Key takeaways: A hydrocele is fluid around the testicle and often goes away by about 12 months. An inguinal hernia is a bulge of intestine or tissue in the groin or scrotum and needs surgical repair. A hard, painful, or discolored bulge that won’t go back is an emergency.
A swollen scrotum in a baby boy is common. Most of the time it’s a hydrocele, which is harmless. Sometimes it’s a hernia, which needs repair.
How They Form
Before birth, the testicles move from the abdomen into the scrotum through a passage. Normally, this passage closes. When it doesn’t close completely, fluid or tissue can move through it.
Hydrocele
What it is: a collection of fluid around the testicle.
Signs:
- Painless swelling of the scrotum, on one or both sides.
- The swelling may look bluish.
- Noncommunicating hydrocele: the swelling stays the same size. It usually goes away on its own, often by about 12 months.
- Communicating hydrocele: the swelling changes size during the day, often larger after activity or crying and smaller after sleep. This means the passage is still open, and it may lead to a hernia. It often needs surgery if it persists.
From the author
From First Breath to First Birthday is my month-by-month guide to your baby’s first year, written as a NICU and postpartum nurse. My book covers common first-year illnesses and the warning signs that mean it’s time to call the doctor, explained the way I’d explain them at the bedside.
Inguinal Hernia
What it is: part of the intestine or other tissue pushes through the open passage into the groin or scrotum.
Signs:
- A bulge in the groin or scrotum that’s more noticeable when your baby cries or strains.
- It may go away when your baby is relaxed.
Inguinal hernias are more common in premature babies and boys, though girls can get them too.
Treatment: inguinal hernias don’t go away on their own and need surgical repair, usually soon after diagnosis, because of the risk of the intestine becoming trapped.
Incarcerated Hernia: An Emergency
A hernia is incarcerated when the tissue gets stuck and can’t go back. This can cut off blood supply.
Seek emergency care if your baby has: a bulge that is hard, tender, red, or discolored; won’t go back in; or comes with vomiting, a swollen belly, or inconsolable crying.
Diagnosis
Your baby’s doctor can usually tell the difference by examining the scrotum and groin. Sometimes an ultrasound is used.
Testicular Torsion
Sudden scrotal pain and swelling can also be caused by testicular torsion, when the testicle twists. It’s an emergency. Seek care right away.
The Bottom Line
Hydroceles are common and often resolve by 12 months. Inguinal hernias need surgery. Any hard, painful, or discolored bulge needs emergency care.
Want more support for your baby’s first year? My book, From First Breath to First Birthday, is available on Amazon.
Related Articles
- Undescended Testicles: What Parents Should Know
- Swollen Breasts and Vaginal Discharge in Newborns
- Hypospadias: What Parents Should Know
- What a Normal Newborn Looks Like: Cone Heads, Milia, Peeling Skin, and More
Sources
- Urology Care Foundation. Hydroceles and inguinal hernias. https://www.urologyhealth.org
- American Academy of Pediatrics. Hydroceles and inguinal hernias. HealthyChildren.org. https://www.healthychildren.org
- Brandt ML. Pediatric hernias. Surg Clin North Am. 2008;88(1):27-43.
This article is for general education and is not a substitute for individualized medical advice. Always talk with your baby’s health care provider or your own provider about your specific situation. If you think your baby or you may have a medical emergency, call 911.
