A scrotal hematoma is a collection of blood within the scrotal sac, usually resulting from trauma to the area. This condition causes noticeable swelling and discomfort. While it is an injury that warrants attention, it is a relatively common occurrence following injury or medical procedures. This article explains what a scrotal hematoma is, its causes, and how to manage the condition.
Defining Scrotal Hematoma
A scrotal hematoma is a collection of blood that has leaked from damaged blood vessels into the scrotal layers. This blood initially pools as liquid but quickly forms a solid blood clot. Because the scrotum, the sac containing the testicles, has a loose structure, it allows for this accumulation of blood.
The hematoma collects in the space surrounding the testes and spermatic cord structures, distinct from the testicle itself. It presents as localized swelling that varies in size. As the blood breaks down, discoloration similar to a bruise develops, changing from red or purple to brown and then yellow over time.
Common Causes and Risk Factors
The most frequent cause of a scrotal hematoma is direct, blunt force impact to the area. This trauma often occurs during sports activities, such as being struck by a ball, or from accidents like falling onto a bike frame or fence post. These impacts rupture blood vessels, causing blood to leak into the scrotal tissues.
Surgical procedures involving the groin or scrotal area are another significant cause, including vasectomy and hernia repair. In these cases, a cut blood vessel may continue to bleed internally, forming a hematoma. Risk factors also include underlying medical conditions that affect blood clotting. Additionally, taking prescription blood-thinning medications increases susceptibility to developing a hematoma after minor trauma or surgery.
Immediate Symptoms and Urgent Care
The onset of a scrotal hematoma is marked by immediate pain and rapid swelling. The swelling can range from a small, firm lump to a large enlargement that makes the scrotum feel tense and heavy. Bruising may appear shortly after the injury or develop over the next few days as the blood moves toward the skin surface.
Signs Requiring Emergency Care
Certain signs indicate a potentially more serious issue requiring immediate medical attention. Severe, unrelenting pain that does not lessen requires an urgent visit to a healthcare provider. Nausea or vomiting accompanying the pain may signal a deeper injury or a condition like testicular torsion. Professional help is also needed if a fever develops or if there is difficulty or pain when urinating.
For initial self-care of a minor injury, the RICE protocol can be safely applied to help manage discomfort and limit swelling.
- Rest is important to prevent further trauma.
- Gently applying an ice pack to the affected area can help reduce swelling and pain.
- Wearing supportive underwear, such as an athletic supporter, provides compression and elevation.
- Over-the-counter pain relievers can be used to help alleviate the discomfort.
Professional Diagnosis and Treatment
The diagnostic process usually begins with a physical examination of the scrotum to assess the size and firmness of the swelling. The healthcare provider will then typically order imaging, most commonly a scrotal ultrasound. Ultrasound uses sound waves to visualize the internal structures, confirming the presence and extent of the blood collection and helping to rule out more serious issues. This imaging is crucial to ensure there is no associated testicular rupture or other injury to the internal structures.
For small to moderate hematomas, the primary treatment path is conservative management, also known as watchful waiting. This involves continued rest, pain management, and allowing the body to slowly reabsorb the clotted blood mass over time. The body’s natural processes will eventually break down the clot, causing the lump to soften and shrink.
In cases where the hematoma is very large, rapidly expanding, or causing severe, debilitating pain, a more interventional approach may be necessary. This can involve a surgical procedure to drain the accumulated blood and clot, which is often done to relieve pressure and prevent complications. A small hematoma may fully resolve in approximately four weeks, but very large collections can take anywhere from three to five months to be completely absorbed by the body.