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Noticing a swelling in your baby boy’s scrotum can be frightening. In most cases, this is caused by a harmless condition called a hydrocele — and for the majority of newborns, it resolves on its own within the first year of life. This guide explains what hydrocele is, what causes it, how it is treated, and when to seek specialist advice.
Baby boys affected at birth
Resolve in first year
Child goes home same day
A hydrocele is a collection of fluid inside the thin pouch (sac) that surrounds the testicle in the scrotum. This fluid makes the scrotum look swollen or enlarged, but in most cases it is completely painless. Hydroceles are very common in newborns, particularly in premature babies, though they can also develop at any age.
The condition is not dangerous in itself, but it does need to be properly assessed by a doctor to rule out other causes and to determine whether it will resolve on its own or require treatment.
A hydrocele is one of the most common conditions seen by paediatric surgeons. Up to 1 in 10 baby boys is born with one. In most cases it disappears without any treatment before the baby’s first birthday. You are not alone — and with the right assessment, your child will be well looked after.
During pregnancy, the testicles develop inside the baby’s abdomen and then gradually move down into the scrotum through a canal. A protective sac travels with the testicles through this canal. Normally, this canal and sac close completely once the testicles are in position.
When the canal or sac does not close properly, fluid can accumulate around the testicle — resulting in a hydrocele. The type of hydrocele depends on how and where this incomplete closure occurs.
There are four main types of hydrocele, each with different causes and treatment approaches:
| Type | Description | Treatment |
|---|---|---|
| Non-communicating Hydrocele | Most common in newborns. Fluid trapped at birth. Often resolves within 12 months. | Mild |
| Communicating Hydrocele | Canal remains open; fluid moves in and out. Size changes during the day. | Moderate |
| Reactive Hydrocele | Caused by infection, injury or testicular torsion. Treated with medication. | Varies |
| Hydrocele of the Cord | Fluid trapped in spermatic cord. Requires surgery. | Surgical |
the canal is more likely to still be open in babies born early
smaller babies have a higher chance of hydrocele at birth
the main cause of a communicating hydrocele
can cause a reactive hydrocele in older children
for example, infection of the tube behind the testicle
for example, children with a brain shunt or on dialysis
Most hydroceles cause no pain and are discovered simply because the scrotum looks larger than normal. Common signs include:
Diagnosis is straightforward and is made through a thorough physical examination by a paediatric surgeon. The doctor will review the history of the swelling, examine the scrotum carefully, and may use one or both of the following tests:
No blood tests are required to diagnose a straightforward hydrocele, though they may be arranged if an infection or other underlying cause is suspected.
The treatment approach depends on the type of hydrocele, the age of the child, and how long the swelling has been present.
For non-communicating hydroceles in babies under 12 months, the standard approach is careful observation. The surgeon will monitor the hydrocele over time. In the majority of cases, the body absorbs the fluid and the swelling disappears naturally before the child’s first birthday. No medication or surgery is needed during this period.
If the hydrocele is reactive — caused by infection or inflammation — it is treated with antibiotics or anti-inflammatory medicines. Once the underlying cause is resolved, the hydrocele usually improves.
Surgery is recommended in the following situations:
The surgical procedure — called a hydrocelectomy — is a day surgery, meaning your child goes home the same day. It is performed under general anaesthesia. The surgeon makes a small cut in the groin crease, drains the fluid, removes a portion of the sac, and if a hernia is present, repairs it at the same time. Dissolvable stitches are used, so there is nothing to remove afterwards.
Usually not. A hydrocele is a painless collection of fluid around the testicle and is very common in newborn boys. It does not harm the testicle. A paediatric surgeon should still check it to make sure the swelling is not a hernia or something else.
Most hydroceles in newborns go away on their own before the first birthday, as the body slowly absorbs the fluid. A communicating hydrocele (the swelling changes size during the day) and a hydrocele of the cord usually do not go away without surgery.
Surgery is usually advised if the hydrocele is still there at 12 to 18 months of age, if it is a communicating hydrocele, if there is also a hernia, or if it is very large, tense or uncomfortable. Your surgeon will examine your child and explain the right timing.
A hydrocele is fluid around the testicle. A hernia is when a loop of bowel pushes through an open canal into the groin or scrotum. Both look like swelling, but a hernia can get trapped and is more urgent. If the swelling becomes hard, painful or red, or your child starts vomiting, come to our Emergency Department immediately.
Most children have only mild discomfort for a day or two. Simple pain medicine given by mouth is usually enough, and most children are back to normal play within a few days.
The operation usually takes less than an hour. It is done as day surgery under general anaesthesia, so most children go home the same day. The stitches dissolve on their own, so there is nothing to remove later.
It is uncommon. Your surgeon will see your child at a follow-up visit to check healing. If the swelling returns, please contact us.
Hydrocele surgery at KidsCare Hospital Rawalpindi is performed by our paediatric surgeons, Dr. Muhammad Umar Nisar and Dr. Muhammad Umar Qureshi. Both are Neonatal, Paediatric & Laparoscopic Surgeons.
KCIH is a dedicated children’s hospital with specialist paediatric surgeons, child-friendly day-surgery care and a 24/7 emergency department. Parents from across Rawalpindi and Islamabad trust us from the first consultation. Call 051-4850480 to book.
