Hydrocele in Adults: Symptoms, Causes and When Treatment Is Needed

A hydrocele is a collection of fluid around a testicle that causes swelling of the scrotum. In adults, a hydrocele may develop gradually and is often painless, although a larger hydrocele can cause heaviness, discomfort or difficulty with daily activities. Because several other conditions can also cause scrotal swelling, a new or changing swelling should be examined rather than diagnosed at home.

A hydrocele is a fluid-filled sac surrounding the testicle. The fluid collects between layers of tissue around the testicle and causes the scrotum to become enlarged.

Adult hydroceles are often non-communicating, meaning the fluid does not freely move between the abdomen and scrotum. They may remain stable for a long time or gradually become larger.

A hydrocele is usually benign, but scrotal swelling can have other causes. An examination is therefore important, particularly when the swelling is new.

The most common symptom is swelling on one side of the scrotum. The swelling is often painless, although a larger hydrocele may cause heaviness or discomfort.

Possible symptoms include:

Adult hydroceles can develop without an obvious trigger, but they may also occur in association with inflammation, infection, injury or other conditions affecting the scrotum.

Possible causes and associations include:

A communicating hydrocele occurs when an opening between the abdominal cavity and the scrotum allows fluid to move into the scrotal sac. An inguinal hernia can also occur through this pathway.

If the swelling changes noticeably in size, extends toward the groin or is associated with a groin bulge, the possibility of a hernia should be assessed.

Most adult hydroceles are not dangerous and do not require immediate treatment if they are small and not causing symptoms. However, a new scrotal swelling should still be examined because hydrocele is only one possible cause of an enlarged scrotum.

A healthcare professional may need to rule out conditions such as an inguinal hernia, infection, testicular inflammation, varicocele, epididymal cyst or a testicular mass.

A doctor can often suspect a hydrocele from the history and physical examination. The scrotum is examined to understand the location, size, consistency and tenderness of the swelling.

Ultrasound is commonly used when the diagnosis is uncertain or when the testicle cannot be adequately examined because of the fluid. It can help distinguish a hydrocele from other causes of scrotal swelling and assess the underlying testicle.

No. A small hydrocele that is stable and does not cause discomfort may simply be monitored after the diagnosis has been confirmed.

Treatment becomes more relevant when the hydrocele becomes large, causes persistent discomfort or heaviness, interferes with daily activities, continues to enlarge, or causes significant concern for the patient.

The decision should also take into account the findings on examination and ultrasound and whether another underlying condition needs treatment.

Some hydroceles may remain stable or change over time, but a persistent adult hydrocele should not be assumed to disappear without evaluation.

If the swelling is newly noticed, increasing or associated with discomfort, it is better to confirm the diagnosis and discuss whether observation or treatment is appropriate.

There is no medicine that reliably dissolves or shrinks an established hydrocele. If the hydrocele is small and not causing problems, observation may be all that is required.

Fluid aspiration can temporarily reduce the swelling in selected situations, but the fluid can return. Aspiration alone is therefore not generally considered a definitive solution for a persistent adult hydrocele.

The appropriate approach depends on the size of the hydrocele, symptoms, underlying cause and overall health.

Hydrocele surgery, called hydrocelectomy, may be considered when the swelling causes persistent discomfort, becomes large, interferes with normal activities or continues to cause problems despite observation.

During hydrocele surgery, the surgeon drains the fluid and treats the surrounding sac so that fluid is less likely to collect again. The exact surgical technique depends on the type and characteristics of the hydrocele.

As with any operation, there are possible risks such as bleeding, infection, swelling, recurrence and persistent discomfort. These risks should be discussed before surgery.

Some swelling, bruising and discomfort are expected after hydrocele surgery and usually improve gradually. Scrotal support or close-fitting underwear may be recommended for comfort.

The exact recovery period varies according to the procedure and the individual. Heavy lifting and strenuous activity are generally restricted for a period recommended by the surgeon.

Increasing pain, redness, fever, significant bleeding, pus or rapidly increasing swelling after surgery should be reported to the treating team.

A hydrocele usually does not directly cause infertility. However, a large hydrocele can make examination of the testicle more difficult, and an underlying testicular or inflammatory condition may be relevant to fertility.

Men with fertility concerns, abnormal semen analysis, testicular pain or changes in testicular size should discuss the complete picture with a urologist rather than assuming that the hydrocele alone explains the problem.

Any new or unexplained scrotal swelling should be assessed. A urologist can determine whether the swelling is actually a hydrocele and whether an ultrasound or other investigation is needed.

You should arrange a urology evaluation if the swelling is increasing, painful, very large, recurrent or affecting your daily activities.

Sudden severe testicular pain is not typical of a simple hydrocele and requires urgent medical assessment. Testicular torsion and other acute scrotal conditions can cause severe pain and need prompt treatment.

Seek urgent medical attention for sudden severe testicular pain, severe pain with nausea or vomiting, rapidly developing swelling, fever with significant scrotal pain, or other acute symptoms.

Hydrocele in adults usually presents as painless scrotal swelling, heaviness or gradual enlargement caused by fluid around the testicle. Many small, asymptomatic hydroceles can be monitored after the diagnosis is confirmed.

Treatment may be considered when a hydrocele becomes large, painful, uncomfortable or disruptive. There is no medicine that reliably removes an established hydrocele, and persistent symptomatic hydroceles may be treated with hydrocelectomy.

Because several other conditions can cause scrotal swelling, a new swelling should be examined rather than assumed to be a hydrocele.