Swollen testicles in toddler

Scrotal Swelling in Children

Your son’s scrotum is the sac that holds the two testicles. Scrotal swelling is a common problem seen in young boys and baby boys. It can have many causes. These are usually divided into painless and painful scrotal swelling.

Hydrocele. Click to Enlarge.

Causes of painless scrotal swelling

Painless swelling can come on suddenly or slowly over time.

Here are some of the more common causes:

  • Hernias and hydroceles. These are the most common causes of scrotal swelling. They are caused by abnormal openings left behind when the testicles descend into the scrotum during development.

    Hydroceles are collections of fluid that pass down into the scrotum and are present in about 10 percent of baby boys at birth. If an opening does not close by itself, a portion of intestine may pass through the opening. This is called a hernia. Hernias occur in about 1 to 5 percent of all newborns and are more common in premature babies.

  • Varicoceles. These painless swellings are caused by enlarged veins in the scrotum that drain the testicles and send blood back to the heart. They are present in 10 to 15 percent of young boys and are more common on the left side of the scrotum.

  • Other causes. Less common causes include idiopathic scrotal edema and tumors of the testicle. Idiopathic is a term used when doctors don’t know what is causing a condition. In this case, there can be rapid scrotal swelling in young boys, but it goes away on its own. Testicular tumors are extremely rare in boys younger than age 15 and account for less than 2 percent of all cancers in children.

Causes of painful scrotal swelling

Painful scrotal swelling can start suddenly or gradually. Painful swelling is less common than painless swelling, but is usually more serious, especially if it is severe and sudden.

Here are some common causes:

  • Testicular torsion. This condition is caused when a testicle twists on its cord. A twisted cord can cut off a testicle’s blood supply and may require emergency surgery—ideally within six hours of the onset of symptoms to save the testicle. Pain is sudden and severe. Testicular torsion occurs in about one out of 4,000 boys. It is most common in infants and boys between ages 12 and 18. Boys often experience pain from a blow to the groin while playing or during sports.

  • Epididymitis and orchitis. These are infections that can be caused by bacteria or viruses. Pain is less severe and more gradual than with torsion. Viral infection of the testicle (orchitis) can be seen in young boys who contract mumps. Epididymitis, marked by a feeling of heaviness, tenderness, and swelling in the scrotum, is usually a bacterial infection of the ducts near the testicle that are important for the storage and development of sperm. Several sexually transmitted diseases, including chlamydia and gonorrhea, can cause epididymitis. When it occurs in older boys, it may be because of unprotected sexual activity. In young boys, it is usually because of an abnormality somewhere in the urinary tract.

  • Zipper entrapment. If part of the scrotum, foreskin, or penis gets caught in a zipper, it can cause immediate, agonizing pain. Emergency room doctors commonly treat both pain and injury while freeing the entrapped tissue.

  • Other causes. Less common causes of painful swelling include other injuries, allergic reactions, and insect bites. Schönlein-Henoch purpura is a condition that may cause painful scrotal swelling in young boys along with rash, joint pain, stomach pain, and blood in the urine; its cause is unknown.

Diagnosis and treatment of scrotal swelling

Any scrotal swelling needs to be examined by your child’s health care provider. The diagnosis begins with taking a medical history and asking about when the swelling started and how painful it is. A physical examination will include an examination of the belly, the scrotum, and the testicles.

In almost all cases, your child’s health care provider will request a urine sample to look for signs of infection. The medical team may also do an ultrasound exam, which involves taking pictures of the structures inside the scrotum by using sound waves.

Depending on the findings, treatment may require:

  • Surgery. For testicular torsion, emergency surgery is usually needed to save the testicle. Surgery may also be needed in cases of a hernia that traps some intestine in the scrotum or a severe injury to the testicle.

  • Antibiotics. If the doctor finds evidence of bacterial infection, he or she will prescribe antibiotics. Young boys who are not sexually active should also have special X-ray studies to look for an abnormality in their urinary system as a possible cause of infection.

  • Observation and other treatments. For conditions like minor trauma, mumps, small hernias, hydroceles, idiopathic swelling, and Schönlein-Henoch purpura, no treatment may be needed. Many of these conditions can be watched to see whether they clear up on their own. Other conditions need attention. Without treatment, varicoceles may over time result in infertility and testicular injury that is not reversible. Testicular cancer in boys responds very well to cancer drugs. Pain medicines and medicines that reduce swelling may also be used during observation for some of these conditions.

