Does one side of your child’s scrotum look bigger than the other? Scrotal swelling in children can happen when fluid collects around a testicle or when an inguinal hernia causes a bulge. If the swelling is new, keeps coming back or persists, arrange a visit with your child’s paediatrician, even if it is painless.
Go to the nearest emergency department immediately if your child develops sudden pain in a testicle or the scrotum. A possible cause is testicular torsion, where the spermatic cord twists and cuts off the testicle’s blood supply. Go straight to hospital without waiting for an outpatient scan.
Sudden pain may occur with swelling, nausea or vomiting.
What is a hydrocele?
A hydrocele is a collection of fluid around a testicle. It can make one side of the scrotum look fuller and is often painless. Some hydroceles change size during the day because fluid can move between the abdomen and the scrotum.
Many hydroceles in babies resolve on their own. Your paediatrician can advise on follow-up based on your child’s age, the examination and whether the swelling persists or changes.
Can an inguinal hernia make one side look bigger?
An inguinal hernia happens when tissue, often part of the intestine, passes through an opening in the groin. It may appear as a bulge in the groin or extend into the scrotum. The bulge may be easier to see when a child cries, coughs or strains and less visible when they relax.
A bulge that becomes firm, painful or discoloured, or occurs with vomiting, needs emergency assessment. These can be signs that tissue has become trapped.
A swelling that comes and goes can be hard to describe if it has disappeared by the time of the appointment. Tell the paediatrician where you first saw it, whether it was in the groin or the scrotum, and what your child was doing at the time. Both a hernia and some hydroceles can change in size, so that detail helps guide the examination.
Watch the Nisarga Diagnostics Reel
The video explains why one side may look bigger and when a paediatric assessment can help. Share it with a parent who may have the same question.
Watch the original video on Instagram.
What will the paediatrician check?
The paediatrician will examine the groin and both sides of the scrotum. Tell them when you first noticed the swelling, whether it comes and goes, and whether your child has had pain, redness or vomiting.
If one side looks empty or a testicle seems to be missing from the scrotum, see our guide to undescended testicle in children.
When might an ultrasound be needed?
A physical examination is usually the first step. If the cause is unclear, the paediatrician may request a scrotal ultrasound to look at the testicle and nearby tissues and check for fluid. The doctor decides whether imaging is needed based on the examination.
If your child’s doctor has recommended a scan, contact Nisarga Diagnostics in Sanjaynagar, Bengaluru for appointment details.
Frequently asked questions
Can one testicle hang lower than the other?
Yes. One testicle can sit lower than the other. If one side newly looks larger or swollen, arrange a paediatric assessment. Read more about why testicles can sit at different heights.
Should I get painless swelling checked?
Yes. Arrange a paediatric visit if swelling is new, persistent or keeps returning, even when your child feels well.
Can a hydrocele and a hernia occur together?
Yes. They can occur together, and both can make one side of the scrotum appear fuller. A paediatrician can assess the groin and scrotum to help determine the cause.
Can a hydrocele go away on its own?
Many hydroceles in infants settle on their own. If the swelling persists, grows or appears for the first time in an older child, have it assessed.
Does every child with scrotal swelling need an ultrasound?
A paediatrician can often decide the next step after examining your child. An ultrasound may help when the cause is unclear. Sudden testicular pain needs immediate emergency assessment.
What happens after a hydrocele is diagnosed?
For many babies with a painless hydrocele, the paediatrician may suggest checking it again at a later visit. If it persists or the examination suggests a hernia, your child may be referred to a paediatric surgeon or urologist to discuss the next step.
Medical references
Founder of Nisarga Diagnostics, is a renowned fetal ultrasound specialist with over 20 years of expertise. An alumnus of Government Medical Colleges in Mysore and Bangalore, he also holds a D.N.B. from the National Board of Examinations, Delhi, and certification from the Fetal Medicine Foundation, London. A former Professor and HOD, he has trained countless PG students and junior radiologists, shaping the future of fetal imaging in India.