7 Common Hydrocele Symptoms You Should Know About

A hydrocele is a fluid-filled sac surrounding a testicle that causes swelling in the scrotum. While this condition is generally painless and harmless, understanding its symptoms is crucial for proper identification and timely medical consultation. Hydroceles can occur in newborns or develop in adult men due to various reasons including injury, infection, or inflammation.

This condition affects approximately 1-2% of adult men and is one of the most common causes of scrotal swelling. Although hydroceles are typically benign, recognizing the symptoms early can help distinguish them from more serious conditions and ensure appropriate medical attention when needed. In this comprehensive guide, we’ll explore the seven most common symptoms of hydrocele to help you identify this condition.

1. Scrotal Swelling

The most characteristic and noticeable symptom of a hydrocele is swelling in the scrotum. This swelling occurs due to fluid accumulation in the thin sheath surrounding the testicle, known as the tunica vaginalis.

Key characteristics of scrotal swelling in hydrocele:

• The swelling is usually smooth and uniform
• It typically affects one side of the scrotum, though bilateral hydroceles can occur
• The swelling may feel like a water-filled balloon when touched
• The size can range from barely noticeable to significantly larger than the normal testicle
• The swelling may fluctuate in size throughout the day, often becoming larger as the day progresses

In infants, the swelling might be present at birth or develop within the first year of life. In adults, the swelling typically develops gradually over weeks or months, though it can occur suddenly following an injury or infection.

2. Feeling of Heaviness in the Scrotum

Many men with hydrocele report a sensation of heaviness or pressure in the affected scrotum. This symptom results from the weight of the accumulated fluid pulling down on the scrotal tissue.

The heaviness is typically more noticeable during certain activities:

• After prolonged standing or walking
• During physical exercise or strenuous activity
• At the end of the day when gravity has had more time to affect fluid distribution
• When wearing tight-fitting clothing or underwear

This feeling of heaviness is generally not painful but can be uncomfortable and may affect daily activities. Some men describe it as a “dragging” sensation that creates awareness of the affected side. The sensation often improves when lying down, as the fluid redistributes and gravity no longer pulls the scrotum downward.

3. Painless Enlargement

Unlike many other scrotal conditions, hydroceles are characteristically painless. The enlargement of the scrotum occurs without significant discomfort in most cases, which is an important distinguishing feature.

Important aspects of painless enlargement:

• The enlargement is typically gradual and progressive
• There is no sharp or acute pain associated with the swelling
• The testicle itself remains non-tender to gentle touch
• The skin over the hydrocele appears normal without redness or warmth

However, it’s important to note that if pain is present, it may indicate a complication or a different condition entirely. Sudden pain combined with scrotal swelling could suggest testicular torsion, infection, or trauma, all of which require immediate medical attention. A hydrocele that becomes painful may have developed complications such as infection or bleeding within the fluid-filled sac.

4. Transillumination Effect

While this is technically a sign that healthcare providers look for during examination rather than a symptom patients notice themselves, understanding transillumination can help you recognize a hydrocele. When a light is shined through the swollen scrotum, a hydrocele will glow or appear translucent due to the clear fluid inside.

What makes transillumination significant:

• The fluid in a hydrocele is typically clear and serous, allowing light to pass through
• This distinguishes hydrocele from solid masses or blood-filled collections
• A positive transillumination test strongly suggests a hydrocele rather than other causes of scrotal swelling
• Healthcare providers use a penlight or special light source during physical examination

If you notice that the swollen area appears somewhat translucent when exposed to bright light, this may indicate a hydrocele. However, this observation should never replace a proper medical evaluation.

5. Discomfort or Pressure Sensation

Although hydroceles are generally painless, many patients experience varying degrees of discomfort or pressure, particularly when the hydrocele becomes large. This discomfort differs from acute pain and is often described as a dull, aching sensation.

