Epididymitis, or inflammation of the epididymis, can be a very painful condition due to the sensitivity of the entire area. Although it usually heals without problems with proper therapy, serious complications can occur without treatment.
What is epididymitis?
Epididymitis, also known as epididymitis in medical circles, is an infection that is usually caused by viruses or bacteria and affects the epididymis. Due to the anatomical conditions, the epididymis is located just above the testicles, the epididymitis can also easily spread to the testicle, so that it can further lead to testicular inflammation. The symptoms of epididymitis develop quite insidiously at the beginning, so that the inflammation can develop quite quickly and spread to nearby parts of the body.
Causes
Epididymitis is mostly caused by bacteria or viruses. In most cases, they enter the body from the outside through the urethra and ascend the seminal ducts to the epididymis. This is also called ascending infection. Often, the pathogens come from a bladder, prostate or urethral infection that spreads further in the body. In younger-aged men, epididymitis is also occasionally caused by chlamydia, which is transmitted through unprotected sex. However, other possible causes of epididymitis can include surgical procedures or a catheter. However, epididymitis can also be triggered by an injury to the epididymis. This can happen, for example, due to an accident or kick. Very rarely, infection of the epididymis also occurs through the bloodstream. From a focus of inflammation in another part of the body, the infectious agents reach the epididymis with the blood and trigger another infection here. In rheumatism patients, epididymitis can also be a concomitant of rheumatism.
Symptoms, complaints, and signs
Acute epididymitis shows very similar symptoms to testicular inflammation (orchitis). Initial symptoms often include pain when urinating and an increased urge to urinate. In addition, the testicle swells. The swelling can be so severe that the folds in the skin disappear completely. Another sign is the clear warming of the affected testicle. It begins to hurt and is particularly sensitive to pressure and touch. The pain may radiate to the abdomen and groin area. The skin on the scrotum begins to turn reddish, which is another typical indication of inflammation. A general feeling of illness with fatigue and exhaustion develops. Some patients also experience fever of up to 40 degrees, accompanied by chills, nausea and vomiting. At the beginning of the disease, the inflammation is clearly demarcated and affects only the epididymis. If treatment is not started immediately, it is very common for the inflammation to spread to the testicle after just one day, as the two structures are very close to each other. As a rule, the symptoms are limited to one side, but in exceptional cases they can spread to the second epididymis and testicle. Chronic epididymitis also causes swelling of the testicle, but there is almost no pain. Overall, it shows few symptoms.
Diagnosis and course
The diagnosis of epididymitis is quite unproblematic after the appearance of the first more severe symptoms. Therefore, the diagnosis is made after green examination and history. There is severe pain in the epididymis. These are accompanied by swelling and warming. It is also possible that there is redness of the scrotum. In worse cases, general inflammatory reactions such as chills, fever and fatigue may also occur. The diagnosis can be corroborated by various procedures. These include: Blood and urine tests, ultrasound diagnostics and palpation of the testicles. Ultrasound diagnostics can be used to determine whether the epididymis is already enlarged and whether abscess formation has already occurred. Normally, epididymitis heals completely with proper treatment. In rare cases, however, it may spread to the second epididymis or become chronic.This can result in the inability of the affected man to conceive. Possible complications of epididymitis may include abscess formation or even blood poisoning.
Complications
Usually, epididymitis is associated with very uncomfortable pain. In this case, the pain from the testicles can spread to the abdomen, back and further to the legs, so that there is a significant reduction in the patient’s quality of life. In most cases, the testicles are swollen and significantly reddened. The skin may also become itchy, and scratching usually only intensifies the itching. Without treatment, patients suffer from fever and pain in the extremities. Chills or a general feeling of weakness may also occur due to epididymitis, complicating the patient’s daily life in the process. In most cases, epididymitis also leads to pain that occurs during urination. These are mainly burning and can lead to psychological discomfort or irritability of the patient. Treatment of epididymitis is usually carried out with the help of antibiotics. There are no particular complications in this process. The symptoms usually disappear after a short time. The patient’s life expectancy is also not negatively affected by epididymitis.
When should one go to the doctor?
If the man experiences swelling of the testicle, pain when urinating or unusually filled scrotum, a visit to the doctor is advisable. If there is general restlessness, increased body temperature, and visual genital changes, a physician should be consulted. If a diffuse sensation of pain develops or if existing pain continues to spread, a doctor should be consulted. In case of a general feeling of illness, nausea as well as vomiting, a medical examination is required. The self-determined taking of medication or the use of ointments should only be carried out in consultation with a doctor. There is a possibility of side effects and contraindications, which can be avoided or reduced with optimal therapy. Discomfort in performing sexual activities, decreased libido, feelings of shame or withdrawal from the partnership may indicate a disease. A physician is needed so that the cause can be determined and treatment initiated. Discoloration of the testicle or other abnormalities of the skin appearance in the genital area should be presented to a physician. Problems with locomotion, disturbances of touch and sensation, and fatigue should be evaluated by a physician. If fatigue occurs quickly and emotional or mental irregularities occur, a physician is needed.
