EPIDIDYMITIS

General information

Epididymitis is an inflammation of the epididymis, an oblong structure attached to the upper part of each testis. The inflammation may be so great that the testicle itself feels greatly enlarged and hardened. However, this does not mean that the testicle is infected. While bacterial infections of the epididymis are common and the most serious of the causes of epididymitis, infections are only one of many reasons that the epididymis can become inflamed.

Bacterial epididymitis usually results from an infection spreading to the epididymis from other male urogenital organs (prostate, bladder, kidney, and urethra). Epididymitis may complicate an infection or may be brought on by injury to the scrotum. The germ causing your infection can be identified by smears or cultures of the urine or prostatic secretions. Epididymitis is not contagious, not inherited, and not a sign of cancer. Most true bacterial infections, such as those caused by Staphylococcus or E. Coli bacteria, cause fever, chills, generalized weakness, redness, swelling and intense pain of the scrotum and epididymis. The onset of the discomfort is usually quick, certainly less than 24 hours, and usually much less. Bacterial infections are treated with antibiotics, appropriate for the bacteria that is causing the infection. In most circumstances the bacteria can be identified in the urine or prostate fluid and tests can be run to determine which antibiotic is most effective.

Some rarer types of bacteria create a different picture altogether. Tuberculosis, for instance, is a bacteria that can spread to the epididymis in unusual circumstances. Tuberculosis epididymitis develops very slowly over days and weeks.

Non bacterial epididymitis simply means an inflammation of the epididymis not cause by a bacteria. The causes are many and include viruses, trauma, and unknown causes. The unknown causes are commonly referred to in medicine as 'idiopathic' - a fancy word for - we don't have a clue! Non-bacterial epididymitis can be just as painful and with a very quick onset. The viral types may be associated with fevers and generalized weakness and ill feeling. Epididymitis caused by trauma or the 'idiopathic' types are not usually associated with the fevers and chills and generalized symptoms. Many believe that these types of epididymitis are caused by a rupture or blow-out of the sperm ducts causing a leakage of sperm fluid into the tissue. The body tissues can be quite irritated by this leakage and hence the redness and swelling. It may be difficult to understand why the body would be so irritated by a fluid that is made in the testicle. Suffice it to say that the body makes acid in the stomach which serves a purpose to digest food. With a perforated stomach ulcer, this acid can leak into the body cavity and cause a life threatening illness. Epididymitis is by itself not life threatening, but the point is made about pain and swelling. The treatment for these types of epididymitis may include antibiotics just to prevent bacteria from infecting the area whose resistance has been weakened.

Important points in treatment of epididymitis

Activity - Go to bed and remain there except for bowel movements until swelling subsides and fever is gone. Getting off your feet helps the epididymis by elevating it. When up, the scrotum hangs down and is constantly being bumped by walking or moving. This doesn't allow the infection to drain out, so to speak.

Diet -

There are no special restrictions on what you may eat. Plenty of fluids are helpful but limit alcoholic beverages.

Anti-inflammatories -

Anti-inflammatory medicine can be very helpful in epididymitis. Ibuprofen is the most common one used today, but other types may work as well or better and without the stomach upset. These may include Feldene, Naprosyn, Toradol or Voltaren to name a few. Even aspirin has anti-inflammatory properties, but at the expense of upsetting one's stomach.

General instructions

• Take your temperature each morning and night; keep a record.
• While you are in bed, support the weight of the scrotum and tender testicles by rolling a soft bath towel and placing it between your legs beneath the inflamed parts. When you are again able to be up and around, you will be more comfortable wearing a jock strap or two pairs of jockey shorts.
• While you are in bed apply either an ice bag or heat (warm compresses, electric heating pad, hot-water bottle) to the inflamed parts. Use whichever gives the most comfort.
• Do not engage in sexual intercourse. The flow of sperm through the epididymis during the early phase can only cause more inflammation and damage.

Medications

Your medicines must be prescribed to your own particular needs. Do not take any medicine (not even medicine you buy without a prescription) without telling your doctor. If drugs are prescribed, carefully follow the instructions on the label.

Notify our office if any of the following happens:

• Oral temperature is over 100 degrees Fahrenheit.
• Pain is not reasonably well controlled.
• Your symptoms don't improve in 4 days.
• You become severely constipated.

Note: After pain and tenderness have subsided, a certain amount of swelling and hardness around the testicle may continue. This will disappear more quickly if you sit in hot water for 15 minutes twice a day. Be careful to avoid any injury to the infected area for 2 or 3 months after all signs of inflammation have subsided.