Know if You Have Epididymitis

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Epididymitis is a condition caused by inflammation of the epididymus. Epididymitis affects about 600,000 men per year, most commonly in the ages of 18-35. The vast majority of cases of epididymitis are caused by an infection by a sexually transmitted infection, or STI (usually gonorrhea and chlamydia). However, because the epididymis is connected to the urethra, men can also acquire the infection from other sources, like E. coli.[1] When epididymitis is present, the scrotum swells. It may seem like a hernia, but the presence of pain indicates it's not. To find out if this is what's afflicting you (and how to deal with it), start with Step 1 below.

Steps

Recognizing the Symptoms

Epididymitis is divided into two general classes: acute and chronic. Acute refers to a symptoms lasting less than 6 weeks; chronic refers to symptoms that last longer than 6 weeks. Symptoms vary from man to man and depend on the cause of the problem.[2]

Early Symptoms

  1. Notice pain in one of your testicles. This is the most common sign of epididymitis. Pain may start in one testicle and then slowly expand to both testicles over time. Pain is usually localized to the underside of the testicle early in inflammation and may slowly spread to encompass the whole testicle, or even both testicles.
    • The type of pain differs depending on how long the epididymis has been inflamed; it may be a sharp or burning pain.
    • Pain is a complex process that is the result of increased blood flow, immune system components, and nerve sensitivity as a result of damage during infection.
  2. Look for swelling or redness in your infected testicle. Again, this may be only on one side or on both sides over time. Some men will find sitting uncomfortable because of the swelling in the testicle.
    • The testicle will also appear red because of the increased blood flow to the area, and become swollen because more fluid is leaking into the infected area. The testicle may feel warm to the touch as well, and this is also because of the increase in blood flow. These symptoms will likely appear within three or four hours from the initial signs of infection.
  3. Pay attention to urinary symptoms. There are many symptoms of epididymitis that men will notice while they are urinating. These may include:
    • A burning pain while urinating
    • Feeling the need to urinate more frequently than usual
    • Blood in the urine
      • Most men who get epididymitis from an infection have an infection that starts in the urethra and then moves up the tube, eventually infecting the epididymus. Any infection in the urinary tract can irritate the bladder, making it overactive or damaging the lining.

Late Symptoms

  1. Notice if urinating is painful. You will start to feel pain when urinating, as the inflammation grows, expanding to the surrounding tissues. In severe cases, blood will appear in your urine, because of the small hemorrhage that occurs inside the tubes that the urine passes through on its way out. This is, quite obviously, not a comfortable feeling.
  2. Look for urethral discharge. Sometimes, a clear, white or yellowish discharge may appear at the tip of your penis due to the inflammation and infection of the urinary tract. This is especially true if your infection is due to an STI.
  3. Take your temperature. As the inflammation and infection spread throughout the body, fever will occur in your body as a defense mechanism. This is an indication of chronic and not acute epididymitis.
    • Fever is your body telling you it is fighting off infection. Anything over 100°F (38°C) should tell you you need to visit the doctor immediately.

Knowing the Causes and Risk Factors

  1. Know your age, habits, and health are risk factors. Epididymitis is most common in young, sexually active men with many sexual partners. Other groups, however, are at risk as well:
    • Men who ride motorcycles or who sit for prolonged periods of time (for instance, at sedentary jobs) are also at a higher risk of developing this problem.
    • Low immunity is an issue, too. Immunocompromised patients, like the ones infected with the HIV virus are vulnerable to infection and inflammation.
    • In men older that 35 or boys younger than 18, E. coli is a common cause of epididymitis (as opposed to STIs).
  2. If you had recent urethral surgery or instrumentation, know you're at risk. Any surgical procedure, or instrumentation of the urethra, like the insertion of a urethral catheter, can cause inflammation. This can spread to the nearby areas, including the epididymis. This inflammation, in turn, sometimes causes epididymitis.
  3. Know that congenital abnormalities are a factor, too. The urinary tract can suffer from congenital abnormalities, making the area itself and the surrounding tissues prone to inflammation or infection. Any slight size or position abnormalities can cause rise to problems such as these.
  4. Be aware that urinary tract infections play a role. An active infection of the urinary tract will cause the tissues around it to become inflamed. This includes the epididymis as well. A recent UTI provides a perfect breeding ground for epididymitis.
  5. Know that orchitis and prostatitis can put you at higher risk. Prostatitis is a condition in which the prostate gland becomes inflamed. The inflammation can spread to the ejaculatory duct and then to the epididymitis, causing epididymitis.
    • In the case of orchitis, the patient is suffering from the inflammation of one of the testicles. Like in the previous cases, the inflammation can spread to the nearby tissues, including the epididymis.