When to see the health care provider

If you child has scrotal swelling at any age, he should be seen by his health care provider. Most scrotal swelling is not painful, but still needs to be evaluated. Your child should be seen right away if he:

  • Has any pain from injury to the testicles that lasts longer than an hour.

  • Has painful scrotal swelling, especially swelling that is severe and starts suddenly. This is a medical emergency.

Enlarged Testicle in Young Boy

Q1. My grandson is nearly 5 years old. He recently developed an enlarged testicle. My daughter says that within a week it grew about four times the size of the other testicle. Is cancer a possibility at this young age?

— Nancy, California

Nancy, I understand your concern. What you describe does sound like a very significant and rapid enlargement. Testicular tumors are unusual in this age group, but they can occur. Your grandson’s condition certainly should be evaluated by a pediatrician or a pediatric urologist.

To diagnose this swelling, the pediatrician will want to know about the history of the swelling: Is it painful, does it change in size with position, was there trauma to the area? On exam, the doctor will look for signs of inflammation, like redness, warmth, or tenderness. It is important to determine what exactly is enlarged: Is it the actual testicle or the scrotum? Painful scrotal swelling should always be examined as soon as possible. Causes such as a twisting of the testicle need to be treated urgently. A frequent cause of painless swelling in the scrotum is a hydrocele, or a collection of fluid in the scrotum. This can result from a variety of causes. Sometimes a hydrocele is present from birth. It may occur as an inflammatory response to an infection in the area, a tumor of the testicle, or a twisting of a small piece attached to the testicle called the appendix testis. Twisting of the appendix testis is reasonably common in this age group. Although it results in no actual damage to the testicle, it may cause impressive swelling and possibly some redness, warmth, and tenderness of the scrotum. An inguinal hernia can also present itself suddenly as swelling in this area, as can bleeding in the scrotal area after trauma. As I mentioned before, the best way to determine the cause of your grandson’s swelling is to have him examined by a pediatrician or pediatric urologist.

Q2. My seven-year-old son has suffered from encopresis for several years. We have tried all traditional “cures” with little or no success. Are there any new surgical treatments for this condition?

— Heather, New Jersey

I do not know of any new surgical treatments for encopresis, also known as fecal incontinence, or the inability to control one’s bowel movements. Figuring out how to help your son recover depends on the type of encopresis he has. The most common form is associated with constipation. About 1.5 percent of children between the age of seven and eight suffer from encopresis related to constipation. This may seem counterintuitive, but constipation can cause the colon to dilate, which can lead to the leakage of fecal matter around any hard, constipated stools, causing soiling of the underpants. Children with this type of encopresis often won’t even know until later that they have soiled themselves. Treating the constipation is critical in curing this type of fecal incontinence. A high-fiber diet, laxatives, stool softeners, or enemas can help treat constipation, though this type of encopresis usually will resolve with time (certainly by the time a child reaches puberty).

Another type of encopresis is not associated with constipation but rather with anxiety, stress, and behavioral problems. This type of fecal incontinence responds best to behavioral therapy that focuses on behavioral changes, like setting aside time for the child to spend on the toilet each day to encourage daily defecation.

Less commonly, encopresis can be the result of a neurologic problem affecting a child’s continence. Hirschsprung’s disease, for instance, is a neurological disorder related to constipation encopresis. People with this disorder are missing nerve cells that are supposed to help with the movement of the colon. Hirschsprung’s disease and other neurological problems that lead to fecal incontinence can be treated with surgery, which involves resectioning of the distal part of the colon.

All children with encopresis should have a thorough physical exam where you can discuss the history of your child’s problem. The physical exam should include an assessment of the anal sphincter tone to determine the type of encopresis and the best ways to manage it. If your son has not been seen by a pediatric gastroenterologist, you might consider making that your next step.

Q3. I fell on a gate a month ago, and about two weeks later I began to have pain in my urethra, especially when I urinate. Other times I will have a shooting needle pain in the area. I feel like I have to go to the bathroom all the time. Could the accident have damaged something?

— Dee, Delaware

If you had injured your urethra, you would most likely have had immediate symptoms such as burning, bleeding, or other lower urinary-tract complaints. Shooting pain in the urethral area, combined with having to go to the bathroom all the time, suggests a urinary-tract infection. While it is possible that the accident could have damaged some of the urethral tissue, this would be less likely to cause the symptoms of urinary frequency. A visit to a health-care provider is in order. A history, examination of the urethra, and urinalysis would likely detect any significant underlying problem or infection.

