Varicocele: Causes, Symptoms, Treatment, Complications and Prevention

Overview

In simple terms, the swelling of veins in the scrotum is known as varicocele. But then, what is a scrotum? Scrotum is the pouch that holds the testicles (testes). The scrotum also contains various blood vessels that supply blood to the reproductive organs. 

Both sides of the scrotum are anatomically different. Although it’s extremely rare, varicoceles can develop on both sides. 

In a varicocele, the veins inside the scrotum become enlarged. The enlarged veins are known as pampiniform plexus. The condition is similar to varicose veins that develop in the legs. This is one of the most common reasons behind male infertility. 

Facts on Varicocele

• Varicocele is the most common problem males belonging to the age of 15-25 develop.

• Not in all cases, but a varicocele is more likely to develop on the left side of the scrotum than the right side.

• Varicocele is similar to varicose veins. Varicose veins tend to occur in the legs while varicocele occurs in the scrotum. 

Causes of Varicocele

The whole reproductive system work in coherence to produce, store and transmit sperm. The testicles produce sperms. 

There is no certain reason behind the swelling of the veins in the testes. But doctors assume anyone of the following reasons can contribute to the enlargement of veins in the scrotum. Some of them are discussed below-

• Valves in the veins don’t function properly

• Blood flow to the testicles is slow that results in the pooling of blood in the veins. 

• The blood from the testicles towards the heart flows backward or pools in the veins.

• Blood flow is restricted by swollen lymph nodes or other masses under the belly. 

Symptoms of Varicocele

In most cases, men do not experience any symptoms. In severe cases, a varicocele can be identified with the following symptoms-

• A lump can be felt in the testicles 

• A low-intensity pain in the testicles

• A feeling of heaviness or pull in the scrotum

• Worm-like or spaghetti-like veins in the scrotum can be seen 

• Discomfort on the side of testicles the veins dilate

• Testicles shrink on the side the veins dilate

Types of Varicocele

There are two types of varicocele which can be further categorized into 3 types.

• Primary Varicocele develops when the left internal spermatic veins and the renal vein creates pressure inside the scrotum. In addition to this, there can be malfunctioning of the valves in the veins.

• Secondary Varicocele develops when an unwanted growth of skin in the scrotum restricts flow to the internal spermatic vein. 

Whether someone is suffering from primary or secondary varicocele, the doctor diagnoses the grade of the varicocele the patient is suffering from.

• Grade 1 varicocele- In this classification of varicocele, the affected veins are not visible to the naked eyes. It gets detected only during a physical examination. 

• Grade 2 varicocele- In this category, the veins are larger than grade 1 but these are still invisible to the eye.

• Grade 3 varicocele- These are enlarged veins that are easily visible to the naked eye. 

Diagnosis of Varicocele

A varicocele can be easily diagnosed through a physical examination. It is easily visible through a self-exam also. 

A varicocele cannot be diagnosed when the patient is lying down. In such cases, doctors diagnose through a Valsalva maneuver. 

In the Valsalva maneuver, the patients exhale forcefully by closing the mouth by pinching the nose shut. 

Doctors also perform a testicular examination. In this diagnostic test, the doctor visually checks for any abnormal growth or bumps by feeling the testicles and the area around it to confirm that nothing is wrong. The urologist also looks for any abnormalities in the epididymis. 

To rule out any other problem, the doctor recommends a scrotal ultrasound. In this diagnostic procedure, the doctor uses high-frequency sound waves to obtain images inside the male reproductive system- testicles and the surrounding area in the scrotum. 

Treatment of Varicocele

Ayurvedic Treatment of Varicocele

According to Ayurveda, some of the herbs that are recommended by doctors to get relief from symptoms are- 

• Varun

• Punarnava

• Rasana

• Turmeric 

Some of the medicines Ayurvedic doctors prescribe are-

• Chirivilwadi kashayam tablets 

• Sukumaram kashayam tablets

• Chandraprabha Vati

Allopathic Treatment for Varicocele

Unfortunately, there are no drugs or medicines that can cure varicoceles. Doctors prescribe painkillers such as acetaminophen or ibuprofen to help get relief from the pain associated with varicocele.

