Epididymitis is the inflammation or infection of the epididymis, the long coiled tube that attaches to the upper part of each testicle. The epididymis functions as a storage, transport, and maturation place for sperm before ejaculation.
In adults, epididymitis is the most common cause of pain in the scrotum, and in adolescents, the second most common cause. The acute form is usually associated with the most severe pain and swelling. If symptoms last for more than six weeks after treatment begins, the condition is considered chronic.
Epididymitis is most common between the ages of 18 and 40, but children can get it, too. Boys who experience painful urination, have a history of urinary tract infections, abnormal bladder function, or abnormalities of the genitals and urinary structures are more inclined to get epididymitis. It is seldom found in adolescents who aren't sexually active.
The infection is especially common among members of the military who exercise for extended periods without emptying their bladders.
Factors that increase the risk of developing epididymitis include:
- infection of the bladder, kidney, prostate, or urinary tract
- other recent illness
- narrowing of the urethra (the tube that drains urine from the bladder)
- use of a urethral catheter
The infection doesn't start in the epididymis. It is an ascending infection that most often starts in the urethra or urinary tract before spreading to the epididymis.
Causes & symptoms
Among men under age 35 who are sexually active, Chlamydia trachomatis or Neisseria gonorrhoeae are the most common causes of epididymitis.
Nonsexually transmitted epididymitis is associated with urinary tract infections and is more common in men who have undergone surgery for urinary tract problems or who have anatomical abnormalities.
Although epididymitis is often caused by and associated with some of the same organisms that cause some sexually transmitted diseases, there are other causes as well. The condition can also be attributed to pus-generating bacteria associated with infections in other parts of the body. This cause, however, is rare.
Epididymitis can also be caused by injury or infection of the scrotum or by irritation from urine that has accumulated in the vas deferens (the duct through which sperm travels after leaving the epididymis).
Epididymitis is characterized by pain in the testes. The pain, which usually develops gradually over several hours or days, is followed by sudden redness and swelling of the scrotum. Generally, only one testicle is affected. The affected testicle is hard and sore, and the other testicle may feel tender. The patient has chills, a low-grade fever, and usually has acute urethritis (inflammation of the urethra).
Sometimes, there is a discharge from the urethra and blood in the semen. Ejaculation can be painful.
Enlarged lymph nodes in the groin cause scrotal pain that intensifies throughout the day and may become so severe that walking normally becomes impossible.
Doctors test for epididymitis through:
- Urinalysis, which will likely show an elevated white blood-cell count and the presence of bacteria.
- Urine culture, to identify the organism responsible for the infection.
- Examination of discharges from the urethra and prostate gland.
- Blood tests to measure white-cell counts, which will be elevated.
- Ultrasound, which will reveal an enlarged epididymis.
The condition may lead to an abscess or cause such complications as infertility, so it is best to consult a urologist about the condition and treatment.
Conventional treatment involves the use of antibiotics to treat the infection and pain killers to ease the pain. With alternative therapies, the treatment involves increasing circulation to the area. This reduces inflammation, which helps the body heal.
Fasting is recommended for some people, since digestion slows down the body's healing mechanisms. A water fast is best, but if that isn't possible, the patient should confine intake to fruit and vegetable juices. If food must be eaten, a light diet of fresh fruits and vegetables is recommended. Fasting eases pain. Fluids should also be increased.
In traditional Chinese medicine, there are formulas of herbs that need to be designed to fit the individual case. Herbs like philodendron (Huang Bai) are used for inflammation in the lower torso area. Pulsatilla, which helps with swelling and pain, particularly in the genitals, and podophyllum are the most effective in treating epididymitis. These plants, however, are toxic, and the herb should only be taken under the direct supervision of an experienced herbalist. Echinacea, horsetail, saw palmetto berries, cranberry extract, and chimaphilla are also effective.
Hydrotherapy may also help. Sitting in hot water increases circulation to the prostate area, alleviating discomfort and speeding recovery. Patients are advised to sit in a tub for 15 to 30 minutes once or twice a day. The water should be as hot as can be tolerated.
Homeopathy is also an option. Homeopathic physicians may prescribe remedies that are specific to the person.
Since epididymitis is caused by an infection and often involves the urinary tract, the following alternative remedies may also be helpful in treatment of the condition:
- Acupuncture, which may help ward off another infection.
- Aromatherapy. A hot sitz bath with drops of juniper berry or sandalwood may relieve symptoms of the infection.
- Chiropractic. Strengthening bladder muscles by adjusting the joints and bones in the pelvic area may keep infection at bay.
Epididymitis is traditionally treated with antibiotic therapy. To prevent reinfection, patients must take their medication exactly as prescribed, even if the patient's symptoms disappear or if he begins to feel better. Over-the-counter anti-inflammatories may be taken to relieve pain. The over-the-counter medicines will have the same effects as herbal anti-inflammatories.
Bed rest is recommended until symptoms subside, and patients are advised to wear athletic supporters when they resume normal activities. If pain is severe, a local anesthetic like lidocaine (Xylocaine) may be injected directly into the spermatic cord. Scrotal ice packs and scrotal elevation are also recommended.
A patient who has epididymitis should not drink beverages that contain caffeine. To prevent constipation, he should use stool softeners or eat plenty of fruit, nuts, whole grain cereals, and other foods with laxative properties.
Strenuous activity should be avoided until symptoms disappear. Sexual activity should not be resumed until a month after symptoms disappear.
If a second course of treatment doesn't eradicate stubborn symptoms, long-term anti-inflammatory therapy may be recommended. In rare instances, chronic symptoms require surgery.
There are two surgical procedures used to treat epididymitis, and both of them cause sterility.
Epididymectomy involves removing the inflamed section of the epididymitis through a small incision in the scrotum.
Bilateral vasectomy prevents fluid and sperm from passing through the epididymis. This procedure is usually performed on men who have chronic epididymitis or on elderly patients undergoing prostate surgery.
Before considering surgeries that will lead to infertility, patients may want to try alternative therapies.
Herbal preparations are very effective in treating epididymitis. Some sources say that given in medicinal doses, the herbs pulsatilla and podophyllum can treat epididymitis with the same results as conventional medicine.
Pain may begin to subside within 24 hours of treatment, but complete healing may take weeks or even months.
Using condoms and not having sex with anyone who has a sexually transmitted disease (STD) can prevent some cases of epididymitis. Also, drinking plenty of fluids, which will increase urine flow, will help prevent urine retention, which can lead to infection.
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