Epididymitis: Symptoms, Diagnosis, and Treatment

Concerns about the epididymis?

Hello, Doctor: I have several difficult questions that I hope you can help me answer.
Thank you.

Since August 19, I have been experiencing pain in my left groin area when pressing or walking.
Initially, I thought it was a strain or a hernia, but after seeing a doctor, I was told it was not a hernia.
Two weeks later, I started to feel a sense of heaviness and dull pain in my left testicle, which became more pronounced when urinating, but there was no swelling or discharge, and I did not have a fever.
However, my appetite decreased.
On September 4, after hiking and drinking very little water while sweating a lot, I noticed a few drops of blood when having a bowel movement.
On September 5, I went to a large hospital where the doctor arranged for kidney and bladder ultrasounds and a urinalysis, but did not perform a scrotal ultrasound.
The results showed everything was normal, and the doctor clinically diagnosed me with acute epididymitis and prescribed antibiotics for two weeks.

I would like to ask:
1.
If it is indeed epididymitis, can the urinalysis be normal?
2.
Is it possible to have epididymitis without swelling?
3.
How can I know if I have fully recovered? I am worried about it becoming chronic epididymitis.

4.
Could the blood (which was dark in color) just be due to high physical activity and dehydration, considering the urinalysis was normal?
5.
I have been feeling more fatigued, having trouble sleeping, and becoming more irritable.
Could these be symptoms related to the condition or the medication? The name of the medication prescribed is Morcasin Tab.

Thank you for your help.

Allen, 30~39 year old female. Ask Date: 2020/09/09

Dr. Xu Wencang reply Urology

Epididymitis may show normal urinalysis results, but there will be swelling.
Follow-up appointments are necessary for monitoring.

Reply Date: 2020/09/09

More Info

Epididymitis is an inflammation of the epididymis, a tube located at the back of the testicle that stores and carries sperm. This condition can be quite painful and is often caused by infections, including sexually transmitted infections (STIs) or urinary tract infections (UTIs). Understanding the symptoms, diagnosis, and treatment of epididymitis is essential for effective management.

Symptoms of Epididymitis
The symptoms of epididymitis can vary, but common signs include:
1. Pain and Swelling: The most prominent symptom is pain in the affected testicle, which may radiate to the groin. Swelling of the epididymis can also occur, but it is possible to have epididymitis without significant swelling.

2. Discomfort During Urination: Patients may experience pain or discomfort while urinating, which can be accompanied by a burning sensation.

3. Ejaculatory Pain: Pain during ejaculation is another symptom that can occur.

4. Changes in Urination: Increased urgency or frequency of urination may be noted.

5. Fever and Chills: In some cases, fever may accompany the other symptoms, indicating a more severe infection.

6. Blood in Urine: Hematuria (blood in urine) can occur, especially if the inflammation affects the urinary tract.

Diagnosis of Epididymitis
Diagnosis typically involves a combination of clinical evaluation and diagnostic tests. In your case, the physician performed a kidney and bladder ultrasound and urinalysis, which returned normal results. Here are some points regarding your specific questions:
1. Normal Urinalysis: It is possible to have epididymitis with a normal urinalysis, especially if the infection is localized to the epididymis and not affecting the urinary tract significantly.

2. Non-Swollen Epididymis: Yes, epididymitis can occur without noticeable swelling. The inflammation may be mild or localized, leading to pain without significant physical changes.

3. Determining Recovery: To know if you have fully recovered from epididymitis, you should monitor your symptoms. Improvement in pain, resolution of discomfort during urination, and absence of fever are good indicators of recovery. Follow-up with your healthcare provider is crucial to ensure that the condition has resolved and to prevent chronic epididymitis.

4. Blood in Urine: The presence of blood in urine, especially after strenuous activity and dehydration, could indeed be related to physical exertion rather than an infection. However, it is essential to report this to your physician for further evaluation.

5. Fatigue and Mood Changes: Feeling more fatigued, having trouble sleeping, and experiencing mood swings can be related to the stress of dealing with a painful condition or side effects from medications. The antibiotic Morcasin (likely a brand name for a specific antibiotic) can also have side effects, including gastrointestinal upset or fatigue. Discuss these symptoms with your doctor, as they may need to adjust your treatment plan.

Treatment of Epididymitis
Treatment typically involves antibiotics to address the underlying infection. In your case, the physician prescribed a two-week course of antibiotics. It's essential to complete the full course, even if symptoms improve before finishing the medication. Pain relief can be managed with over-the-counter pain relievers, and supportive measures like rest and scrotal elevation may help alleviate discomfort.

In conclusion, while epididymitis can be a concerning condition, understanding its symptoms and treatment can help manage it effectively. If you have ongoing concerns or if symptoms worsen, it is crucial to follow up with your healthcare provider for further evaluation and management.

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