The discomfort associated with hydrocele may manifest as:

• A constant awareness of the affected testicle
• Pressure in the lower abdomen or groin area
• Difficulty finding comfortable positions while sitting or lying down
• Mild aching that worsens with activity and improves with rest
• Discomfort during sexual activity or physical exercise
• Irritation from the enlarged scrotum rubbing against the inner thighs

The level of discomfort often correlates with the size of the hydrocele. Larger hydroceles are more likely to cause noticeable discomfort, while smaller ones may produce no discomfort at all. This symptom can affect quality of life and may prompt men to seek medical evaluation even when the hydrocele is not causing other problems.

6. Variation in Size Throughout the Day

A distinctive characteristic of some hydroceles, particularly communicating hydroceles, is that the size of the swelling can change throughout the day. This fluctuation occurs due to fluid movement between the scrotum and the abdominal cavity.

Patterns of size variation include:

• The swelling may be smaller in the morning after lying down all night
• Progressive enlargement occurs during the day, especially with upright activities
• The hydrocele may decrease in size when lying flat or elevating the scrotum
• Physical activity or straining may temporarily increase the size
• Coughing or bearing down might make the swelling more prominent

This variation in size is more common in infants and young boys with communicating hydroceles, where there is still an open connection between the abdominal cavity and the scrotum. In adults, most hydroceles are non-communicating and tend to maintain a more constant size, though some variation may still occur due to changes in body position and fluid dynamics.

7. Difficulty Seeing or Feeling the Testicle

As fluid accumulates around the testicle, it can become increasingly difficult to feel or distinguish the normal testicular tissue beneath. This symptom is particularly evident in moderate to large hydroceles where significant fluid surrounds the testicle.

Characteristics of this symptom include:

• The testicle feels obscured or buried within the swollen scrotum
• Normal testicular contours are difficult to palpate
• The affected side feels uniformly swollen rather than having distinct testicular shape
• Self-examination becomes challenging or impossible
• The testicle may feel like it’s floating within the fluid-filled sac

This symptom can be concerning for men who regularly perform testicular self-examinations, as it prevents proper assessment of the underlying testicle. It’s important to have a healthcare provider evaluate any scrotal swelling that makes it difficult to examine the testicle properly, as this ensures that no underlying testicular abnormalities are missed.

Main Causes of Hydrocele

Understanding what causes hydroceles can provide insight into prevention and risk factors. Hydroceles develop through different mechanisms depending on age:

In Newborns and Infants:

• Congenital hydrocele: During fetal development, the testicles descend from the abdomen into the scrotum through a passage called the processus vaginalis. Normally, this passage closes before birth, but if it remains open, abdominal fluid can flow into the scrotum, creating a hydrocele
• Patent processus vaginalis: When the connection between the abdomen and scrotum fails to close properly, fluid can move back and forth, causing a communicating hydrocele
• Most congenital hydroceles resolve spontaneously within the first year of life as the passage gradually closes

In Adult Men:

• Inflammation or infection: Conditions such as epididymitis or orchitis can trigger fluid production around the testicle
• Injury or trauma: Blunt trauma to the scrotum can result in fluid accumulation as part of the healing response
• Obstruction of lymphatic or venous drainage: Blockage in the normal fluid drainage pathways can cause fluid to accumulate
• Surgical complications: Hydroceles may develop following hernia repair, vasectomy, or other scrotal surgeries
• Infections: Parasitic infections such as filariasis (common in tropical regions) can block lymphatic vessels and cause hydrocele
• Tumors: Although rare, testicular or scrotal tumors can produce excess fluid or block drainage
• Idiopathic causes: In many adult cases, no specific cause can be identified, and the hydrocele develops spontaneously

Age is also a risk factor, with hydroceles being more common in men over 40 years old. The exact reason for this age-related increase is not fully understood but may relate to gradual changes in the scrotal tissues and drainage systems over time.

