Scrotal Pain-A Hydrococele Or Water In The Sack Down There

There are a number of conditions that can cause pain and swelling in the scrotum. A benign condition is a hydrococele, which is a common cause of pain and swelling and can be easily treated. A hydrocoele is a collection of fluid around the testicle.

Hydorcocele

Hydrococele demonstrating a fluid collection around the testicle

Most often these swellings are a painless swelling of the scrotum. Hydrocoeles can affect males of any age, but usually occur in men older than 40 years. They may affect one side of the scrotum or both sides. In many cases, no cause is found. Possible causes include: blunt trauma to the scrotum, infection (eg. epididymo-orchitis, rarely as a result of a testicular tumour or from a torsion of the testes where the testicle twists and compromises the blood supply to the testicle.

Symptoms of a hydrocoele:
The most common presentation of a hydrococle is a painless, enlargement of the scrotum. There may be a sensation of heaviness or dragging. Hydrocoele is not usually painful (pain may be an indication of an accompanying infection).


Investigations: A light shined through the scrotum will cause the hydrocoele to illuminate (transillumination).
Investigation is not usually required in children. For adults, an ultrasound of the testis may be required. 
Since testicular lumps could potentially be missed on physical examination (due to the collection of fluid preventing full examination of the testis), an ultrasound is often advised. An ultrasound of the scrotum will confirm the diagnosis of hydrocoele & also identify any abnormal testicular lumps. 


Treatment of hydrocoeles:
If the hydrocoele is small, no treatment is usually required and the hydrococele can be checked on an annual basis at the time of the physical examination. For larger hydrocoeles, drawing off of the fluid using a needle & syringe may be indicated. However, such needle aspiration is not therapeutic because the fluid usually reaccumulates quickly & is associated with a risk of infection. For larger hydrocoeles, or where there is a suspected underlying tumor, surgery may be required. Hydrocoeles can usually be cured with a relatively simple surgical operation.


Bottom Line: Most hydrocoeles occur with normal testes. Always see your doctor if you notice any change in the size and/or shape of your scrotum or testes.
For more information, please view my video on YouTube on hydrococele, http://www.youtube.com/watch?v=WRCVUbYqV4E

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