Epididymitis causes scrotal and testicular pain due to an inflammation/infection of the epididymis: a tiny tube that connects each testicle to the body. The epididymis connects to the vas deferens, which travels up to the prostate, where it connects with the urethra. You can think of the epididymis as a sperm rookery — the place where sperm maturation occurs.
Epididymitis are similar to prostatitis in that the acute form of both conditions is usually caused by an infection (predominantly bacterial) and the chronic form is often the result of lower urinary track obstruction, such as BPH, urethral strictures, neuro-psychogenic issues, as well as pelvic floor dysfunction or other musculoskeletal imbalances of the pelvis (lumbosacral, sacroiliac, and others).
Referred pain from renal colic (a kidney stone lodged in lower part of the ureter), biomechanical problems with the L5-S1 joint (where the base of the spine meets the sacrum), or the Iliolumbar ligament can also mimic Epididymitis.
As with acute prostatitis, acute epididymitis is usually a bacterial infection that develops over the course of several days. In acute epididymitis, the pain and swelling are frequently in only one testicle, which will hang lower in the scrotum. Acute epididymitis is most common in young men ages 18 – 35 and is usually treated with antibiotics; however, acute epididymitis can also be caused by bladder outlet obstruction.
Like all fluids, urine follows the path of least resistance. If the pelvic floor/urinary sphincter is tightly constricted, it can cause urine to back up into the ejaculatory ducts that connect the vas deferens with the urethra. The urine then travels down the vas deferens to the epididymis, where it causes a lot of irritation and possibly infection.
Chronic epididymis typically occurs in older patients (50 and older). The average length of symptoms is just under five years, and the pain is close to a 5 out of 10 (with 10 being excruciating), which obviously has a huge impact on patients’ quality of life.
- Medical history
- Physical exam
- Screens for chlamydia and gonorrhea
- Complete blood count
- Testicular ultrasound
Our approach to treating chronic epididymitis is similar to how we treat chronic prostatitis — we look for a urinary obstruction first. Chronic clutching of the urinary sphincter muscles, Bladder Outlet Obstruction, and urethral stricturesall cause both these chronic conditions. In both cases, the best cure is an integrated physical therapy protocol to open these pelvic floor restrictions and regain normal tone and mobility.