Communicating Hydrocele

A communicating hydrocele is a type of fluid-filled sac surrounding your testicle that causes swelling in your scrotum. It has an opening (communication) to your abdominal cavity. Your abdominal cavity is a large, hollow space in your abdomen. It holds many vital organs, including your stomach, intestines and kidneys. It also contains abdominal fluid. When you have a communicating hydrocele, the opening allows abdominal fluid to pass into your scrotum. This is what causes swelling.

A hydrocele (pronounced “HY-dro-seel”) can change in size throughout the day. You may notice more swelling on one side of your scrotum. The swelling may go away while you’re lying down or sleeping. It may increase if you’re moving around a lot. The hydrocele usually doesn’t cause pain. But it can become large and uncomfortable.

Anyone with testicles, no matter their age, can have a communicating hydrocele. But they’re very common in newborns. In newborns, they usually go away on their own within the first year. But if a communicating hydrocele doesn’t go away on its own and you don’t get surgical treatment, it can cause an inguinal hernia.

Is it harmful?

A communicating hydrocele won’t harm your testicles or your ability to have biological children (fertility). But if it causes an inguinal hernia, harmful complications may develop. These can include pain or a blocked intestine.

Symptoms of a communicating hydrocele

In children, symptoms may include:

• Swollen or enlarged scrotum
• Swelling that increases and decreases throughout the day

Older children and adults may have those same symptoms as well as:

• Inflammation
• Discomfort as their scrotum swells and gets heavy
• Pain as their scrotum increases in size

What does it feel like?

If you touch your communicating hydrocele, it may feel like a soft, small water balloon in your scrotum.

Causes

A communicating hydrocele forms while the fetus is developing in the uterus (in utero).

During typical fetal development, a thin membrane (processus vaginalis) forms between the stomach lining and scrotum. The testicles begin in the abdomen. They eventually move through the processus vaginalis into the scrotum. Afterward, tissue will block the opening.

But if the processus vaginalis remains open, fluid flows back and forth from the abdominal cavity through the scrotum, like waves at a beach.

How doctors diagnose a communicating hydrocele

Healthcare providers can usually diagnose it through a physical exam. They may shine a light through the scrotum to look for any fluid around a testicle.

A provider may recommend an ultrasound if the scrotum is very swollen or feels hard. It can help them rule out other possible causes of swelling, like testicular cancer.

How do you differentiate between a communicating and noncommunicating hydrocele?

In a noncommunicating hydrocele, the processus vaginalis closes as expected. But there’s extra fluid in the scrotum. Unlike a communicating hydrocele, a noncommunicating hydrocele usually stays the same size or grows very slowly.

A noncommunicating hydrocele may be present at birth. But this type usually occurs as a result of an injury to the scrotum in children and adults.

How do you fix a communicating hydrocele?

In infants, a communicating hydrocele will often disappear within the first year without any treatment. Your child’s pediatrician will likely suggest that you keep an eye on the area. They may also recommend scheduling regular checkups every few months.

If a communicating hydrocele doesn’t go away within a year of birth, your child may need a hydrocelectomy. During this procedure, a surgeon:

• Makes a small cut (incision) in the groin
• Drains the abdominal fluid from around the testicle
• Closes the processus vaginalis

Recovery time

Recovery times vary. But most infants start to feel better a few days after surgery. Your baby will be able to eat and play. But it’s a good idea for them to avoid activities that could injure their groin area for at least two to three weeks. These include climbing and using straddling toys, like bicycles and seesaws.

When should I see my healthcare provider?

Call your child’s healthcare provider if you notice any symptoms of a communicating hydrocele or inguinal hernia. These include:

• Swelling or a lump around your infant’s scrotum or just above it
• Clear pain in your infant’s scrotum that may improve while they’re resting
• Loss of appetite or difficulty feeding
• Nausea and vomiting
• Pooping less than usual

After a hydrocelectomy, call your child’s provider if they have:

• Heavy bleeding
• Increased swelling
• Increased pain
• Signs of infection, like a fever, chills and skin discoloration (red, purple, brown or black)

What can I expect if I have a communicating hydrocele?

The overall outlook is good. In infants, it usually goes away on its own without any treatment. But if you or your child need treatment, surgery has a very good success rate.

Is there anything I can do to feel better?

If a communicating hydrocele causes mild pain, you can help relieve it with nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. Not everyone can take these medications. Check with a healthcare provider before you take them or give them to your child.

Is a communicating hydrocele a hernia?

No. But an inguinal hernia can sometimes develop if the processus vaginalis opening is wide and you don’t treat a communicating hydrocele. An inguinal hernia may be painful. In some cases, it may also be dangerous.