What is epididymitis

Epididymitis is a very painful condition usually caused by infection or inflammation of the epididymis, which is the tube-shaped structure connected to the testicle.

Causes

Epididymitis may be caused by the spread of a bacterial infection from the urethra (the opening at the end of the penis) or the bladder. In children, it usually develops due to inflammation from a direct trauma, torsion of the appendix epididymis, or reflux of urine into the epididymis.

Signs and symptoms

Epididymitis usually begins with a gradual onset of testicular pain that increases in severity over time. The testicle can become swollen, tender to touch and red. Other symptoms can include:

• Discomfort in the lower abdomen or pelvis
• Red and tender area on the side of the scrotum
• Pain or burning during urination
• Discharge from the urethra
• Fever

Testing and diagnosis

Physical examination shows a red, tender and sometimes swollen lump on the affected side of the scrotum. Tenderness is usually present in a small area of the testicle where the epididymis is attached.

The following tests may be performed:

• Scrotal ultrasound
• Urine culture
• Uroflow: measures the urine flow rate and the time needed to empty the bladder along with an ultrasound to see if any urine is left in the bladder

If your child is having acute (sudden) scrotal pain, he should be taken to the emergency room for evaluation immediately.

Treatment

In most cases, epididymitis will get better on its own over time. Rest and ibuprofen can help decrease the inflammation and improve the pain. Some episodes of epididymitis are caused by bacterial infection and require antibiotics if the urine is infected. Your doctor will recommend the most appropriate treatment for your child.

Voiding habits can contribute to epididymitis, such as infrequent voiding or straining with urination. We will ask that your child empties his bladder on a routine schedule, increase the amount of water he drinks, and monitor bowel movements for any signs of constipation

Reviewed by: Division of Urology
Date: April 2014