Treatment and therapy
The therapy of epididymitis should be carried out as early as possible, this allows a complete healing. Initially, the affected epididymis can be cooled and elevated. The entire testicle should also be immobilized. Appropriate analgesic and anti-inflammatory medications can be taken to combat the general inflammatory reactions. The bacteria causing epididymitis are treated with antibiotics. In the rare cases of a virus-related epididymitis, the administration of special drugs against the viral disease is omitted. Only the aforementioned therapy is administered to alleviate the symptoms. To prevent a chronic course, attention should be paid to consistent implementation of the therapy. This allows the epididymitis to heal in about two to three weeks. However, the swelling of the affected scrotum may take longer. If the epididymitis has already led to abscess formation or similar complications, surgical intervention may be necessary. Physical exertion should be avoided to support the therapy.
Outlook and prognosis
Epididymitis requires, above all, a great deal of patience. The healing process can be delayed up to six weeks, even with correct treatment. Only after that does the scrotum feel like normal again in many sufferers. As a rule, however, epididymitis heals well. However, some complications are possible. These can include fistulas, local destruction of the tissue, and extension of the inflammation to the seminal and urinary tracts.Occasionally, an abscess may also develop in the more pronounced epididymitis. This must be surgically removed. Frequent occurrence or carryover can lead to narrowing and scarring of the vas deferens or epididymis. This impedes sperm transport, which may result in infertility, especially in the case of bilateral obstruction. In addition, the inflammation could spread to the other testicle. In the case of recurrent inflammation, the only remedy is usually surgical transection of the spermatic cord or removal of the diseased epididymis. In more advanced stages, sometimes the testicle itself must also be removed. In addition to blood poisoning, Fournier’s gangrene is a very feared complication that is particularly severe in patients with a weakened immune system. This leads to tissue death of the connective tissue strands in the affected testis. Which in turn can lead to a severe inflammatory response by the body with a very high mortality rate.
Prevention
It is difficult to prevent epididymitis. People with changing sexual partners should definitely use condoms, as this prevents infection with chlamydia. Other infections, such as bladder or prostate infections, should be treated early to prevent the infection from spreading.
Follow-up care
Treatment of epididymitis usually results in a complete cure. The patient is not further affected. Since there is freedom from symptoms, there is also no reason for further follow-up examinations. However, infection is possible again at any time. To prevent this, preventive measures should be taken. The patient is responsible for these measures during follow-up care. He will be informed by his doctor about appropriate behavior. Sexual intercourse should only take place in a protected manner. Complaints about the prostate and urinary tract should be reported to a physician immediately. Experience has shown that starting treatment in the early stages leads to the best chances of recovery. Epididymitis takes a chronic course in some patients. In such cases, long-term follow-up care is necessary. Complications such as an abscess or blood poisoning must be prevented. Infertility can also develop. The doctor and the patient agree on an individual appointment schedule. Medicinal treatment to reduce pain accompanies the procedure. During a follow-up appointment, the physician palpates the testicle and scrotum. This is followed by a blood or urine analysis. This will reveal the inflammation levels. In certain cases, an ultrasound and X-ray may also be indicated. A detailed follow-up is usually used to discuss the question of surgery.
What you can do yourself
Epididymitis is very unpleasant for those affected, but it heals relatively quickly. To achieve relief, the swollen testicle should be elevated. This is achieved, for example, by using a so-called jockstrap. This jockstrap is a special carrying bag that “catches” the affected scrotum. This prevents the diseased testicle from pulling downwards under its own weight and thus causing pain. Instead, it is relieved. Furthermore, tight-fitting underwear should be worn. This also gives “stability” to the swollen scrotum and reduces pain. Boxer shorts or similar should be avoided during the acute pain phase. Most patients will find it extremely pleasant if the swollen testicle is cooled. A cold washcloth or compresses can be used. However, ice-cold water or even ice should never be used. This would only damage or destroy the surrounding tissue even more. Rest and a lying position with the legs elevated also have a pain-relieving effect. Sports or major exertion should be avoided during this time. If the inflammation and the associated pain are so severe that painkillers are necessary, relief can be achieved by taking ibuprofen.
