passage of fluid from the abdominal cavity to the scrotum when you were in the safety of your mother’s womb. This sheath of tissue usually seals up by the time a boy is 1-2 years old. But if it doesn’t, he is at risk for the development of a Hydrocele. There are multiple types of primary Hydrocele which I won’t go into in this article. They all result in the same thing: fluid accumulating around the testicle.

One cause of Hydroceles is infection. World wide the most common cause of secondary Hydrocele is Filariasis. This is usually an infection with Wuchereria bancrofti that affects 120 million people globally in more than 73 countries and is carried and delivered to humans by our infective friend the mosquito. These cases are limited to tropical regions and are considered a neglected tropical disease. The main cause of filariasis in the United States? Not mosquitos. It’s trauma and/or complications after a hernia repair.

Whatever the cause, the result is the same: damage to what is called the lymph system. The lymph system is responsible for carrying fluid to and from places in the body, and if it is damaged your body’s ability to carry that fluid away is diminished. And you guessed it, that results in swelling. In this case: swelling in your testicles.  

Symptoms and Diagnosis of Hydroceles

Symptoms of Hydroceles will often start out as merely swelling. “So, my balls will get bigger?” Yes, you’ll be well hung. Congrats. But it won’t be your testicles that are huge. It’ll be the fluid around them. In fact, if the swelling gets high enough then you won’t be able to even feel your testicles in your scrotum.

Diagnosing hydroceles typically involves a physical examination by a medical doctor and imaging tests such as ultrasound. If you are noticing symptoms of a Hydrocele it’s important that you have it checked out. It may not be a Hydrocele, it may be a hernia, tumor, or that your testicle or epididymis (the organ right next to the testicle in your scrotum) are inflamed or infected. 

Treatment Options

Treatment options range from non-surgical approaches like observation and aspiration to surgical procedures like hydrocelectomy. Your healthcare provider will work with you to determine the most suitable treatment plan based on your individual condition. 

The likelihood of a good outcome due to a Primary Hydrocele is very high! The likelihood of a good outcome due to a Secondary Hydrocele depends on severity of damage to the lymph system.

One last thing….

If you are a parent and you notice your baby has symptoms of a Hydrocele the first thing to do is not to panic. 80-90% of male infants have the potential to have a Hydrocele because the sheath between the abdominal cavity and scrotum isn’t closed yet. 60-75% of baby boys no longer have this potential by the time they are 2 years old. And, get this, it’s estimated that 1 in five men have the potential to have a primary hydrocele until later in their adult life, but only about 6% of these become clinically evident. 

If you are having testicular swelling and pain don’t hesitate to reach out to learn more. Remember, if your testicular pain is acute (came on suddenly) you need to go to the emergency room in case you are having a testicular torsion. If it is not acute pain I would be happy to be a resource to you while you consider the best course of action. Reach out to me here to ask any questions or to schedule an appointment to get help!

Soli Deo Gloria,

Todd Rundell, Doctor of Physical Therapy

Men’s Health Specialist

P.S. 

At Renewal Physical Therapy we want to give our patients the tools to take care of their bodies so they can spend less on medical professionals and more on the rest of their lives. The first step in this process is making sure our patients are well educated. We are happy to answer your questions or to send you more material to help you better understand your condition. Just reach out to us!