Hydrocele

Hydrocele is a collection of fluid around a testicle that usually causes painless swelling of the scrotum. It is common in newborn boys and can also occur in adults, often after inflammation, injury or for no clear reason.

Overview

Hydrocele is a condition in which clear fluid collects in the thin sac surrounding a testicle, leading to swelling of the scrotum. It may affect one side or, less commonly, both sides. A hydrocele is usually not dangerous and is often painless, but any new scrotal swelling should be examined by a qualified doctor to confirm the cause.

Hydroceles are common in newborn boys because the pathway between the abdomen and the scrotum may not have fully closed before birth. In many infants, the fluid is gradually absorbed and the swelling reduces over time. In older boys and adults, hydrocele can occur when fluid production and absorption around the testicle become unbalanced.

There are two broad types. A non-communicating hydrocele is fluid trapped around the testicle without an open connection to the abdomen. A communicating hydrocele means there is a remaining opening between the abdominal cavity and the scrotum, which may allow fluid to move in and out and can sometimes be associated with an inguinal hernia.

Symptoms

The main symptom of hydrocele is swelling in the scrotum. The swelling is often smooth, soft or tense, and may be more noticeable at the end of the day or after activity. Many people do not have pain, which is why the condition may be discovered during bathing, changing a baby’s diaper or a routine medical examination.

In infants, parents may notice that one side of the scrotum looks larger than the other. With a communicating hydrocele, the size may appear to change during the day because fluid can move between the abdomen and scrotum. The baby is usually otherwise well, feeding normally and not distressed by the swelling.

In adolescents and adults, a hydrocele can cause a feeling of heaviness, fullness or mild discomfort, especially if it becomes large. It should not usually cause severe pain. Symptoms that are not typical for a simple hydrocele include sudden intense testicular pain, redness, fever, nausea, vomiting, a hard lump in the testicle or swelling after a significant injury; these require prompt medical attention.

Causes & Risk Factors

In babies, hydrocele is usually related to normal development before birth. The testicles form in the abdomen and move down into the scrotum through a small passage. If this passage does not close fully or closes after fluid has entered the scrotum, a hydrocele can develop.

In adults, hydrocele may develop without a clear cause. It can also occur after inflammation or injury in the scrotum. Conditions that irritate the tissues around the testicle may increase fluid formation or reduce the normal drainage of fluid.

Possible causes and risk factors include:

• Being a newborn boy, especially when the abdominal-scrotal passage has not fully closed.
• Previous scrotal injury, trauma or surgery.
• Inflammation of the testicle or epididymis.
• Infections affecting the scrotal area or reproductive tract.
• Inguinal hernia, particularly when swelling changes in size.
• Less commonly, an underlying testicular or scrotal condition that needs evaluation.

Because several conditions can cause scrotal swelling, it is important not to assume that all swelling is a hydrocele. Medical assessment helps distinguish hydrocele from hernia, varicocele, epididymal cyst, infection, testicular torsion or a testicular mass.

Diagnosis

Diagnosis begins with a medical history and physical examination. The doctor may ask when the swelling started, whether it changes size, whether there is pain, fever, urinary symptoms, injury or previous surgery. In children, the doctor may also ask whether the swelling increases when the child cries, strains or stands.

During examination, the doctor checks the scrotum, testicles, groin and abdomen. A light may be shone through the scrotum in a test called transillumination. Fluid-filled swelling often allows light to pass through, although this test is not enough on its own to rule out other conditions.

Scrotal ultrasound is commonly used when the diagnosis is uncertain, when the hydrocele is large, when pain is present or when an underlying problem needs to be excluded. Ultrasound is painless and uses sound waves to show the testicle, surrounding fluid and blood flow. In selected cases, urine tests, blood tests or infection screening may be considered if inflammation or infection is suspected.

Treatment Options

Treatment for hydrocele depends on age, symptoms, size, cause and examination findings. The right approach is decided by a urologist or pediatric surgeon after assessment. Many hydroceles do not require immediate treatment if they are small, painless and not causing concern.

In infants, observation is often recommended because many hydroceles resolve naturally as the child grows. The doctor may monitor the size of the swelling and check for signs of a communicating hydrocele or inguinal hernia. Surgery may be considered if the hydrocele persists, becomes very large, appears to communicate with the abdomen or is associated with a hernia.

