Epididymitis

1 What Is Epididymitis?

The epididymis is a long, tightly coiled tube that lies above and behind each testicle. It collects and stores maturing sperm made by the testicles prior to ejaculation. Inflammation and infection of the epididymis is called epididymitis.

2 Symptoms

Pain and tenderness along with swelling of the scrotum, which can gradually get worse, are common symptoms of epididymitis. Other symptoms include fever, chills, and frequent, painful urination. 

The mean age of patients with epididymitis is forty-one. The acute form usually develops over the course of several days, with pain and swelling frequently in only one testis, which will hang low in the scrotum. There is often a recent history of dysuria or urethral discharge. Fever is also a common symptom. In the chronic version, the patient may have painful point tenderness, but may or may not have an irregular epididymis upon palpation, although palpation may reveal an indurated epididymis. A scrotal ultrasound may reveal problems with the epididymis, but such an ultrasound may also show nothing unusual. The majority of patients who have chronic epididymitis have had symptoms for over five years.

Urinary Tract Infections

Although urinary tract infections in men are rare, a bacterial infection is the most common cause of acute epididymitis. The bacteria in the urethra back-track through the urinary and reproductive structures to the epididymis. In rare circumstances, the infection reaches the epididymis via the bloodstream.

In sexually active men, Chlamydia trachomatis is responsible for two-thirds of acute cases, followed by Neisseria gonorrhoeae and E. coli (or other bacteria that cause urinary tract infections). Particularly among men over the age of thirty-five in whom the cause is E. coli, epididymitis is commonly due to urinary tract obstruction. Less common microbes include Ureaplasma, Mycobacterium, and cytomegalovirus, or Cryptococcus in patients with HIV. E. coli is more common in boys before puberty, the elderly, and men who have sex with other men. In the majority of cases in which bacteria are the cause, only one side of the scrotum is the locus of pain.

Non-infectious causes are also possible. Reflux of sterile urine (urine without bacteria) through the ejaculatory ducts may cause inflammation with obstruction. In children, it may be a response following an infection with enterovirus, adenovirus or Mycoplasma pneumoniae. Rare non-infectious causes of chronic epididymitis include sarcoidosis (more prevalent in black men) and Behçet's disease.

Any form of epididymitis can be caused by genitourinary surgery, including a prostatectomy and urinary catheterization. Congestive epididymitis is a long-term complication of a vasectomy. Chemical epididymitis may also result from drugs such as amiodarone.

The disease can be controlled with timely medication and complete control over the mind and body, which is very essential.

3 Causes

The main causes of epididymitis generally depend on the age and behavior of the individual.  Children get affected due to urinary tract infections, which are common among them. Sexually active young men are linked to sexually transmitted infections, and elderly men to enlargement of the prostate gland. The bacterial infections mainly spread over the rectal area. Urological procedures may cause epididymitis., along with a groin injury.

4 Making a Diagnosis

Epididymitis can be diagnosed with a physical test and a discussion of one’s medical history. A culture of penal discharge may also be taken and checked for a possible bacterial infection. A urinalysis and urine culture are used to check for urinary tract infection, blood tests are used to look for an elevated white cell count, and an ultra sound will make sure there is no torsion of the testicles. The doctor will also check to see if there is a loss of blood flow to the testicles and may offer surgical treatments. The tests also confirm the person does not have any kind of tumor. 

5 Treatment

Antibiotics help treat epididymitis. Other supportive treatments include bed rest with the hip area elevated. Anti-inflammatory medicines like ibuprofen or ketoprofen can be used to relieve discomfort caused by epididymitis.

In order to reduce the risk of epididymitis, one has to minimize the risk of spreading the infection to other partners. Sexual activities should be avoided until a medical examination has taken place. Partners should also be tested and checked for possible sexual diseases or infections. 

Epididymitis is the most frequent cause of acute onset scrotal pain in adults. In contrast with men who have testicular torsion, the cremasteric reflex (elevation of the testicle in response to stroking the upper inner thigh) is not altered. If the diagnosis is not clear from the patient's history and a physical examination, a Doppler ultrasound scan can confirm an increased blood flow to the affected epididymis (whereas torsion is characterized by ischemia). If the inflammation spreads to the testicle, the condition may be reclassified as epididymo-orchitis, or orchiepididymitis.

Swelling from epididymitis may stretch along the inguinal canal and may appear similar to that of a hernia, particularly an inguinal hernia. It may be distinguished from these, however, in that, with the exception of an incarcerated indirect inguinal hernia, inguinal hernias generally are not painful, and the swelling they produce often disappears upon lying down. Neither is the case with epididymitis. Also, hernias are not episodic, whereas epididymitis frequently is.

6 Prevention

Preventing having the sexually transmitted disease will prevent you from having epididymitis in the first place. Things, like practicing safe sex and reducing sex partners, can help a lot. 

If you have recurrent urinary tract infections, have them treated by the doctor to reduce the likelihood of having epididymitis.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with epididymitis.

Epididymitis tends to cause pain. Here are following tips that may give your relief from pain:

  • An athletic supporter can help support your scrotum, so wear them for the meantime
  • Resting in bed, lying down, to elevate the scrotum
  • If you can tolerate it, apply cold packs to the scrotum to ease pain
  • Do not lift heavy objects
  • Don’t have sex (oral, vaginal, any activity that involves touching the genitals) until the doctor is sure that infection has cleared

8 Risks and Complications

There are several risks and complications associated with epididymitis.

Here are the factors that increase your risk of having epididymitis:

  • Sticking to risky sexual behaviors, like having sex without a condom and having sex with someone with sexually-transmitted disease
  • Having a history of sexually-transmitted disease
  • Infections in the prostate gland and urinary tract
  • Having procedures that affect the urinary tract, like inserting a urinary catheter
  • Having an uncircumcised penis
  • Having an abnormality in the urinary tract
  • Having conditions that cause prostate enlargement, such as benign prostatic hypertrophy

Leaving epididymitis untreated can cause it to become chronic. Untreated epididymitis can cause the following complications:

  • Formation of abscess in the scrotum
  • Having epididymo-orchitis, causing the infection from the epididymis to spread to the testes
  • In rare cases, reduced fertility
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