What is epididymitis?
Epididymitis is an inflammation of the epididymis, the oblong structure attached to the upper part of each testis. The inflammation may be so great that the testicle itself feels greatly enlarged and hardened.
What causes epididymitis?
While bacterial infection of the epididymis is common as well as the most serious cause of epididymitis, infection is only one of many reasons the epididymis can become inflamed. Bacterial epididymitis usually results from an infection spreading to the epididymis from other male urogenital organs (prostate, bladder, kidney and urethra). Epididymitis may complicate an infection or may be brought on by injury to the scrotum. The germ causing your infection can be identified by smears or cultures of the urine or prostatic secretions. Epididymitis is not contagious, not inherited and not a sign of cancer. Most true bacterial infections, such as those caused by Staphylococcus or E. Coli bacteria, cause fever, chills, generalized weakness, redness, swelling and intense pain of the scrotum and epididymis. The onset of the discomfort is usually quick, certainly less than 24 hours and usually much less. Bacterial infections are treated with antibiotics appropriate for the bacteria that is causing the infection. In most circumstances the bacteria can be identified in the urine or prostate fluid, and tests can be run to determine which antibiotic is most effective.
Some rarer types of bacteria create a different picture altogether. Tuberculosis, for instance, is a bacteria that can spread to the epididymis in unusual circumstances. Tuberculosis epididymitis develops very slowly over days and weeks.
Nonbacterial epididymitis simply means an inflammation of the epididymis not cause by a bacteria. The causes are many and include viruses, trauma and unknown causes. Nonbacterial epididymitis can be just as painful and have a very quick onset. The viral types may be associated with fevers, generalized weakness and ill feeling. Epididymitis caused by trauma or by unknown origin are not usually associated with the fevers, chills and generalized symptoms. Many believe that these types of epididymitis are caused by a rupture or blow-out of the sperm ducts, which causes a leakage of sperm fluid into the tissue. The body tissues can be quite irritated by this leakage; hence, the redness and swelling. Why would the body be irritated by a fluid that is made in the testicle? Consider that the body also makes acid in the stomach which serves to digest food, yet with a perforated stomach ulcer, this acid can leak into the body cavity and cause a life-threatening illness. Similarly, epididymitis by itself is not life threatening, but it can result in pain and swelling. The treatment for these types of epididymitis may include antibiotics to prevent bacteria from infecting the area where resistance has been weakened.
How is nonbacterial epididymitis treated?
Go to bed and remain there, except for bowel movements, until swelling subsides and fever is gone. While you are in bed, support the weight of the scrotum and tender testicles by rolling a soft bath towel and placing it between your legs beneath the inflamed parts. When you are again able to be up and around, you will be more comfortable wearing a jock strap or two pairs of jockey shorts. While you are in bed apply either an ice bag or heat (warm compresses, electric heating pad, hot water bottle) to the inflamed parts. Use whichever gives the most comfort.
There are no special restrictions on what you may eat. Plenty of fluids are helpful, but limit alcoholic beverages.
Anti-inflammatory medicine can be very helpful in epididymitis. Ibuprofen is the most common one used today, but other types may work as well or better and without the stomach upset. These may include Feldene, Naprosyn, Toradol or Voltaren. Even aspirin has anti-inflammatory properties but may upset one's stomach. Do not take any medicine (not even non-prescription medicine) without telling us. If drugs are prescribed, carefully follow the instructions on the label.
Do not engage in sexual intercourse or have an ejaculation. The flow of sperm through the epididymis during the early phase can only cause more inflammation and damage.
When is it important to call the office?
Call our office when any one or more of the following take place:
- Oral temperature is over 100 degrees Fahrenheit
- Pain is not reasonably well controlled
- Your symptoms don't improve in four days
- You become severely constipated
Note: After pain and tenderness have subsided, a certain amount of swelling and hardness around the testicle may continue. This will disappear more quickly if you sit in hot water for 15 minutes twice a day. Be careful to avoid any injury to the infected area for two or three months after all signs of inflammation have subsided.