In adults, observation may be suitable when the hydrocele is mild and no underlying problem is found. If the hydrocele causes discomfort, becomes large, interferes with daily activities or creates diagnostic uncertainty, a procedure may be recommended. Surgical repair, often called hydrocelectomy, removes or adjusts the sac so fluid is less likely to collect again. The procedure is performed by a specialist, and the method depends on individual anatomy and health status.

Other approaches, such as drainage with or without a sealing treatment, may be considered in selected adults who are not good candidates for surgery, but they may have limitations such as recurrence or infection risk. If the hydrocele is related to infection, inflammation, injury or another condition, treatment also focuses on that underlying cause. Patients should not try to drain or treat a hydrocele at home.

Living With / Prognosis

The outlook for hydrocele is generally good. In babies, many hydroceles improve without intervention, while those that persist can usually be treated effectively by pediatric surgical specialists. In adults, a hydrocele may remain stable for a long time, but it can also gradually enlarge and become uncomfortable.

Living with a small, painless hydrocele may involve regular follow-up, especially if the doctor wants to monitor size or check for changes. Supportive underwear may reduce the sensation of heaviness in some adults. People should avoid self-diagnosis, because scrotal swelling can have many causes and some require urgent care.

After treatment, recovery guidance depends on the procedure performed and the person’s overall health. A specialist will usually advise on wound care, activity, return to exercise and follow-up. Any increasing pain, fever, wound redness, significant swelling or new symptoms after a procedure should be reported to the treating team.

For international patients seeking evaluation, Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals diagnose and treat urological conditions such as hydrocele in both children and adults. Care decisions are made after clinical assessment and appropriate imaging when needed.

When to See a Doctor

A doctor should evaluate any new or unexplained scrotal swelling, even when it is painless. This is important because hydrocele can resemble other conditions, including inguinal hernia or testicular problems. Early assessment helps confirm the diagnosis and decide whether observation or treatment is appropriate.

Parents should arrange medical review if a baby or child has scrotal swelling, swelling that changes size, swelling that appears with crying or straining, or a groin bulge. These features may suggest a communicating hydrocele or hernia, which needs specialist evaluation.

Urgent medical care is needed if scrotal swelling is accompanied by sudden or severe testicular pain, nausea, vomiting, fever, redness, tenderness, abdominal pain or a testicle that appears higher than usual. These symptoms may indicate conditions such as testicular torsion or infection, which require prompt assessment. Adults should also seek review if a hydrocele grows quickly, becomes uncomfortable or is associated with a hard lump or unexplained testicular change.

Frequently asked questions

What is a hydrocele?

A hydrocele is a collection of fluid around a testicle inside the scrotum. It usually causes painless swelling and may affect one or both sides. Although it is often benign, a doctor should confirm the diagnosis because other conditions can also cause scrotal swelling.

Is hydrocele common in babies?

Yes, hydrocele is common in newborn boys and is often related to normal development before birth. Many infant hydroceles improve naturally during the first 1 to 2 years of life. A pediatrician or pediatric surgeon should still assess the swelling, especially if it changes size or is associated with a groin bulge.

Can hydrocele go away without treatment?

In babies, many hydroceles go away on their own as fluid is absorbed and the passage between the abdomen and scrotum closes. In adults, a small painless hydrocele may be monitored, but it may not disappear completely. Follow-up helps ensure that it is not enlarging or linked to another condition.

Does hydrocele cause pain?

A simple hydrocele is usually painless. Some adults may feel heaviness, pressure or mild discomfort if the swelling becomes large. Sudden severe testicular pain is not typical of a simple hydrocele and should be treated as urgent until assessed by a doctor.

How is hydrocele diagnosed?

Diagnosis usually starts with a physical examination of the scrotum, testicles and groin. The doctor may use transillumination and may request a scrotal ultrasound to confirm fluid around the testicle and check the testicle itself. Additional tests may be used if infection or inflammation is suspected.

What is the treatment for hydrocele?

Treatment may be observation, especially in babies or in adults with a small painless hydrocele. If the hydrocele is large, persistent, uncomfortable or associated with a hernia, a specialist may recommend a procedure such as surgical repair. The right treatment is chosen after examination and, when needed, ultrasound.

Can hydrocele affect fertility?

A simple hydrocele usually does not directly affect fertility. However, very large hydroceles or underlying conditions such as infection, inflammation or testicular disease may need assessment. Men with concerns about fertility, testicular size or persistent scrotal swelling should consult a urologist.

References

• American Urological Association
• European Association of Urology
• Mayo Clinic
• Cleveland Clinic
• National Health Service

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.