Scrotal Swelling in Children
What is scrotal swelling in children?
The scrotum is the sac that holds the 2 testicles. Scrotal swelling
is a common problem in baby boys and young boys. It can have many causes. These are
often divided into painless and painful scrotal swelling.
What causes scrotal swelling in a child?
Causes of painless scrotal swelling
Painless swelling can happen
quickly. Or it may happen slowly over time. Causes can include:
- Hernia or hydrocele. These are the
most common causes of scrotal swelling. They are caused by abnormal openings left
behind after the testicles move into the scrotum during growth in the womb. A
hernia is a bulge of intestine through the opening. A hydrocele is a buildup of
fluid in the scrotum. About 1 in 10 baby boys have a hydrocele at birth. About 1
in 100 to 1 in 20 of all babies have a hernia at birth. They are more common in
preterm babies.
- Varicocele. This is a painless
swelling caused by enlarged veins in the scrotum. About 1 in 10 to 3 in 20 young
boys have this problem. It’s more common on the left side of the scrotum.
- Other causes. Less common causes
include idiopathic scrotal edema and testicle tumors. Idiopathic means it has an
unknown cause. Testicle tumors are very rare in boys younger than age 15.
Causes of painful scrotal swelling
Painful swelling can also happen
quickly. Or it may happen slowly over time. It’s less common but often more serious,
especially if it is severe and sudden. Causes can include:
- Testicular torsion. This is when a
testicle twists on its cord. A twisted cord can cut off the blood supply. Pain is
sudden and severe. This problem may need surgery within 6 hours to save the
testicle. Testicular torsion happens in about 1 out of 4,000 boys. It’s most
common in babies and boys between ages 12 and 18. It can happen from a hit to the
groin while playing or during sports.
- Torsion of testis appendage. This
is when a small sac on the top of the testicle suddenly twists. This causes pain
at the top of the testicle and scrotum. It’s common in boys between ages 8 and 12.
This is treated with over-the-counter pain medicine such as acetaminophen or
ibuprofen.
- Epididymitis and orchitis. These
are infections that can be caused by bacteria or viruses. Pain is less severe and
happens more slowly than with torsion. Viral infection of the testicle (orchitis)
can happen in young boys who have mumps. Epididymitis is an infection of the ducts
near the testicle that store sperm. It’s often caused by bacteria. Symptoms
include a feeling of heaviness, pain, and swelling in the scrotum. Sexually
transmitted diseases such as chlamydia and gonorrhea can cause epididymitis. In
older boys, it may happen from unprotected sex. In young boys, it may happen from
a problem in the urinary tract.
- Zipper entrapment. If part of the
scrotum, foreskin, or penis gets caught in a zipper, it can cause severe pain
right away.
- Henoch-Schönlein purpura. This
condition may cause painful scrotal swelling in young boys. It also causes a rash,
joint pain, stomach pain, and blood in the urine. Experts don't know what causes
it.
- Other causes. Less common causes
of painful swelling include other injuries, allergic reactions, and insect
bites.
What are the symptoms of scrotal swelling in a child?
Symptoms vary depending on the cause. In addition to the swelling, your child may also have pain or other symptoms. Make sure your child sees his healthcare provider for a diagnosis.
How is scrotal swelling diagnosed in a child?
The healthcare provider will ask about your child’s symptoms and
health history. He or she may also ask about your family’s health history. He or she
will give your child a physical exam. The physical exam will include an exam of the
belly, the scrotum, and the testicles. Your child will likely have a urine test. A urine
sample will be checked for signs of infection. Your child may also have an ultrasound.
These are painless imaging tests that use sound waves or a small amount of radiation to
show tissues in the body.
How is scrotal swelling treated in a child?
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
Depending on the cause of your child’s scrotal swelling, treatment may include:
- Surgery. For testicular torsion, your
child will often need emergency surgery to save the testicle. Your child may also
need surgery if he has a severe injury to the testicle. He may need emergency surgery
if a hernia is trapped or strangulated. If the hernia is not trapped, the healthcare
provider often recommends elective surgery. Testicular cancer often requires
surgery.
- Medicine. If your child has a bacterial infection, he will be given antibiotic medicine. Testicular cancer in boys responds well to cancer medicines. But it may also require radiation treatment.
- Watching over time. Your child may
not need treatment for conditions such as minor injury, mumps, a small hernia,
hydrocele, idiopathic swelling, or Henoch-Schönlein purpura. Many of these can be
watched to see if they go away on their own. The healthcare provider may give your
child pain medicine and medicine to reduce swelling while watching for some of these
conditions.
Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.
What are possible complications of scrotal swelling in a child?
Without treatment, a varicocele may over time lead to testicle damage
and being unable to have children (infertility). Sudden and severe causes of scrotal
swelling, such as testicular torsion, require surgery within a few hours. Otherwise the
testicle can die.
When should I call my child’s healthcare provider?
Call the healthcare provider if your child has:
- Painful scrotal swelling
- Pain from injury to the testicles that lasts longer than an hour
- Symptoms that don’t get better, or get worse
- New symptoms
Scrotal swelling that is severe and starts suddenly is a medical emergency. Take your child to an emergency room right away.
Key points about scrotal swelling in children
- The scrotum is the sac that holds the 2 testicles. Scrotal swelling is a common problem in baby boys and young boys. It can happen quickly, or happen slowly over time.
- It can have many causes. These are
often divided into painless and painful scrotal swelling.
- Your child will likely have a urine
test. A urine sample will be checked for signs of infection. Your child may also have
an ultrasound or X-ray study.
- In some cases, your child may not need treatment. The swelling may just be watched over time, and may go away on its own.
- In other cases, your child may need treatment with medicine or surgery.
- Scrotal swelling that is severe and starts suddenly is a medical emergency.
Next steps
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
Online Medical Reviewer:
Donna Freeborn PhD CNM FNP
Online Medical Reviewer:
Liora C Adler MD
Online Medical Reviewer:
Raymond Kent Turley BSN MSN RN
Date Last Reviewed:
11/1/2018
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