Testicular Hydrocele in Adults: Causes, Symptoms and Treatment in the UK

In the UK, thousands of men experience scrotal swelling at some point in their lives. A hydrocele is one of the most common causes of this. It occurs when fluid builds up in the thin pouch that holds the testes (the tunica vaginalis). This results in a soft, non-tender swelling in the scrotum that can occur on one or both sides.

While the prospect of scrotal swelling can be alarming, it is important to know that a hydrocele is not a cancer and is generally not a threat to fertility. However, because it can mimic other more serious conditions, such as testicular cancer or an inguinal hernia, getting an accurate diagnosis via a healthcare professional is essential. Following NHS and NICE guidance, most doctors will perform a physical examination and may use a technique called transillumination—shining a light through the scrotum to see if it is fluid-filled.

The primary symptom of a hydrocele is a painless enlargement of the scrotum. For most UK patients, the swelling feels like a small, fluid-filled balloon. Key characteristics include:

• A soft, smooth surface.
• The ability to feel the testicle within the fluid (though large hydroceles may make this difficult).
• The swelling is usually not painful, but the added weight can cause a dull ache or heavy sensation.

In adult men, hydroceles are often 'acquired' rather than congenital. Common causes include minor trauma or injury to the scrotum, inflammation of the testicle or epididymis (epididymo-orchitis), or occasionally a blockage in the spermatic cord. In many cases, no specific cause is found. NICE guidelines suggest that any new lump in the scrotum should be assessed within two weeks to exclude malignancy, even if it feels like a simple hydrocele.

Hydrocele vs Inguinal Hernia

It is often difficult for patients to distinguish between a hydrocele and an inguinal hernia, as both cause groin or scrotal swelling. An inguinal hernia occurs when a piece of fat or bowel pushes through a weak spot in the abdominal wall into the groin. Unlike a hydrocele, a hernia often 'disappears' when you lie down or can be pushed back in. A hydrocele remains constant in size regardless of position. If the lump appears suddenly when coughing or lifting, it is more likely to be a hernia, which requires different surgical management.

When you speak to a GP online in the UK, they can provide a vital first step in your diagnostic journey. During a video consultation, a doctor can discuss the history of the swelling, assess any associated symptoms like pain or urinary issues, and provide guidance on what to look for during a self-examination.

If you have noticed a change in the shape or size of your testicles, an online doctor can:

• Assess the likelihood of the swelling being a hydrocele based on your history.
• Advise on whether you need an urgent physical examination or a scrotal ultrasound.
• Explain the UK referral pathways for urological concerns.
• Provide reassurance if the symptoms do not align with 'red flag' indicators.

Our editorial team ensures all advice aligns with the latest British Association of Urological Surgeons (BAUS) standards.

In many adult cases, if the hydrocele is small and not causing physical discomfort, a 'watch and wait' approach is adopted. Many hydroceles resolve on their own if they were caused by a temporary infection. However, if the swelling becomes large, heavy, or aesthetically distressing, treatment may be required.

Surgical Options

The standard treatment in the UK is a hydrocelectomy. This is a minor surgical procedure, usually performed under general anaesthetic as a day case. The surgeon makes a small incision in the scrotum or groin to drain the fluid and remove or 'fold' the pouch to prevent fluid from re-accumulating.

Aspiration

In some cases, fluid can be drained using a needle (aspiration). However, this is rarely recommended by UK specialists because the fluid almost always returns within a few months, and there is a small risk of introducing infection into the scrotum.

While you cannot treat a hydrocele at home, you can manage the symptoms. Wearing supportive underwear, such as athletic supporters or 'jockstraps', can help relieve the heavy sensation. It is also crucial to continue regular testicular self-examinations. If you notice the skin becoming red, hot, or if the swelling suddenly becomes very painful, these are signs of complications such as infection or a strangulated hernia, requiring immediate medical attention.