What are Hydroceles and Inguinal Hernias?

Hydrocele
Hydrocele
Image © 2003 Fairman Studios, LLC.

Inguinal Hernia
Inguinal Hernia

Hydroceles occur when fluid fills a sac in the scrotum of the penis (in the "inguinal canal"). About 10 in 100 male infants have a hydrocele at birth. Hydroceles can also develop with swelling or injury of the scrotum.

An inguinal hernia occurs if a small part of the intestine drops into the scrotum with the testes. The intestine can form a lump in the scrotum. There are 2 kinds of inguinal hernias. Indirect inguinal hernias occur in about 1 in 100 baby boys and the rate is higher in premature infants. Direct inguinal hernias are fairly common in older adult males.

Hydroceles and inguinal hernias can become a problem for males. Females do not get hydroceles, but they can get hernias. Ten times more males get hernias than females.



What are the Signs of a Hydrocele?

Hydroceles don't often cause symptoms. Even though the swelling may worry new parents, it does not bother a baby and often goes away in the first year. In older males a hydrocele is most often painless, but may cause some pain due to the increased size of the scrotum.

What are the Signs of a Hernia?

Only about 25% of hernias cause pain. If the bulge forms where the thigh and groin meet, it can often be seen and felt. If the bulging intestine enters the scrotum, it can cause pain and/or swelling.



What Causes Hydroceles and Hernias?

How the testicles descend into the scrotum during pregnancy
How the testicles descend into the scrotum during pregnancy
Image © 2003 Fairman Studios, LLC.

Hydroceles

The testicles develop near the kidneys in the abdomen. By the end of pregnancy, they move down to their normal position in the scrotum.

A muscle lining opens in the scrotum (the inguinal ring) to let the testes drop from the abdomen, forming a sac or canal. If the ring stays open or reopens, a small amount of fluid can move from the belly to the scrotum through this passage. This causes a hydrocele. In most boys this canal closes.

Hydroceles can also happen after injury and swelling of the scrotum. They can get better in a few months. If not, they need medical attention.

Hernias

Inguinal hernias happen when the open lining does not close before birth. That leaves a weak area in the groin. Pressure can cause the intestine to push through and bulge out. The bulge may hurt or burn. A hernia can occur soon after birth or much later in life.

Hernias that occur in older adult males are common and can happen from pressure, like straining during bowel movements, heavy lifting, coughing, sneezing or obesity . This pressure forces part of the intestine through that weak spot in the groin or abdominal wall.

There is no proof that hernias are inherited, even if many family members have them.



How are Hydroceles or Hernias Diagnosed?

Your health care provider will often ask about your health history, conduct a physical exam, and may use imaging tests (like ultrasound) to look closer. He or she may:

  • apply pressure to the abdomen and scrotum to check for tenderness and an inguinal hernia.
  • ask you to cough to see how the bulge changes in your groin or abdomen with pressure
  • shine a light through the scrotum (transillumination) to look for fluid. If you have a hydrocele, this test will show the presence of clear fluid surrounding the testicle.
  • conduct an ultrasound or x-ray to see whether or not there is a hernia, testicular tumor or other cause of scrotal swelling

To look further, your health care provider might recommend blood and urine tests to check if there is an infection.



How are Hydroceles Treated?

Non-Communicating and Communicating Hydroceles
Non-Communicating and Communicating Hydroceles

Hydroceles call for surgery if they cause symptoms, become large, or show a change in size during the day. If the hydrocele is "non-communicating," meaning that there is no related inguinal hernia, a cut is made in the scrotum. The hydrocele is cut out and tissue is removed.

If there is "communication," or a related inguinal hernia, a cut is made in the upper groin area. This allows the hernia to be repaired at the same time as the hydrocele. In children it is often better to use an approach through the groin to avoid missing a hernia.

A hydrocele can also form on the other side, and the risk is about 5 out of 100 cases. The urologist may want to check the other side of the groin, making a small cut through the abdominal wall and looking through a small laparoscope (instrument inserted through the abdominal wall).

Inguinal Hernia
Inguinal Hernia

Inguinal hernia repair
Inguinal hernia repair

How are Hernias Treated?

Surgery to fix the muscle ring that did not close is recommended for a hernia in a child. Hernias do not go away on their own. They may cause problems if they block the bowels, and this can lead to the need for emergency surgery. In infants and children, a small cut is made in the groin. The urologist sews the canal shut and repairs the muscle ring. This procedure can be done in an outpatient setting. In teens and adults, laparoscopic surgery (performed through the abdominal wall) may be considered.

A hernia can develop on the other side of the groin, but this depends on the age of the child. Younger children treated for a hernia are much more likely to have a hernia on the other side. In younger children a laparoscope is sometimes used to look at the opposite side. If the exam shows that a hernia is present or likely to occur, then surgery on both sides is done as a preventive measure.



What Can Be Expected After Treatment for Hydroceles and Hernias?

After surgery, there will be pain that will require medication. In most cases, the pain will lessen during the first week so that drugs are no longer needed. Full activity may be restricted for a few weeks, based on your child's age and whether both sides were treated. If your son still plays on straddle toys, such as a rocking horse, he may have to avoid them for a while.

The teste and scrotum may stay swollen for a few weeks after surgery before returning to normal. After surgery, less than 1 out of 100 cases have a hernia or hydrocele return, but parents and patients should be aware of this possibility.

What Questions Should I Ask My Health Care Provider?

  • What treatment options do I have?
  • Are there any exercises that help?
  • Can dietary changes help?
  • What types of surgery should I consider? Which do you recommend?
  • What will recovery look like?
  • What can I do to make recovery easier?
  • Will a hernia return after surgery in the groin or in another area?
  • Will the hydrocele return after surgery?