Hydrocele: Symptoms and Causes

What is Hydrocele?

A hydrocele is a fluid-filled sac that forms around one or both testicles, leading to swelling in the scrotum. It is typically painless and may cause a feeling of heaviness or discomfort. Hydroceles can affect males of any age but are most common in newborns and older men.

In infants, hydroceles often develop before birth when fluid from the abdomen flows into the scrotum through a natural opening. This usually resolves on its own within the first year of life. In adults, this may occur due to inflammation, injury, or an underlying condition such as infection or trauma.

Hydroceles may affect one testicle (unilateral hydrocele) or both (bilateral hydrocele). While many cases are mild and resolve naturally, persistent or large hydroceles may require medical evaluation to rule out other conditions and prevent complications.

How Does Hydrocele Form?

A hydrocele can form at different stages of life, from infancy to adulthood, and the cause varies depending on age.

Hydrocele in Infants and Newborns

Hydroceles are common in newborns and usually form before birth. During fetal development, the testicles move from the abdomen down into the scrotum through a tunnel called the inguinal canal. As the testicles descend, a sac of fluid also travels with them. Normally, this passage closes after birth, and the fluid is absorbed by the body. However, if the passage doesn’t close properly, it can trap fluid in the scrotum, resulting in a hydrocele in newborns or hydrocoele in infants.

Hydrocele in Older Children and Adult Men

In older boys and adult men, a hydrocele can develop due to:

• Injury to the scrotum or testicle
• Inflammation or infection, such as epididymitis or orchitis
• Previous surgery, particularly around the groin or scrotal area
• Underlying medical conditions, including testicular torsion or tumours (rare)

This form of hydrocele, often referred to as a secondary hydrocele, tends to develop when there is an imbalance in fluid production and absorption in the scrotum. When the body produces more fluid than it can absorb, or if the drainage system is blocked, fluid starts collecting around the testicle, leading to noticeable swelling. This can happen on one side (e.g., left hydrocele) or both. Some men may refer to the condition as “water in testicles” or “fluid on scrotum”, especially when the swelling becomes more visible over time.

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Types of Hydrocele

Hydroceles are generally classified into two main types: communicating and non-communicating hydroceles. Each type develops differently and can affect infants, children, or adults.

Communicating Hydrocele

A communicating hydrocele occurs when there is an open connection between the abdominal cavity and the scrotum. This happens if the processus vaginalis, a natural tunnel that forms during fetal development, does not close properly. As a result, fluid from the abdomen can pass into the scrotum and collect around the testicle.

This type of hydrocele is more common in newborns and young children. The swelling may increase during the day or when the child is active and reduce when lying down. In some cases, a communicating hydrocele may be associated with an inguinal hernia, which may require prompt attention.

Primary (Non-communicating) Hydrocele

In a non-communicating hydrocele, the processus vaginalis is closed, but fluid remains trapped in the scrotal sac. This fluid may be present at birth or can develop later due to inflammation, trauma, or infection.

This type is often seen in adult men and tends to remain stable in size or grow slowly over time. It usually does not fluctuate throughout the day like a communicating hydrocele.

Difference Between a Hydrocele and a Varicocele

Hydrocele and varicocele are two different conditions that both cause swelling in the scrotum, but they have distinct causes and characteristics.

Symptoms of Hydrocele

Most hydroceles do not cause pain and are often noticed as painless swelling on one or both sides of the scrotum. The symptoms may vary depending on the type and severity of the condition. Common signs include:

• A painless, soft swelling in the scrotum (often described as “water in testicles” or “fluid on the scrotum”)
• A feeling of heaviness or discomfort in the scrotum
• A larger scrotum, especially noticeable after activity
• In some cases, pressure or mild pain due to increased swelling
• The swollen area may be more noticeable while standing and less prominent when lying down

In infants (hydrocele in newborns), the scrotal swelling is usually detected at birth and tends to go away on its own within the first year.

If the hydrocele becomes very large or causes discomfort, it may interfere with normal activities like walking or sitting. In rare cases, it may be associated with an underlying condition such as infection or injury.

Causes of Hydrocele

The causes of hydrocele vary by age group:

In Adults:

• Injury or trauma to the testicles or scrotum
• Infection in the testicle or epididymis (epididymo-orchitis)
• Inflammation due to a medical condition
• Post-surgical fluid accumulation
• In rare cases, testicular tumours

In Newborns:

During fetal development, the testicles descend from the abdomen into the scrotum through a tube (processus vaginalis). This tube normally closes, but if it remains open, fluid can flow into the scrotum, causing a hydrocele in infants or newborn hydrocele.