Homeopathic Treatment for Varicocele

Homeopathic medicines work on the symptoms of a disease. Some of the common homeopathic medicines are-

• For getting relief from severe inflammation in the testes, take Pulsatilla.

• To get rid of excessive itching in the groins, doctors prescribe Rhus Toxicodendron.

• For immediate relief from pain in the testicles and spermatic cord, Nux Vomica is recommended.

• For immediate relief from pain and inflammation, Hamamelis is the appropriate option. 

Home Remedies for Varicocele 

Diet 

Special care needs to be taken by varicocele patients regarding their diet. The list of food items that doctors recommend are-

• Buttermilk

• Variety of rice which is red

• Radish

• Horse gram 

• Ginger

• Pepper

• Pomegranate

• Sour fruits

• Jaggery

• Ghee

• Soup

• Milk 

• Water boiled with ginger and coriander 

The list of food items that doctors recommend not to eat are-

• Processed, fatty food

• Carbonated and sugary drinks

• Alcohol

• Spicy, salty food items

• Food that is difficult to digest such as cream, red meat, fat of cow, fish, pig, etc. 

Lifestyle Instructions

When diagnosed with a varicocele of any grade, doctors recommend some tips until the surgery is performed-

• Avoid sex

• Restrict any strenuous exercise or lifting heavyweights

• Do not swim or take a bath 

• Avoid driving or operating any high machinery

• Restrict excessive straining while passing stools 

Surgery of Varicocele

• Varicocelectomy-   This is a daycare procedure that can be performed at the doctor’s clinic. Performed under the influence of anesthesia, the urologist redirects the blood flow to other unaffected veins by closing the affected one.  An obstructed vas deferens is repaired surgically in a varicocele surgery.

This can be performed into two eyes-

1. Microscopic varicocelectomy- In this type of varicocelectomy, the surgeon makes an incision of 1cm. Through this incision, the veins are ligated using a microscope. The whole procedure is completed within 2 to 3 hours. 

2. Laparoscopic varicocelectomy- In this type, the surgeon makes several small incisions through which a long, slender tube known as a laparoscope is inserted. The doctors ligate the veins through these incisions.  The whole procedure is completed within 30 minutes. 

3. Percutaneous embolization-  With the help of X-ray guidance, a contrast dye is injected through a tube to check where the problem originates. This is done by tracking all the veins that leads to the varicocele. The flow of blood is diverted by blocking the blood flow in the affected vein with the help of coils, plugs with or without sclerosant. The whole procedure is performed by making a small hole in the groin or neck. 

Complications of Varicocele

Leaving a varicocele untreated for long can lead to severe complications. Some of them are discussed below-

Infertility

Varicocele is one of the prime contributors to increasing infertility and lower sperm count in males in India. The main reason being that an increased blood flow raises the temperature of the testicles thereby, lowering sperm production. 

Shrinking of Testicles

As the veins of the scrotum get enlarged, the testes tend to become smaller and softer. This is also known as testicular atrophy or shrinkage. 

Imbalance of Hormones 

When diagnosed with varicocele, there are higher levels of luteinizing hormone secretion. This is an abnormality as this hormone is found in higher levels in women.  

Prevention of Varicocele

There are no preventive measures that can stop varicocele from occurring. But fortunately, there are some tips that improve circulation, strengthen vein structure and boost collagen production. These factors prevent new veins from swelling.

• Avoid a sedentary lifestyle. It is important that you don’t sit or stand for long periods without any break. 

• Drink lots of water. Keep yourself hydrated to prevent sperm damage and maintain proper pH balance.

• Maintain a healthy lifestyle. To live a healthy life, stop consuming excessive alcohol or caffeine, stimulant drugs, smoking or consuming a low fiber, processed food diet. 

• Consume Vitamin C-rich food. Vitamin C-rich food encourage collagen production and recovery. Some food that are rich in Vitamin C are broccoli, strawberries, mango, tomato, papaya, kale, and bell peppers. 

• Ensure a healthy heart. People suffering from untreated diabetes or any cardiovascular diseases are more likely to suffer from arterial obstruction, poor circulation of blood as well as varicoceles. 

• Eat food high in antioxidants to prevent damage to sperm.