A swollen scrotum can be alarming, even when it doesn’t hurt. One common cause is a hydrocele, which is a buildup of fluid around a testicle. In adults, it can show up after inflammation, an injury, an infection, or surgery, and sometimes it appears without a clear reason.
The good news is that many hydroceles are harmless. The not-so-good news is that swelling can feel heavy, get in the way of daily life, or make it hard to tell if something else is going on.
This guide breaks down the best treatment for hydrocele in adults based on what matters most: your symptoms, how fast it’s changing, and your personal goals. You’ll learn when watchful waiting makes sense, when needle drainage is considered, and why surgery is often the most lasting option.
Hydrocele in adults: what it is and when it is a problem
A hydrocele is fluid trapped in a thin sac around the testicle. Think of it like a small water balloon sitting in the scrotum. It can be small and barely noticeable or large enough to feel awkward and uncomfortable.
Most adult hydroceles cause painless swelling on one side. Some people notice the scrotum looks uneven or feels “full.” Others describe a dragging or heavy feeling, especially after being on their feet all day.
Hydroceles in adults can happen for a few reasons:
Inflammation: Irritation in the testicle or epididymis can trigger extra fluid.
Injury: A hit during sports or an accident can lead to swelling.
Infection: Some infections cause inflammation and fluid buildup.
After surgery: Procedures in the groin or scrotum can sometimes lead to fluid collection.
No clear cause (idiopathic): This is common. It doesn’t mean you did anything wrong.
A hydrocele becomes more of a problem when it affects comfort, mobility, or confidence, or when it keeps getting bigger. It also becomes a problem when it’s hard to be sure it’s “just” a hydrocele without checking. Some conditions can look similar at first glance.
For a plain-language overview of symptoms, causes, and common treatments, see Hydrocele in Adults: Symptoms, Causes, and Treatment.
Hydrocele symptoms and how they affect daily life
Most hydroceles don’t hurt, but they can still be disruptive.
Common symptoms include:
- Visible swelling on one side of the scrotum
- A heavy or pulling sensation
- Mild discomfort that’s worse with walking or standing
- A scrotum that seems to change size (often larger later in the day)
Day-to-day impact can be more real than people expect. Exercise can feel clumsy. Sitting on a bike seat may hurt. Sex can feel awkward, even if there’s no pain. And for many men, the appearance alone can chip away at confidence.
Hydroceles usually don’t cause infertility by themselves. Still, the cause of swelling matters. If swelling is tied to infection, inflammation, or another condition, that underlying issue may need treatment.
When to see a doctor right away
A hydrocele is often slow-growing and painless. These signs are not typical and should be checked urgently:
- Sudden, severe scrotal pain
- Nausea or vomiting with testicle pain (possible torsion)
- Fever
- Warmth and redness of the scrotum
- Swelling that grows quickly over hours or days
- Blood in urine
- A new hard lump in or on the testicle
New scrotal swelling should be evaluated because other problems can mimic a hydrocele, including an inguinal hernia or testicular cancer. Getting checked quickly is about safety and peace of mind.
How hydrocele is diagnosed (and why ruling out other causes matters)
Diagnosis usually starts with a conversation and a physical exam. A clinician will ask when the swelling started, whether it changes during the day, and if you’ve had pain, fever, injury, urinary symptoms, or recent surgery. Those details can point toward inflammation or infection rather than a simple fluid collection.
Next comes the exam. The clinician feels the scrotum and testicle, checking for tenderness, firmness, and the location of the swelling. They may also check the groin and lower abdomen to look for signs of a hernia.
A common office step is transillumination, sometimes called the “light test.” A bright light is placed against the scrotum. Clear fluid often glows, which supports the idea of a hydrocele. But it’s not enough by itself to rule out other causes.
That’s why scrotal ultrasound is so common. Ultrasound can confirm fluid around the testicle and also check for issues that can hide behind swelling, such as a hernia, infection, a tumor, or a varicocele. The Mayo Clinic’s hydrocele diagnosis and treatment overview explains these steps in patient-friendly terms.
Practical prep tips can make the visit smoother:
Bring a quick timeline (when it started, changes in size).
List recent injuries, surgeries, or infections.
Write down your top questions so you don’t forget them.
The usual tests: exam, light test, and scrotal ultrasound
Transillumination is simple and fast, but it’s not a guarantee. Some other masses can still let light through in certain ways, and a hydrocele can also sit next to something else that needs attention.
Scrotal ultrasound is painless and doesn’t use radiation. A small probe moves over the scrotal skin with gel. It usually takes a short time and gives clear answers: is this fluid, where is it, and what does the testicle itself look like?
Questions to ask at your appointment
Keeping it simple helps. A short checklist:
- Is it definitely a hydrocele?
- Is there any sign of a hernia?
- Is infection or inflammation involved?
- How large is it, and is it likely to keep growing?
