Epididymitis

What is causing pain in the groin region?

Inflammation of the epididymis, which is a long coiled tube that stores and transports sperm from the testes is called epididymitis.  This can cause pain and swelling in the testes.  It generally affects men in the age group of 14 and 35 but can affect men of all ages.  A sexually transmitted infection or a bacterial infection can cause this problem.

There are two types of epididymitis called acute epididymitis and chronic epididymitis.  Acute epididymitis occurs suddenly and this condition can last for six weeks.  It is also associated with severe pain.  Chronic epididymitis occurs slowly over time and can last for more than six weeks.  The pain associated with this condition is comparatively milder.  A condition where the testes are inflamed is called orchitis.  When both the epididymis and the testes are inflamed together, it is called epididymo-orchitis.

Symptoms of epididymitis

Redness and swelling in the testes are not noticed until it is accompanied by pain.  Epididymitis can cause a significant amount of pain and warmth in the testes.  Pain may involve either one or both the testes.  Other symptoms may include fever, chills, enlarged testicles, testicles become sensitive to touch, pain radiating from testes to the abdomen or pelvis, burning sensation while passing urine, frequent urge to pass urine, blood in the urine, discharge from the penis, as well as fluid build-up around the testicles causing a lump.

The symptoms of epididymitis may highly depend on the cause.  If it is caused due to sexually transmitted infection, you may experience discharge from the penis.  Frequency and urgency of urination associated with burning upon urination may occur when the cause is from urinary tract infection.  Another condition called testicular torsion where the blood supply is cut off due to twisting of the testicle can also cause pain in the testes.  This is a more serious condition where surgical treatment is required.

Causes

The bacterial infection caused either by sexually transmitted infection or through urinary tract infection are the two main causes of epididymitis.  It has been found that the infection generally starts in the prostate, bladder, or the urethra.  The two main causes of epididymitis are discussed below:

Sexually transmitted infection (STI)

Unprotected sex with multiple partners is considered to be the main cause of epididymitis related to STI.  It has been estimated that a maximum number of cases of epididymitis are generally related to STI and is very rarely caused by other infections.

Urinary tract infection (UTI)

UTI accounts to a minimal number of cases causing epididymitis.  Children and older men are usually affected.  Some of the risk factors that cause UTI include enlarged prostate that can be pressing on the bladder, insertion of the catheter into the penis due to kidney problems, as well as surgery affecting the bladder, groin, or the prostate gland.  Some of the other causes of epididymitis in children include injury to the region, abnormal twisting of the epididymis, as well as urine flowing back into the epididymis.  These bacterial infections generally spread from the urethra or bladder.

Other causes of epididymitis

Several other medical conditions can cause epididymitis and these include mumps, Behcet disease, tuberculosis, medication side effects from amiodarone, anatomical problems of the urinary tract, injury to the groin, as well as congenital problems related to the kidney and the bladder.

Diagnosis

Finding the cause of the symptom would be the first thing your doctor would concentrate on.  The doctor would inquire about your medical history to understand the cause.  This will be followed by a thorough physical examination.  Next, a urine sample will be collected to look for the presence of bacteria.

When a patient is suffering from acute epididymitis, the urine is generally infected whereas during chronic epididymitis, urine is not infected.  If the infection has affected the urethra, a swab test may be conducted from the urethra.  An ultrasound imaging may be required to check for blood flow in the epididymis as well as the structure of the testes.  Further tests may be required depending on the severity of the symptom.  Once a diagnosis is made, appropriate treatment will be started.

Treatment

Treatment of acute epididymitis is started with a course of antibiotics.  The antibiotic course may include a course lasting 1-2 week.  The appropriate antibiotic is determined based on the bacteria found in the urine test.  A severe case of epididymitis may require admission to the hospital.  Symptoms of fever, vomiting, as well as severe pain together, would warrant hospital admission.

Severe pain may require a prescription of narcotics for a few days.  Tuberculosis epididymitis is considered to be a very severe case but occurs rarely.  Anti-tuberculous drugs are used to treat this condition.  A very serious case might require a surgery where the teste and the epididymis may need to be removed.

Epididymitis caused by medication side effect such as amiodarone is treated by stopping the drug altogether.  Other types of non-infectious epididymitis do not have any specific treatment.

Additional care needs to be rendered for at least 1–2 days by elevating the scrotum in a lying down position.  When the scrotum area is above the heart, it helps the blood to flow adequately to the area and reduce the symptoms of swelling and pain.  Icing the area every couple of hours can relieve the symptoms.

Extra fluids would be helpful if the epididymitis is caused due to an infection.  Anti-inflammatory drugs may be prescribed to ease the pain.  The drugs also help reduce the swelling around the testes.

Treatment for chronic epididymitis is mainly accomplished with the use of pain medications and applying heat to the area.  As discussed earlier, pain associated with chronic epididymitis is generally mild and is not as severe as acute epididymitis.

Recovery

Acute epididymitis would require at least a couple of days for the swelling and pain to subside.  Once the antibiotics kick in, the symptoms would gradually decrease.  Persistence of pain and swelling after 48 hours of initiation of treatment needs to be reported to the doctor for further assistance.  Overall discomfort may last for several weeks after the course of antibiotics is completed.

Complete bed rest with elevation of the scrotum can result in fast recovery.  Tuberculous epididymitis which is the most severe form of epididymitis and needs several months to heal with medicine.  There is a high possibility that the testes may shrink after treatment and also result in reduced sperm production.  Epididymitis caused by medication side effects gets better with the cessation of the drug.  Regular follow up with the healthcare provider is important to check for any abnormalities and recurrence.

Chronic epididymitis symptoms would reduce substantially with the use of heat and pain medications.  There is always a high chance of recurrence and may even take months to years for it to recur.  Symptoms once recur may sometimes be better or even worse than the first episode.  Certain cases of chronic epididymitis may also require surgery which is quite rare.  If surgery has been done, the recovery time would generally be around a couple of weeks.  Depending on the condition, your healthcare provider may also suggest microsurgery to block nerves on the spermatic cord.

Final thoughts

Majority of acute epididymitis cases are successfully treated using suitable antibiotics.  The prognosis is generally good and may not cause any long-term sexual or reproductive problems.  There is a high possibility that the infection may return in the future and also cause some complications but is usually rare.  Seeking treatment right away is important to prevent complications.  The complete course of antibiotics should be completed for the symptoms to cure.  Regular follow up visits are needed after the treatment.  Following these directions will help ensure that you make a complete recovery.

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