Treating the Illness

  1. Get on antibiotics. Epididymitis is treated based on the cause of the inflammation. As most cases are caused by some form of infection, a quick visit to your doctor will probably render you a prescription for an antibiotic. The type and dose of antibiotic depends on if the infection is sexually transmitted or from another source.
    • For gonorrhea and chlamydia infections, treatment will consist of a single dose of ceftriaxone 100mg as a shot intramuscularly, followed by 100mg doxycycline as a pill twice a day for 10 days.
    • In some cases, the doxycycline may be replaced by a 1g, single dose of azithromycin.
    • A 10-day course of 300mg ofloxacin twice a day is typically used to treat epididymitis caused by E. coli.
  2. Take an anti-inflammatory like ibuprofen. These can be used to reduce the pain of the inflammation. They're convenient as they're probably already in your bathroom cabinet and relatively effective. However, self-medication with an analgesic like ibuprofen should not extend for more that 10 days.
    • For ibuprofen, 200mg given every 4-6 hours should help to reduce the pain and inflammation associated with epididymitis in adults. This dose can be increased to 400mg if necessary.
  3. Get some much needed rest. Resting in bed for a few days will help you deal with the pain associated with the condition. As long as you will be staying in bed, your crotch area will suffer a small amount of stress, reducing pain. Keep the testicles elevated as often as possible to keep your symptoms at bay.
    • When lying or sitting, placing a towel or rolled shirt below the scrotum can help to reduce discomfort.
  4. Use a cold pack. Applying cold packs to your scrotum will reduce inflammation by decreasing the blood flow. Simply wrap the ice pack in a towel and apply it to the scrotum. Keep it there for about 30 minutes and no longer in order to avoid skin damage.[3]
    • Never apply ice directly to your skin. That's just asking for more trouble!
  5. Take a sitz bath. Fill your bathtub with {{safesubst:#invoke:convert|convert}} of warm water, and sit there for about 30 minutes. The warm water will increase the blood flow and help the body to fight off the infection. You can do this as often as you need.
  6. Look into herbal remedies. There are three main herbs that have been found to help with epididymitis:
    • Echinacea. This herb is great for fighting infection and reducing inflammation. You can use it to make a healthy tea. Mix one tablespoon of dried Echinacea flowers with a quarter of a tablespoon dried peppermint and boil the mix in a pot of water. Drink the tea each day, for pain relief.
    • Pulsatilla. Pulsatilla comes in two forms: tincture and infusion. The Pulsatilla herb has great anti-inflammatory properties. When used as a tincture, you must administer 1 or 2 ml of tincture, three times a day. For preparing an infusion, you will need one teaspoon of dried herb and one cup of water. Put the herb in the boiling water and leave it to infuse for 10-15 minutes.
    • Horsetail. Another great herb that can help you get rid of this condition is horsetail. It has great antimicrobial properties, and will help you reduce inflammation. You can use one to three tablespoons of dried or fresh horsetail leaves for preparing a cup of tea. Put the desired amount of herb in a cup and pour boiling water over it. Let it infuse for five to ten minutes, strain the herbs and drink the tea.

Tips

  • Wear proper support. An athletic supporter will provide a good support for your scrotum, reducing pain. Boxers are typically less supportive than briefs.
  • It is important to seek treatment with a physician if you suspect epididymitis. This condition, left untreated, can cause serious problems, including infertility in some men.
  • Chronic epididymitis may have a variety of symptoms. In some patients, testicular pain may be the only sign of a problem. Often, pain is less severe than for acute epididymitis, with a gradual onset.

Warnings

  • Refrain from having sex. Avoid intercourse as long as the symptoms are visible. Having sex will induce a greater amount of stress to the area, causing more discomfort.
  • Testicular torsion can be mistaken for epididymitis initially. However, with testicular torsion, blood flow gets cut off and the testicle eventually dies. Since the two can be mistaken for each other, it's imperative you visit your doctor to know what's ailing you.

Things You'll Need

  • Antibiotics
  • Cold pack
  • Anti-inflammatory (like ibuprofen)
  • Herbal remedies (optional)

Sources and Citations

  1. ↑ http://www.nlm.nih.gov/medlineplus/ency/article/001279.htm
  2. ↑ http://www.cdc.gov/std/treatment/2010/epididymitis.htm
  3. ↑ http://www.mayoclinic.org/diseases-conditions/epididymitis/basics/lifestyle-home-remedies/con-20032876
  • Trojian, Thomas H., Timothy S. Lishnak, and Diana Heiman. "Epididymitis and orchitis: an overview." American family physician 79.7 (2009).
  • Kadish, Howard A., and Robert G. Bolte. "A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages." Pediatrics 102.1 (1998): 73-76.
  • Petrack, Emory M., and Waseem Hafeez. "Testicular torsion versus epididymitis: a diagnostic challenge." Pediatric emergency care 8.6 (1992): 347-350.

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