A scrotal hematoma is a collection of blood that pools within the scrotum, the pouch of skin containing the testicles, when a blood vessel leaks. The hematoma itself forms in the scrotal sac, not necessarily within the testicle. However, an injury can sometimes affect both the scrotal tissues and the testicle, leading to swelling and other noticeable symptoms.
Causes of a Scrotal Hematoma
The most frequent cause of a scrotal hematoma is direct trauma to the groin area. This type of blunt force injury can occur during contact sports, from an accident like falling on a bicycle frame, or during a physical altercation. The impact can rupture small blood vessels, leading to internal bleeding that accumulates in the sac.
A scrotal hematoma can also be a complication following certain surgical procedures, such as a vasectomy or hernia repair. A small vessel may be nicked, causing blood to leak and pool in the scrotum, sometimes appearing days after the procedure.
Less commonly, underlying medical factors can contribute. Individuals who take blood-thinning medications (anticoagulants) or those with inherited bleeding disorders have an increased risk of bleeding from even minor injuries.
Symptoms and When to Seek Medical Attention
The primary symptoms include significant swelling, which can cause the scrotum to appear much larger than normal. This is accompanied by pain, which can range from a persistent, dull ache to a severe and sharp sensation, and a feeling of heaviness.
One of the most visible signs is skin discoloration. The accumulated blood beneath the skin results in bruising that can make the scrotum appear dark red, purple, or even black. This bruising may develop shortly after an injury or appear several days later. A firm lump or mass can sometimes be felt within the swollen scrotum.
When to Seek Immediate Medical Attention
It is important to seek prompt medical evaluation for any suspected scrotal hematoma, but certain symptoms warrant immediate attention. Sudden, excruciating pain in the scrotum is a red flag. The development of a fever could indicate a secondary infection. Difficulty or pain during urination is another serious sign that requires urgent assessment. These symptoms could point to a more severe underlying issue, such as a testicular rupture or torsion, which is a medical emergency.
Diagnosis and Medical Treatment
Diagnosing a scrotal hematoma begins with a physical examination of the groin area. A healthcare provider will assess the extent of the swelling, discoloration, and tenderness. The primary diagnostic tool is a scrotal ultrasound, which uses sound waves to create a picture of the internal structures. An ultrasound confirms the presence and size of the hematoma and allows the physician to check blood flow to the testicles using a Doppler ultrasound. This ensures the testicles have not been seriously injured and are receiving adequate blood supply, ruling out conditions like testicular torsion.
Treatment depends on its size and the severity of the symptoms. For smaller, uncomplicated hematomas, a conservative approach includes rest, applying ice packs, and using scrotal support, such as an athletic supporter, to alleviate discomfort. Over-the-counter pain medications can help manage pain.
In cases involving very large, painful, or enlarging hematomas, surgical intervention may be necessary. This procedure, known as surgical drainage, involves making an incision in the scrotum to remove the accumulated blood clot. Surgery is also required if the ultrasound reveals an associated injury to the testicle, such as a rupture.
Recovery and Outlook
For most individuals with a scrotal hematoma managed conservatively, the body gradually reabsorbs the collected blood. This process can take several weeks to a few months, depending on the initial size of the hematoma. During this time, the swelling will slowly decrease, and the skin discoloration will fade.
Following a doctor’s instructions during recovery is important. This involves avoiding strenuous activities, heavy lifting, and contact sports until cleared by a physician to prevent re-bleeding.
The overall outlook for a scrotal hematoma is excellent, with most cases resolving without long-term issues. Potential complications can include an infection or an abscess within the hematoma, which would require further medical treatment.