Hydrocele (Water Hernia): Causes, Symptoms & Treatment

Hydrocele, also called water hernia, is a change in the testicle, which is benign and usually occurs without pain. It accumulates water in the scrotum.

What is a hydrocele?

A hydrocele can occur only on the testicle, or/and also on the spermatic cord. There is both a primary, that is, a congenital hydrocele, and a secondary, that is, an acquired hydrocele. This can therefore develop in the course of life due to different causes. The primary hydrocele can occur on one or both sides and often regresses without treatment in the first months of life. Such a congenital hydrocele is not uncommon. There is also a special form of hydrocele, acute hydrocele. It can be caused by trauma, hemorrhage or infection. This form differs from the other two in the form of severe pain.

Causes

The causes of hydrocele vary. In primary hydrocele, the cause is due to a developmental phase in the womb. The peritoneum bulges out in a funnel shape into the scrotum, takes place in the body of the unborn child and later regresses. Water can then accumulate there, resulting in a hydrocele. The testicles of the child descend from the abdominal cavity into the scrotum only shortly before birth or within the first year of life. In doing so, they must slide through the aforementioned protrusion, which normally closes afterwards. If this is not the case, a hydrocele can form there or, if it fails to close completely, even an inguinal hernia. Secondary hydrocele can affect male children or adults during life. There are several triggers for this, such as inflammation of the testicles or epididymis (see epididymitis). In addition, injuries or testicular tumors can lead to a hydrocele. Hydrocele can also occur as a result after surgery to remove varicose veins from the testicle (varicoceles).

Symptoms, complaints, and signs

A hydrocele can manifest itself with very different symptoms. A swollen testicle is typical of the condition. The degree to which the testicle is swollen depends primarily on the location and extent of the fluid accumulation. In the early stages, the hydrocele usually does not cause any further symptoms. Only with the enlargement of the testicle do further symptoms appear, such as throbbing pain or a feeling of pressure or heaviness. In a severe course, an acute scrotum occurs, which is associated with severe pain. Acute hydrocele can lead to severe swelling of the testicle. There is also an increased risk of developing infertility. Many affected individuals also notice a throbbing sensation in the scrotum area. Externally, a hydrocele can be recognized primarily by the swelling of the testicle. In severe cases, bleeding may also occur, which is manifested by a partial red coloration of the scrotum. A congenital hydrocele occasionally regresses on its own. However, hydrocele or inguinal hernia may occur, which can cause serious complications. In the most severe cases, the affected testicle dies.

Diagnosis and course

Hydrocele is diagnosed with the help of various examinations, the first being palpation by the physician. Here it is determined whether the scrotum is swollen and other external abnormalities are present. In most cases, an ultrasound examination is performed to confirm the presence of a hydrocele. The course of a hydrocele is generally positive, since it is a benign change of the testicle. The primary hydrocele can usually resolve itself and no treatment is necessary. In the case of secondary, on the other hand, the cause should be treated. Surgery may also be necessary if the hydrocele persists. However, the prognosis is still positive.

Complications

In most cases, hydrocele does not cause any particular complications or discomfort. The change in the testicle is benign in this case and there is usually no pain for the patient. The testicles are relatively swollen and fill with water. Without treatment, pain in the testicles may occur in the further course of this disease, but in the first instance it does not occur.Pain in the testicles is a very unpleasant symptom for the man and can lead to a severe reduction in quality of life. The affected person appears depressed due to the hydrocele and no longer actively participates in social life. Furthermore, psychological complaints and depression may develop if the hydrocele is not treated. Pain at rest can also lead to sleep disturbances at night. In many cases, no treatment is necessary. However, if the hernia does not resolve on its own, surgery can be performed to relieve the symptoms. In this case, no particular complications occur. The patient’s life expectancy is also not affected by the hydrocele.

When should one go to the doctor?

