Hydrocele
A hydrocele is a fluid-filled swelling around one or both testicles. It’s usually painless and harmless, though it can cause discomfort or a feeling of heaviness. Hydroceles are common in newborns and older men, and treatment is available if it becomes bothersome.
Overview | Symptoms & Causes | Diagnosis | Treatment Options
What is a Hydrocele?
The testicles (or testes) are two small, oval-shaped organs inside the scrotum that produce sperm and testosterone. Each testicle is surrounded by a thin sac called the tunica vaginalis, which normally contains a small amount of fluid to allow smooth movement within the scrotum.
A hydrocele occurs when excess fluid collects in this sac, causing noticeable swelling. Hydroceles can develop at any age, from infancy to adulthood, and can affect one or both sides. It is usually painless, although the swelling can sometimes feel heavy or uncomfortable. Hydroceles are generally harmless but can occasionally indicate an underlying problem in the testicle or scrotum that may need assessment.
Understanding Hydroceles
A hydrocele often develops gradually and may not cause discomfort at first. While some hydroceles remain small and painless, others can grow larger and become more noticeable.
Common signs and symptoms include:
- A soft, smooth swelling in one or both sides of the scrotum
- A feeling of heaviness or fullness in the scrotum
- Swelling that may fluctuate in size throughout the day
- Usually painless, though larger hydroceles can cause mild discomfort
- The swelling may be more noticeable when standing and less obvious when lying down
Although hydroceles are generally harmless, any sudden increase in size, pain, or redness should prompt medical evaluation to rule out infection or other underlying conditions.
Common Causes
A hydrocele occurs when fluid collects in the thin sac surrounding the testicle (the tunica vaginalis). In many cases, the exact cause isn’t clear, but several factors can contribute to its development.
| Congential | Some boys are born with a hydrocele due to incomplete closure of the processus vaginalis, the channel that allows the testicle to descend into the scrotum. |
| Injury or trauma | Trauma to the scrotum can trigger fluid accumulation. |
| Infection or inflammation | Conditions such as epididymitis, orchitis, or other infections in the scrotum can lead to a reactive hydrocele. |
| Tumours or growths | Rarely, hydroceles may develop secondary to testicular tumours. |
Diagnosing Hydroceles
Hydroceles are usually diagnosed through a combination of physical examination and imaging:
| Clinical Examination | A healthcare provider will examine the scrotum for swelling. Hydroceles typically feel smooth and fluid-filled, and are usually painless. They may transilluminate - light passes through the fluid when a light is shone behind the scrotum. |
| Ultrasound | If there is uncertainty, an ultrasound of the scrotum can confirm that the swelling is fluid-filled and help rule out other causes such as hernias, cysts, or testicular tumours. |
A proper diagnosis ensures that any underlying conditions causing the hydrocele are not missed and guides the appropriate management plan.
Treatment Options
Most hydroceles are painless and do not require treatment unless they cause discomfort, become very large, or are associated with another underlying condition.
| Observation | Small, asymptomatic hydroceles are often monitored over time, especially in infants, as they can sometimes resolve on their own. It should be re-checked if you experience new symptoms such as any sudden increase in size, pain, or redness. |
| Aspiration | In some cases, fluid can be drained with a needle, but this is usually temporary and may need to be repeated. It is less commonly recommended because the hydrocele can recur. |
| Surgical Repair (hydrocelectomy) | For persistent, large, or symptomatic hydroceles, a surgical procedure may be performed to remove or repair the fluid-filled sac. |
Treatment choice depends on the size of the hydrocele, the presence of symptoms, and the patient’s overall health.
How can Lanthorn help?
Testes & Scrotum Ultrasound - only £150
A non-invasive scan to confirm the presence of a hydrocele, assess its size, and check for any other underlying conditions in the testes or scrotum.
Referral to a specialist
If the hydrocele is large, symptomatic, or associated with other conditions, we can refer you to a urologist for further assessment and treatment.