- What are my options right now?
- What happens if I wait?
- What does recovery look like for surgery?
- What symptoms mean I should call back sooner?
Best treatment for hydrocele in adults: choosing the right option
The “best” treatment depends on what’s happening in your body and what you need from treatment.
A small, painless hydrocele might be best left alone with check-ins. A large or growing hydrocele may be better treated with surgery because it’s the option most likely to fix the problem long-term. Needle drainage can help in select cases, but it often isn’t a permanent solution.
Your decision usually comes down to four factors:
Symptoms: Is it uncomfortable, heavy, or limiting your life?
Size and growth: Stable or clearly getting bigger?
Health status: Are you a good candidate for anesthesia and surgery?
Personal preference: Are you aiming for a lasting fix or a short-term option?
For more clinical detail on treatment approaches and when each is used, see Hydrocele Treatment & Management.
Watchful waiting for small, painless hydroceles
Watchful waiting fits best when the hydrocele is small, not painful, and not changing much.
“Watching” doesn’t mean ignoring it. It usually means:
- Periodic checkups to confirm it’s stable
- Self-checks so you notice changes early
- Tracking size and discomfort (a simple note in your phone is enough)
Comfort matters too. Supportive underwear can reduce the heavy feeling. If mild aching shows up after a long day, rest and scrotal support may help.
If a clinician suspects infection or inflammation, treating that underlying issue may reduce swelling. Even when the hydrocele doesn’t fully go away, addressing the cause can prevent worsening.
Hydrocelectomy surgery, the most effective long-term treatment
For many adults with bothersome swelling, hydrocelectomy is the most lasting fix.
In plain terms, a hydrocelectomy drains the fluid and then repairs or reshapes the sac around the testicle so fluid is less likely to collect again. It’s often done as an outpatient procedure, meaning you go home the same day. Anesthesia is used so you’re comfortable during surgery.
Recovery varies, but a typical pattern looks like this:
First few days: soreness, swelling, bruising, and a need for rest.
First 1 to 2 weeks: gradual improvement, avoiding heavy lifting and intense exercise.
Several weeks: swelling continues to settle, with a return to most normal activity based on your surgeon’s advice.
Common short-term effects include bruising and swelling, sometimes more than people expect at first. It usually improves step by step.
Main risks to discuss include:
- Infection
- Bleeding or hematoma (blood collection)
- Recurrence (fluid coming back)
- Injury to nearby structures (rare, but important to understand)
Surgery is often recommended when the hydrocele is large, uncomfortable, keeps growing, causes cosmetic distress, or makes it harder to confirm the diagnosis with confidence. If you want a straightforward explanation of what the procedure involves and how non-surgical care fits in, Hydrocele Treatment: Hydrocelectomy & Non-Surgical Care is a helpful reference.
Needle drainage and sclerotherapy, when they are used and downsides
Needle drainage (aspiration) removes fluid using a needle. It can shrink the swelling quickly, which sounds ideal, but there’s a catch: it often comes back because the sac still produces fluid.
Aspiration may be considered when someone isn’t a good candidate for surgery, needs short-term relief, or wants time to decide. It’s not usually the first choice for a long-term fix.
There are also risks, including infection and bleeding. Because the area is sensitive, sterile technique and proper follow-up matter.
Sclerotherapy is sometimes done after aspiration. A medication is placed into the sac to irritate the lining so it’s less likely to refill. Results vary, and recurrence can still happen. Some people also have more discomfort afterward compared with aspiration alone.
If you’re deciding between these options, it helps to be clear about your goal. Is it temporary relief, or are you trying to solve the problem for good?
How to decide: a simple decision guide
Here’s a practical way to think about it:
If it’s small and not bothering you, watchful waiting is often reasonable, with periodic exams to confirm nothing is changing.
If it’s uncomfortable, large, or keeps growing, hydrocelectomy is often the best long-term choice because it targets the reason the fluid returns.
If you can’t have surgery (or you need a temporary fix): ask about aspiration, with or without sclerotherapy, and talk through the chance it may recur.
If swelling is new or changing, get it evaluated first. The most important step is confirming the diagnosis before choosing any treatment.
Conclusion
A hydrocele is fluid around the testicle, and in adults it often shows up as painless swelling that feels heavy or awkward. The best treatment for hydrocele in adults depends on how much it affects your life, how large it is, and whether it’s stable or growing.
For mild cases, watchful waiting with regular check-ins can be safe and sensible. For hydroceles that are large, uncomfortable, or persistent, hydrocelectomy is usually the most permanent option. Needle drainage, with or without sclerotherapy, can help in select situations, but it often isn’t a lasting fix.
If you notice new or changing scrotal swelling, schedule an evaluation so the cause is clear. Seek urgent care for sudden severe pain, fever, redness, or fast-growing swelling because those signs need quick attention.