A hydrocele must be examined by a physician in any case. Since the degeneration can also turn into a malignant tumor, early diagnosis and treatment of the disease always has a positive effect on the further course and can prevent complications. A doctor should be consulted for hydrocele whenever there is swelling on the testicles. This swelling occurs mainly without a particular reason and permanently. Pain does not usually occur. Accumulations of water can also be seen on the testicles. Only in rare cases there is pain or other unpleasant sensations on the testicles. Therefore, if the symptoms of hydrocele occur over a longer period of time and do not disappear on their own, a visit to a urologist is necessary in any case. Treatment also usually takes place at the urologist’s office and can completely limit the hydrocele. The life expectancy of the patient is not negatively affected by this disease.

Treatment and therapy

If a congenital hydrocele does not also have an inguinal hernia, the affected child does not initially require treatment because the water accumulation will resolve on its own. If the hydrocele has not receded by the end of the first year of life, surgery will be necessary. This is only a minor procedure in which an incision is made at the groin to close the connection between the peritoneum and the scrotum there. In the worst case, a hydrocele will form again after a few months, but this rarely happens. In the case of secondary hydrocele, therapy is started to treat the cause. As a result, the water accumulation can often recede. If the hydrocele nevertheless persists or there is no clearly identifiable cause, surgery is also advised in this case to eliminate the symptoms. A special technique is used to prevent the hydrocele from forming again.

Outlook and prognosis

The majority of patients diagnosed with hydrocele can expect improvement. Statistically, it has been determined that nine out of ten patients experience resolution of typical symptoms. A life without limitations is the rule. Two risk groups are to be distinguished: Infants up to the age of two and all others. The disease in babies usually heals on its own. The others require surgical therapy. Infants are in a constant state of development. This causes the origin between the testicle and the abdominal cavity to close on its own. Often this happens around the fourth month of life. From the age of three, the only option is surgical intervention. This usually proceeds without complications. Possible difficulties are also known from other operations: Infections, swellings and others. Only rarely does the hernia recur. If no surgery is performed, complications regularly arise. For example, permanent infertility is possible. Fluid in the scrotum then squeezes off the blood supply. Testicular torsion is also conceivable, in which the testicle interferes with blood flow. In any case, the genital area is very sensitive. Pain occurs increasingly in everyday life.

Prevention

One cannot directly prevent a hydrocele; one can only try to keep the risk of developing it as low as possible. For example, anyone who suffers or has suffered from testicular or epididymitis should treat it consistently with medical advice. Those who participate in certain sports where there is an increased risk of injury to the genital area should take adequate precautions to protect themselves. For example, there are genital protectors for athletes that could be put on.

Aftercare

Following surgery, the patient usually remains in the hospital for one to two days to provide the necessary aftercare. This consists of removing the wound drainage tube and checking the surgical wound the day after surgery. Any wound pain that occurs can be discussed with the doctor during the ward round and treated appropriately with medication. Patients must take it easy and avoid physical exertion for the first two weeks after discharge. Hot baths or full baths in general are taboo during this time; instead, the shower should be used. Sauna sessions or the use of hot water bottles or heating pads are also contraindicated within this time frame. As long as no redness, swelling or pain develops, wound healing proceeds according to plan. Nevertheless, the patient is advised to make a follow-up appointment with his urologist shortly after discharge and to provide him with the hospital’s discharge letter. This contains all the information about the treatment and medications administered. The sutures begin to dissolve after two weeks and gradually fall off by themselves over a period of up to three months. If irritation from the suture material occurs or if there is still residue on the wound after this period, a physician should be contacted.

What you can do yourself

A hydrocele usually requires surgical treatment. Some home remedies and tips support the treatment. Initially, those affected should wait and see. Sometimes the blockage on the testicles dissolves after some time and the fluid can drain away by itself. This process can be supported by a bath with Epsom salt. The warm water, in combination with the salts, ensures that the fluid is drawn out of the body through the skin and the swelling subsides. In addition, Epsom salt is rich in magnesium, which relaxes muscles and relieves pressure sensitivity. However, if the hydrocele hurts, an Epsom salt bath can cause further inflammation. If pain is present, it is best to seek medical attention. After the recovery period, rest and warmth are recommended. Children should spend as much time as possible in bed during the first two days after treatment. Men should not engage in sexual activity for at least a week. Lastly, the scrotum and especially the area around the hydrocele should be spared. Protective underwear or a bandage will keep the irritated area from further stress and help with recovery.