Noticing a swollen or enlarged scrotum in your newborn baby or young son can be alarming for any parent. However, this common condition, known as a hydrocele, is usually painless and harmless. Understanding what it is can provide significant peace of mind.
What is a Hydrocele?
A hydrocele is a fluid-filled sac surrounding a testicle that causes swelling in the scrotum. This sac is a remnant of the natural development process that happens before a baby is born. You can think of it as a small balloon of fluid that makes the scrotum look puffier than usual, often on one side but sometimes on both.
In most cases, a hydrocele is not painful and does not affect the health of the testicle or future fertility.
What Causes a Hydrocele in Infants and Children?
The causes differ slightly between newborns and older boys, but both are related to a natural part of development.
1. Communicating Hydrocele in Newborns
Before birth, a baby boy’s testicles develop inside his abdomen. They gradually descend into the scrotum through a tunnel called the processus vaginalis. This tunnel is supposed to close shut on its own shortly before or after birth.
A communicating hydrocele occurs when this tunnel fails to close completely. This allows abdominal fluid to travel down into the scrotum and become trapped around the testicle. The size of the swelling may change throughout the day, often appearing larger when the baby is crying or active (as pressure increases) and smaller after he has been lying down.
2. Non-Communicating Hydrocele in Newborns
Sometimes, the tunnel closes correctly, but a small amount of fluid remains trapped inside the scrotum. This is a non-communicating hydrocele. The body will usually reabsorb this fluid gradually over the first year of life.
3. Hydrocele in Older Boys
If a hydrocele suddenly appears in an older boy or teen, it may be caused by:
- Injury or trauma to the scrotum, testicle, or groin.
- Infection of the testicle or epididymis.
- Inflammation from another condition.
- Torsion (twisting) of the testicle (a medical emergency).
Because a sudden hydrocele in an older child can signal an underlying issue, it’s important to have it evaluated by a doctor promptly.
Common Symptoms of a Hydrocele
The primary sign of a hydrocele is a soft, fluid-filled swelling in the scrotum. Here’s what parents typically observe:
- Swelling: One side of the scrotum is noticeably larger than the other. It may look like a water-filled balloon.
- No Pain: The swelling is usually not painful or tender to the touch. Your baby should not be in distress from the hydrocele itself.
- Size Changes (Communicating Type): The size may fluctuate with activity level.
- Blue-Tinted Appearance: If the scrotum is very full of fluid, the skin might have a faint blue tint that you can see when light is shone through it (transillumination—a test a doctor performs).
Important Note: If the swelling is accompanied by significant pain, redness, vomiting, or fever, seek immediate medical attention, as these could be signs of a more serious condition like a hernia or testicular torsion.
How is a Hydrocele Diagnosed?
Diagnosing a hydrocele is typically straightforward. A pediatrician or pediatric urologist will:
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Perform a Physical Exam: They will gently feel the scrotum and may check for a cough impulse (a sign of a communicating hydrocele/hernia).
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Conduct a Transillumination Test: The doctor will dim the lights and shine a bright light from behind the scrotum. Because the sac is filled with clear fluid, the light will glow through it, confirming the presence of fluid rather than a solid mass.
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Use an Ultrasound (in some cases): If the physical exam isn’t clear, or if the doctor suspects a hernia or another issue, an ultrasound may be ordered to get a detailed image and rule out other causes.
Hydrocele Treatment Options for Children
The treatment plan depends entirely on the type of hydrocele and the child’s age.
1. Observation and Waiting (Most Common)
For infants born with a hydrocele, the first course of action is almost always watchful waiting. The vast majority of non-communicating hydroceles—and even some communicating ones—will resolve on their own without any intervention by the time a child is 12 to 24 months old as the fluid is reabsorbed and the passage seals.
2. Hydrocele Surgery (Hydrocelectomy)
Surgery is recommended if:
- The hydrocele does not go away on its own after age 1-2 years.
- It is a communicating hydrocele that continues to change size (as this has a risk of developing into an inguinal hernia).
- The hydrocele becomes very large, tense, or uncomfortable.
- It appears suddenly in an older child.
The surgical procedure for a hydrocele is common, safe, and performed under general anesthesia. The surgeon makes a small incision in the groin or scrotum, drains the fluid, and then closes the connection (the processus vaginalis) to prevent recurrence. It is typically an outpatient procedure, meaning your child can go home the same day.
3. Aspiration (Rarely Used)
Draining the fluid with a needle (aspiration) is generally not recommended for children. The fluid almost always returns, and the procedure carries risks of infection and injury.
Recovery and Outlook After Treatment
Recovery from hydrocele surgery is usually quick. Your child might experience some bruising and swelling, which is normal. The doctor will advise you on pain management and any activity restrictions (like avoiding vigorous play for a few weeks). The long-term outlook is excellent, and recurrence after a properly performed surgery is very rare.
Frequently Asked Questions (FAQ)
Q: Can a hydrocele turn into a hernia?
A: A communicating hydrocele and an inguinal hernia are caused by the same issue—an open tunnel from the abdomen. The difference is what passes through: fluid (hydrocele) or abdominal contents like intestine (hernia). A communicating hydrocele can potentially become a hernia, which is why doctors monitor them.
Q: Will a hydrocele affect my son’s fertility?
A: No. A simple hydrocele does not affect the testicle itself or future fertility. The surgery to correct it is also designed to protect all structures and does not impact fertility.
Q: How can I tell the difference between a hydrocele and a hernia?
A: It can be difficult for a parent to tell. Generally, a hydrocele feels smooth and fluid-filled, while a hernia may feel more lumpy. A key sign is if the bulge can be pushed back into the abdomen or reduces when lying down (more indicative of a hernia). Only a doctor can make a definitive diagnosis.
Q: When should I call the doctor?
A: Contact your pediatrician if you notice any new scrotal swelling. Seek immediate emergency care if the swelling is accompanied by:
- Severe pain
- Redness
- Vomiting
- Fever