Swelling or discomfort in the scrotum can be a source of concern. Among the more common issues affecting this area are varicoceles and hydroceles. Both involve swelling but originate from distinct underlying problems.
What is a Varicocele
A varicocele is an enlargement of veins within the scrotum. This condition is comparable to varicose veins in the legs, where veins become swollen and twisted. The affected veins are in the spermatic cord, which extends from each testicle into the lower abdomen.
A varicocele is due to faulty valves within these veins, which regulate blood flow back to the heart. When these valves do not function correctly, blood can pool, leading to dilated and more noticeable veins. Varicoceles most commonly occur on the left side of the scrotum, due to anatomical differences in venous drainage on that side.
Many individuals with a varicocele experience no symptoms. Others may notice a dull ache or a sensation of heaviness in the scrotum. This discomfort often worsens after prolonged standing or physical activity and may improve when lying down. A characteristic symptom is the feeling of a “bag of worms” when the affected area is touched.
Diagnosis of a varicocele involves a physical examination by a healthcare provider, often performed with the patient standing or during a Valsalva maneuver (straining as if having a bowel movement) to make veins more prominent. An ultrasound of the scrotum is used to confirm the diagnosis and assess the extent of venous enlargement and blood flow. A semen analysis may be recommended to evaluate potential effects on fertility.
Treatment for a varicocele varies depending on symptoms and whether it is causing complications like testicular atrophy or infertility. For asymptomatic cases or mild discomfort, observation and supportive undergarments might be sufficient. If pain is significant, over-the-counter pain relievers can be used. Surgical interventions, such as a varicocelectomy (tying off or clipping the enlarged veins) or embolization (blocking the veins with coils or a sclerosing agent), are considered for persistent pain, testicular shrinkage, or fertility concerns.
What is a Hydrocele
A hydrocele is a collection of fluid around the testicle, leading to swelling in the scrotum. This fluid-filled sac can affect one or both sides and may feel like a water balloon. While hydroceles can occur at any age, they are common in infants and often resolve on their own.
Hydroceles are categorized into two types: communicating and non-communicating. A communicating hydrocele occurs when an open connection exists between the abdominal cavity and the scrotum, allowing fluid to flow in and out. This type is common in newborns and results from the incomplete closure of a pathway that forms during testicular descent. A non-communicating hydrocele forms when fluid is trapped in the scrotum, even if the connection to the abdomen has closed.
Causes of hydroceles vary with age. In infants, they are often congenital, stemming from the developmental process in the womb. In older children and adults, hydroceles can develop due to scrotal injury, inflammation, or infection. Sometimes, they may appear without a clear cause.
The main symptom of a hydrocele is a painless swelling of the scrotum. The size of the swelling may fluctuate throughout the day, sometimes being smaller in the morning and larger in the evening. While not painful, a large hydrocele can cause a sensation of heaviness or mild discomfort.
Diagnosis begins with a physical examination by a healthcare provider, who will inspect and palpate the scrotum. A common diagnostic technique is transillumination, where a light is shone through the scrotum; if it illuminates, it suggests the presence of clear fluid, supporting a hydrocele diagnosis. An ultrasound may also be performed to confirm the fluid collection and to rule out other causes of scrotal swelling, such as a tumor or hernia.
Treatment approaches depend on the type and symptoms of the hydrocele. Many hydroceles, especially in infants, resolve spontaneously within the first year of life as the body reabsorbs the fluid or the connecting pathway closes. For persistent or symptomatic hydroceles, particularly in adults, surgical repair known as a hydrocelectomy is the main treatment option. This involves removing the fluid and often part of the sac.
Distinguishing Between Varicocele and Hydrocele
While both varicoceles and hydroceles cause scrotal swelling, they are distinct conditions with different underlying causes and characteristics. A primary distinction lies in what is causing the swelling: a varicocele involves enlarged veins, whereas a hydrocele is a collection of fluid.
The feel and appearance of the scrotum often provide the first clue. A varicocele is described as a “bag of worms” due to enlarged, twisted veins. A hydrocele, conversely, presents as a smooth, soft, and fluid-filled swelling. The swelling from a hydrocele can also cause one side of the scrotum to hang lower.
Pain patterns also differ between the two conditions. Varicoceles cause a dull ache or a sensation of heaviness in the testicle, which can worsen with prolonged standing or physical exertion. Hydroceles are painless, though a large fluid collection can lead to a feeling of discomfort or heaviness.
A simple diagnostic test that helps differentiate them is transillumination. When a light is shone through the scrotum, a hydrocele will illuminate because it contains clear fluid. A varicocele, being a mass of blood vessels, will not allow light to pass through.
The impact on fertility is another difference. Varicoceles are a common cause of male infertility, potentially affecting sperm quality and production due to increased testicular temperature. Hydroceles do not directly affect fertility. While less common, it is possible for an individual to have both a varicocele and a hydrocele simultaneously. Any new or concerning scrotal swelling or discomfort warrants prompt medical attention for an accurate diagnosis and appropriate management, as other serious conditions can present with similar symptoms.