Prevention Strategies

While congenital hydroceles cannot be prevented, there are several strategies that may help reduce the risk of developing acquired hydroceles in adulthood:

Protect Against Scrotal Injury:

• Wear appropriate protective equipment during contact sports or activities with risk of groin injury
• Use athletic cups or protective gear during high-risk activities
• Practice safe techniques when engaging in physical activities or sports

Prevent and Treat Infections Promptly:

• Practice good genital hygiene to reduce infection risk
• Seek prompt medical attention for symptoms of epididymitis, orchitis, or sexually transmitted infections
• Complete full courses of prescribed antibiotics for any urogenital infections
• Practice safe sexual behaviors to prevent sexually transmitted infections that could lead to inflammation

Address Underlying Conditions:

• Manage conditions that increase abdominal pressure, such as chronic constipation or chronic cough
• Maintain healthy weight to reduce pressure on pelvic and scrotal structures
• Treat any lymphatic or venous disorders under medical supervision

Regular Self-Examination:

• Perform monthly testicular self-examinations to detect changes early
• Become familiar with normal testicular size, shape, and consistency
• Report any new swelling, lumps, or changes to a healthcare provider promptly

It’s important to note that even with preventive measures, some hydroceles may still develop without any identifiable preventable cause. Early detection through awareness of symptoms and regular self-examination remains one of the most effective approaches to managing this condition appropriately.

Frequently Asked Questions

Can a hydrocele go away on its own?

In infants, most hydroceles resolve spontaneously within the first 12-24 months of life as the processus vaginalis closes naturally. In adults, small hydroceles may occasionally resolve on their own if the underlying cause is treated, but most persist without intervention and may require surgical treatment if they cause symptoms or concern.

How can I tell the difference between a hydrocele and a hernia?

Both conditions can cause scrotal swelling, but there are key differences. A hydrocele typically feels smooth, fluid-filled, and doesn’t change significantly with coughing or straining. An inguinal hernia often produces a bulge that may extend into the scrotum, changes size with position or straining, and may be accompanied by a gurgling sensation. A healthcare provider can definitively distinguish between these conditions through physical examination and imaging if needed.

Is a hydrocele dangerous or a sign of cancer?

Hydroceles themselves are not dangerous and are benign conditions. However, in rare cases, they can develop secondary to testicular tumors. Any new scrotal swelling should be evaluated by a healthcare provider to rule out serious underlying conditions. An ultrasound examination can visualize the testicle beneath the fluid and identify any concerning masses.

When should I see a doctor about scrotal swelling?

You should seek medical evaluation for any new scrotal swelling, especially if accompanied by pain, redness, fever, or sudden onset. Immediate medical attention is necessary if you experience sudden severe pain, as this could indicate testicular torsion, which is a medical emergency. Even painless swelling warrants evaluation to confirm the diagnosis and rule out other conditions.

Can hydroceles affect fertility or sexual function?

Small to moderate hydroceles typically do not affect fertility or sexual function. However, very large hydroceles may cause discomfort during sexual activity and, in rare cases, might affect sperm production due to increased temperature or pressure on the testicle. If you have concerns about fertility and have a hydrocele, discuss this with your healthcare provider.

Do hydroceles require surgery?

Not all hydroceles require treatment. In infants, observation is usually recommended as most resolve naturally. In adults, surgery may be recommended if the hydrocele is large, causing significant discomfort, continues to grow, or if there’s concern about underlying testicular pathology. Small, asymptomatic hydroceles can often be monitored without intervention. The decision should be made in consultation with a healthcare provider based on individual circumstances.

Can lifestyle changes help with hydrocele symptoms?

While lifestyle changes cannot cure a hydrocele, certain measures may help manage symptoms. Wearing supportive underwear can reduce the feeling of heaviness, avoiding activities that worsen discomfort may help, and maintaining a healthy weight can reduce pressure on the area. However, these are comfort measures only and do not address the underlying fluid accumulation.

References:

• Mayo Clinic – Hydrocele
• NHS – Hydrocele
• Johns Hopkins Medicine – Hydrocele
• Urology Care Foundation – Hydrocele
• Healthline – Hydrocele