Learn more in the Everyday Health Healthy Living Center.

Hydroceles

A hydrocele is a very common condition affecting boys, where a fluid-filled sac develops inside the scrotum around the testis, making it look swollen. It is not painful and feels like a balloon filled with water.

One or both sides of the scrotum can be affected. Before your baby is born his testicles develop in the abdomen, and before birth they move down into the scrotum. Usually the tube which they pass through closes off by itself, but if this does not happen, a small amount of fluid from the abdomen leaks into the scrotum. This can cause swelling on one or both sides of the scrotum.

Most hydroceles disappear on their own. Hydroceles do not cause serious problems, but they may enlarge and become uncomfortable. The testicle is not damaged by the fluid and fertility is not affected.

If the hydrocele has not disappeared by around 15-18 months of age, it is unlikely to do so and your child can have an operation to correct this.

The operation

Your child with a hydrocele will need a small operation under general anaesthetic.

Your child will come to hospital on the day of the operation and is usually home the same day. During the operation, the doctor stitches closed the canal inside the groin. The stitches are under the skin and dissolve by themselves. There will be a scar in the groin crease. The scar fades with time, but never disappears completely.

What about activity after the operation?

Your child can play normally after the operation.

Is there pain after the operation?

Your child may be uncomfortable, so will be given medication for the pain.

Ask your doctor for advice on medication and dosage, and whether your child should be restricted from any activities when home. Pain is not the only cause of distress after an operation. Fever, anxiety and hunger can all contribute.

Will your child have to come back to hospital?

Your child will need to have a check-up with the doctor after you go home. Ask about a follow-up appointment before you leave the hospital.

Please contact your GP if:

  • You are not able to control your child’s pain with the pain medication.
  • Your child becomes unwell and cannot keep down oral fluids.
  • Your child has a temperature of over 38.50 C.
  • There is fresh bleeding from the wound area.
  • The area looks red, swollen or feels hot.

Remember:

  • The operation can be safely performed in one day.
  • After the operation, your child can play normally.
  • Hydroceles may look unsightly but are usually not serious.

My baby’s testicles are swollen – what’s going on?

If your baby’s testicles are swollen just after birth, it’s most likely because of the extra fluid newborns carry or the extra dose of hormones he may have received from you just before birth. This swelling is harmless, and he’ll flush the fluid out in his pee after a few days. If the swelling continues, particularly if your son has only one swollen testicle, your baby may have developed a hydrocele, in which fluid from the abdomen accumulates in a testicle, or possibly an inguinal hernia, in which a loop of the intestine pokes down into the testicle.

What does it mean if one of my baby’s testicles is swollen?

He probably has a hydrocele (pronounced hydroseal). A boy’s testicles develop inside of his abdomen while he’s in the womb, and then sometime before birth they usually push through a tunnel in the tissue between the groin and the abdomen and descend into the scrotal sac. At that point, the passage through the abdominal wall should close up. If it remains open, as it does in up to 50 percent of newborn boys, fluid may accumulate around the testicle and cause swelling. This round, soft area of swelling, called a hydrocele, shouldn’t bother your baby and will probably go away by the time he turns 1. If it doesn’t go away by his first birthday, he may need minor surgery to drain the fluid and close the opening.

What is this hard lump that bulges out of my son’s testicle when he cries?

It’s most likely an inguinal hernia, so you should get it checked out by a doctor. About 4 percent of boys (and up to 30 percent of premature babies), are born with an opening in their abdominal wall large enough to allow a loop of their intestines to poke through into the genital area. The loop creates a firm, oblong lump about the size of your thumb in your baby’s scrotum (the loose sac of skin beneath the penis that contains the testicles). This lump is called an inguinal hernia. It may disappear back into the abdomen when your baby is relaxed and then bulge out again when he’s active or crying. Your baby will need minor surgery to repair the hernia, but it is not an emergency unless you notice that the swelling has suddenly gotten larger, harder, or darker, or if your baby is vomiting or in pain. This may mean that the loop of intestine has become trapped in the scrotum and thus cut off from its blood supply. If this is the problem, your baby will need immediate surgery to prevent damage to the intestines.

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