Post-Surgery Concerns: Scrotal Swelling and Groin Pain After Hernia Repair

Postoperative scrotal swelling and sagging, along with groin pain, after inguinal hernia surgery?

Hello Dr.
Tsai, I would like to ask you about my condition.
In mid-August, I underwent surgery for a left inguinal hernia.
After the surgery, I occasionally experience pain or a sensation of pressure in the groin area.
I didn't pay much attention to the condition of my scrotum until about three weeks post-surgery when I suddenly felt a sense of heaviness while coughing.
I noticed that the left side of my scrotum had dropped significantly, almost half a testicle lower than the right side.
I immediately returned for a follow-up appointment, worried about a possible hernia recurrence that could cause the swelling and drooping.
The doctor assured me that there was no problem and that it would gradually improve.
Now, nearly two months post-surgery, the condition of my scrotum is that in the morning, after waking up, it seems okay; the left side is only slightly lower than the right.
However, by evening, when the skin is not as tight, it droops significantly, about half to a full testicle lower.
If I experience severe pain in the groin area in the afternoon (it doesn’t hurt when lying down or sitting, but it does when standing or walking), I immediately check in the restroom, and I almost always notice a significant swelling and drooping.
This has caused me to walk awkwardly and limit my movements, as I am hesitant to make any sudden movements.

I would like to know if it is normal to experience this kind of condition two months post-surgery.
What could be the reason for this? I often feel anxious about this situation.
I would appreciate your help in answering my questions.
Thank you.

Niming, 30~39 year old female. Ask Date: 2020/10/05

Dr. Cai Zhuorong reply Urology

During the process of inguinal hernia surgery, it is necessary to disrupt a portion of the cremaster muscle to access the surgical site, which may result in the affected side's testicle being positioned lower postoperatively.
However, there is no need for concern.

Reply Date: 2020/10/05

More Info

After undergoing a left inguinal hernia repair surgery in mid-August, it is not uncommon to experience some discomfort or sensations of heaviness in the groin area. The symptoms you describe, such as occasional pain, a feeling of being "pushed," and scrotal swelling, can be concerning, especially when they seem to worsen with certain activities like coughing or standing.
Firstly, it is important to understand that after hernia repair surgery, the body goes through a healing process that can take several weeks to months. During this time, it is normal to experience some discomfort as the tissues heal and the nerves regenerate. The sensation of heaviness or a "downward pull" in the scrotum may be due to a combination of factors, including swelling, inflammation, and the adjustment of the surrounding tissues post-surgery.

The swelling in the scrotum, particularly if it is more pronounced in the evening, can be attributed to fluid accumulation or changes in blood flow as the day progresses. When you are upright and active, gravity can cause fluid to pool in the scrotal area, leading to a noticeable difference in size between the left and right sides. This is often referred to as "scrotal edema" and can be a common occurrence after surgery, especially if there has been manipulation of the tissues in that area.

Regarding the pain you experience, it is essential to differentiate between normal post-operative discomfort and signs of complications, such as a recurrence of the hernia. The fact that you do not experience pain when lying down or sitting suggests that the discomfort may be related to pressure or strain on the area when standing or walking. If the pain is sharp or accompanied by other symptoms like fever, significant swelling, or changes in bowel habits, it would warrant immediate medical attention.

It is also important to consider your activity level during recovery. Engaging in heavy lifting or strenuous activities too soon after surgery can exacerbate discomfort and potentially lead to complications. It is advisable to follow your surgeon's recommendations regarding activity restrictions during the recovery period.

In summary, while some post-operative discomfort and swelling can be expected after inguinal hernia repair, persistent or worsening symptoms should be evaluated by your healthcare provider. They may perform a physical examination and possibly imaging studies to rule out any complications, such as a recurrence of the hernia or other issues. It is always better to err on the side of caution and seek medical advice if you have concerns about your recovery.
In the meantime, consider using supportive garments, such as a jockstrap, to provide additional support to the scrotal area, especially during activities. Additionally, applying ice packs to the area may help reduce swelling and discomfort. Remember to listen to your body and avoid activities that exacerbate your symptoms until you have fully healed.

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