Epididymitis vs. Testicular Torsion: How to Tell the Pain Apart

There was a young man who sent a private message asking for help in the middle of the night, but the sudden pain in the scrotum was confused by the messy information on the Internet: should he take anti-inflammatory drugs or have an operation immediately? 

This kind of panic is very common; male reproductive system discomfort is easy to embarrass people, and epididymitis and testicular torsion are two diseases with similar symptoms but different consequences: one can be alleviated by drugs, and the other can cause testicular necrosis a few hours later. 

Today, I will talk to you about the difference between these two kinds of pain to help you not get lost at the critical moment.

Epididymitis and Testicular Torsion: Different Pain Characteristics and Symptoms

The pain of epididymitis and testicular torsion are both "distress signals" of the body, but the degree of urgency varies greatly. This is like a leaking water pipe: one leaks slowly, and there is time to deal with it calmly; the other suddenly bursts, and the brake must be turned off immediately, or the whole house will suffer. The pain of epididymitis and testicular torsion corresponds to these two situations.

Epididymitis: progressive pain 

Epididymitis is inflammation caused by bacterial invasion of the epididymis, the "sperm warehouse." The most prominent feature of its pain is that it is "progressive" and does not attack suddenly, leaving time for people to react.

Pain in epididymitis increases slowly: 

It usually starts with a slight swelling, which may only feel like a small stone in the scrotum in the morning. At noon, the swelling turns into a dull pain, which is more obvious when walking and rubbing. At night, the pain may spread to the whole scrotum and even involve the lower abdomen. Have a patient describe it: "Like someone gently pinching the epididymis, the force slowly increased from tolerance to restlessness."

Inflammation causes many symptoms: 

Inflammation will activate the immune system, in addition to local pain, often accompanied by fever (more than 100.4℉) and fatigue; there may also be frequent urination, urgency, and a burning sensation in the urethra when urinating. 

Externally, the inflamed epididymis is swollen, hard, and tender to the touch, but the testis is usually in its normal position without significant displacement.

Testicular Torsion: sudden, severe pain 

If epididymitis is "chronic torture," testicular torsion is "acute crit." It is caused by a sudden twist of the spermatic cord, which cuts off the blood supply to the testicles, and is an emergency. In the face of sudden and severe pain, it must be dealt with immediately.

Sudden outbreak of testicular torsion pain: 

Pain attacks without foreshadowing may suddenly appear when sleeping, eating, or even bending down, such as the instantaneous spread of a knife; the pain is unbearable. The patient recalled, "When playing games, he suddenly jumped up with pain, and his clothes were soaked with cold sweat in an instant, and he could not stand at all." The pain continues to increase and can become unbearable within a few minutes, so that it cannot be relieved by rest.

Affects the digestive system: 

Spermatic cord torsion can stimulate abdominal nerves, in addition to scrotal pain, often accompanied by nausea, vomiting, and diarrhea in some people. Externally, the twisted testis may be displaced upward and elevated, with intense tenderness and increased stiffness when touched, and the epididymis may be in an abnormal position (such as running in front of the testis). 

More importantly, whether lying, sitting, or standing, the pain will not be relieved, and it will always be painful.

Testicular torsion is an emergency and requires timely medical treatment:

Testicular torsion has a golden period of reduction within 6 hours; the probability of necrosis increases dramatically over 12 hours, and the testicle can hardly be preserved over 24 hours. 

There was a 17-year-old boy who woke up in the middle of the night with pain because he was embarrassed to tell his parents about it until dawn, and eventually, the testicular necrosis was removed. This sudden pain must not be hesitated; one must immediately go to the emergency room.

Epididymitis or Testicular Torsion? Here's How to Distinguish Them by Medical Tests

Some people worry that their judgment is not accurate. In fact, there is no need to worry; doctors have professional diagnostic methods, and we just need to describe the symptoms truthfully. 

Physical examination: palpation to identify differences 

The doctor can make a preliminary judgment by touching: the epididymis of patients with epididymitis is swollen and tender, but the position of the testis is normal; the testis of patients with testicular torsion moves upward, the tenderness is severe, and there is a typical "lifting pain"—the pain is aggravated when the scrotum is lightly supported, which is not a feature of epididymitis. 

Ultrasonography: blood flow determines authenticity

This is the most critical diagnostic basis, just like the "vascular fluoroscopy" of the scrotum. Epididymitis due to inflammation leads to increased local blood flow; ultrasound shows "rich blood flow." In testicular torsion due to vascular occlusion, blood flow decreases or even disappears; ultrasound shows "lack of blood flow." The comparison between the two is clear.

Medical history description: the more detailed, the more accurate 

Do not be shy when seeking medical advice, and clearly inform them of the onset of pain, specific feelings, and accompanying symptoms (such as fever and abnormal urination). "Bulging started at 8 o'clock this morning" and "sudden severe pain 10 minutes ago" are two very different phrases for doctors, which will immediately start emergency treatment.

How to Manage the Pain of Epididymitis and Testicular Torsion

After defining the differences from pain, the coping style is also clear, and the core principle is "to deal with the situation without delay."

Epididymitis: Standardized anti-inflammatory is the core

Epididymitis is mostly caused by bacterial infection, and antibiotics are the main treatment. Doctors will prescribe oral or intravenous antibiotics according to the patient's condition, which should be taken continuously for 2-4 weeks. After the symptoms are relieved, the drug should not be stopped without authorization; otherwise, it is easy to relapse.

Clinically, many doctors will recommend antibiotic treatment with the Chinese patent medicine Diuretic and Anti-inflammatory Pill developed by Dr. Li's clinic. It can clear heat and promote diuresis, promote blood circulation and remove blood stasis, effectively alleviate epididymal inflammation and edema, alleviate discomfort such as frequent urination and urgent urination, and help the patient recover more thoroughly. 

During treatment, attention should be paid to rest, avoiding strenuous exercise, and wearing loose underwear to reduce scrotal compression; when the pain is obvious, it can be relieved by a local cold compress with analgesics according to medical supervision.

Testicular Torsion: Operate against the clock 

There is no "conservative treatment" for this disease, and the only way is to immediately operate to restore the spermatic cord and restore the testicular blood supply. If the operation is timely, the testicular function can be restored; if it has been necrotic, it needs to be removed to avoid affecting the other testicle. Doctors usually fix both testicles after surgery to prevent recurrence.

Conclusion 

If the scrotal pain is getting worse and accompanied by fever and frequent urination, it may be epididymitis, and you can go to the urology department in time. If the pain suddenly breaks out and is severe and unbearable, accompanied by nausea and vomiting, you need to go to the emergency department immediately. This is likely to be testicular torsion, and every second counts in the survival of the testicle.

Health is no trivial matter, especially when it comes to problems that may affect life but also need to be addressed decisively. I hope this article can help you understand the nature of the two kinds of pain, and I also hope that everyone who encounters trouble can seek medical treatment in time to protect their health.