When to see a Hydrocele Doctor?

It is important to consult a doctor if you or your child notices swelling in the scrotum, as it could be caused by a hydrocele or another underlying condition that needs treatment.

In infants, a hydrocele is often harmless and tends to go away on its own within a year. However, if the swelling continues beyond 12 months or starts getting larger, it is best to have it checked by a healthcare provider. Sometimes, what appears to be a hydrocele could actually be linked to an inguinal hernia, where part of the intestine slips into the scrotum through a weak spot in the abdominal wall. This may require surgery.

In older children or adult men, medical attention is recommended if:

• The swelling becomes painful or uncomfortable
• The hydrocele gets larger over time
• There are symptoms of infection such as redness, warmth, or fever
• You notice a sudden change in the size of the scrotum

Seek urgent medical care if you or your child experiences:

• Severe or sudden pain in the testicle or scrotum
• Swelling that appears rapidly, especially after an injury
• Nausea or vomiting along with scrotal pain

These may be signs of testicular torsion, a medical emergency where the testicle twists and cuts off its own blood supply. It requires immediate surgery to save the testicle and prevent long-term damage.

Hydrocele Treatment Types

Non-Surgical Hydrocele Treatment

Aspiration and Sclerotherapy – This minimally invasive procedure involves draining the fluid from the hydrocele using a needle, followed by injecting a solution to prevent it from refilling. It is mainly used for men who cannot undergo surgery. However, the hydrocele may return and require repeated treatment.

Surgical Hydrocele Treatment

Laser Hydrocelectomy – Laser hydrocelectomy is a minimally invasive surgical procedure that uses a focused laser beam to drain the fluid and remove the hydrocele sac. It offers faster recovery, minimal discomfort, and a low risk of recurrence.

Open Hydrocelectomy – In this traditional surgical method, the surgeon makes a small incision in the groin or scrotum to remove the hydrocele sac and close off any abnormal connections. It is done under general anaesthesia and is considered highly effective. This is the most commonly performed procedure for hydrocele in men when long-term resolution is needed.

What Happens if a Hydrocele is Left Untreated?

In many cases, a hydrocele may not cause serious issues and can be left alone if it is small and painless. However, if ignored for too long, a hydrocele can gradually increase in size and cause discomfort, heaviness, or swelling in the scrotum.

In rare cases, an untreated hydrocele can lead to complications. One such risk is the development of an inguinal hernia, especially in infants or when the opening between the abdomen and scrotum (the processus vaginalis) doesn’t close properly. This allows part of the intestine to push into the scrotum, which may be painful and potentially serious.

In adults, long-standing or large hydroceles may cause pressure on nearby structures in the scrotum, leading to discomfort during walking, sitting, or sexual activity. While mild hydroceles may resolve on their own, secondary hydroceles caused by infection, injury, or underlying conditions require medical attention to address the root cause.

If left untreated, there is also the risk that what appears to be a hydrocele might actually be another condition such as a tumour or a hernia, which makes proper diagnosis important.

Can You Prevent a Hydrocele?

Hydroceles in newborns usually happen naturally and cannot be prevented. They often resolve on their own within the first year.

In older children and adults, the risk can be reduced by protecting the testicles from injury. Wearing protective gear during sports or strenuous activity helps prevent trauma that may lead to a secondary hydrocele. While there is no sure way to prevent all hydrocele types, staying alert to symptoms like swelling or discomfort in the scrotum and seeking early medical advice can help avoid complications.

Risk Factors and Complications of Hydrocele

Risk Factors

Hydroceles are most common in newborn males and occur in around 5% of births. Premature babies are at a higher risk of developing a hydrocoele in infants, especially if born more than three weeks early.

In older males, risk factors for developing a hydrocele in men include:

• Injury or trauma to the scrotum (e.g. during sports or accidents)
• Inflammation in the testicles or scrotal area
• Infections, including sexually transmitted infections (STIs)

Complications

Most hydroceles are harmless and often don’t affect fertility or cause long-term issues. However, if left untreated, certain complications may arise, such as:

• Infection or tumour: These may interfere with testicular function, reducing sperm production and potentially affecting fertility.
• Inguinal hernia: In some cases, a hydrocele may be linked to an inguinal hernia, which can lead to serious complications if a part of the intestine becomes trapped.

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