The epididymis rests on top of the testicle and consists of the tightly wound epididymal duct, which can be several meters long.

Functionally, they are responsible for the mobility of the sperm. Inflammation of this structure, also called epididymitis, can cause severe pain and increased swelling of the epididymis.

Cystitis as a cause of epididymitis

Bladder infections in men go hand in hand with the risk that pathogens will be spread to other parts of the urogenital tract and lead to further inflammation.

This is particularly the case with recurrent, recurring urinary tract infections.

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The main risk factor for recurrent urinary tract infections is the presence of residual urine: urine that remains in the bladder after urination.

This is caused, for example, by enlargement / hyperplasia of the prostate.

Also read our article on a Prostate enlargement

However, residual urine can also be observed in younger patients as part of congenital narrowing of the urinary tract.

In this case, E.coli, Pseudomonas, Klebsiella or Proteus mirabilis are the most common bacterial pathogens. Clinically, the main symptoms of cystitis are pain when urinating, frequent urination and the feeling of residual urine.

Do you have pain when urinating? - Then read our article on this Pain when urinating in men

Inflammation of the testicles as a cause of epididymitis

Inflammation of the testicles (orchitis) can also lead to involvement of the epididymis due to the bacteria rising along the spermatic cord.

Clinically, these two forms are difficult to differentiate from one another, as they cause identical symptoms with swelling of the testicles and pain.

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In the case of a combined inflammation, one speaks of epididymoorchitis.

In addition to infectious causes, an autoimmune reaction, a previous trauma or drug side effects, such as with amiodarone, are possible.

In the diagnosis of testicular inflammation, testicular torsion must be ruled out as soon as possible, as this can lead to the death of the testicle with subsequent infertility if it persists for a long time.

In addition to adequate antibiotic and pain-relieving therapy, the treatment of testicular inflammation consists primarily of local cooling and elevation of the scrotum, as well as strict bed rest. Because of the risk of ascending urinary tract infection, regular urological checks should be carried out.

Prostate inflammation as a cause of epididymitis

Since the vas deferens run through the prostate, inflammation of this structure can lead to involvement of the epididymis and testes.

A distinction must be made here between an acute and chronic form of inflammation, although both of these are mostly due to a bacterial infection.

A prostate inflammation leads to pain in the lower abdomen or over the pubic bone due to swelling, residual urine and frequent urination with pain.

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Please also read our article on this Pain when urinating in men

Occasionally blood may be mixed in. Diagnostically, the existence of the typical symptoms, as well as a clear pressure pain during the palpation examination are groundbreaking.

Would you like to know what can be behind blood in the urine? - Then read our article Causes of blood in the urine

The diagnosis can be confirmed by an ultrasound and possible complications, such as an abscess, can be excluded.

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Therapeutically, antibiosis (antibiotics), bed rest and a high level of fluid intake are usually sufficient and healing occurs after a few days.

Urethritis as a cause of epididymitis

Transmission of bacterial inflammation from the urethra called urethritis can lead to epididymal involvement.

Would you like to find out more about urethritis? - then read our main article on the topica urethritis

Sexually transmitted diseases, such as gonorrhea (gonorrhea) or a chlamydial infection, are particularly possible pathogens.

However, other bacteria such as mycoplasma and mechanical irritation, such as with a catheter system, are also possible.

Classic symptoms are pain when urinating and during sexual intercourse, constant itching and burning of the urethra and white to greenish discharge.

Please also read our article on this Pain during intercourse

In addition to adequate fluid intake and pain therapy, antibiotic therapy is the focus of the treatment concept. The sexual partner should always be treated at the same time in order to avoid re-infection.

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Catheters as a cause of epididymitis

In the context of urological diseases associated with bladder dysfunction or urinary outflow disorder, it may be necessary to use a urine catheter / urinary catheter to ensure continuous urine outflow.

The installation of a urinary catheter is associated with an increased risk of infections of the urethra or the urinary bladder.

This, in turn, can lead to acute inflammation of the epididymis and testicles. If the catheter is found to be infected, it should be removed as soon as possible and antibiotics initiated.

Sexual intercourse as a cause of epididymitis

Sexually transmitted infections, such as gonorrhea (gonorrhea), which is characterized by an inflammation of the urethra with possible involvement of the epididymis and testicles, can be transmitted during sexual intercourse.

Symptoms are mainly pain when urinating and during sexual intercourse.

Read our articles on this Pain when urinating in men and Pain during intercourse

Especially with gonorrhea, a whitish discharge in the morning, the so-called “Bonjour droplet”, can be observed.

The risk of contracting these infections through sexual intercourse is considered to be relatively high. In addition to the causal connection between sexual intercourse and epididymitis, this inflammation can also lead to a restriction in fertility, in the sense of sterility.

This is due to adhesions in the seminal duct, which can arise as part of the inflammation, and thus relocate it. If the testicles are involved, impaired sperm production can also occur. However, these complications are rare due to timely and effective therapy with antibiotics.

Rheumatism as a cause of epididymitis

Rheumatological diseases are another possible cause of acute epididymitis.

This applies above all to the rheumatic group of seronegative (rheumatoid factor negative) spondylarthritis, such as Bechterew's disease or psoriatic arthritis.

They are characterized by inflammatory back pain, which occurs mainly at rest, and the involvement of other joints in the body.

However, so-called reactive arthritis can also occur in the context of infectious diseases such as chlamydial infection.

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This usually occurs two to three weeks after the actual infection and, in addition to inflammation of large joints, can also lead to inflammation of internal organs such as the epididymis.

Are there also psychological causes for epididymitis?

In almost all cases, with the exception of young children, infection can be identified as the underlying cause of epididymitis.

However, it happens that despite extensive diagnostics, no cause of the inflammation can be found. In these cases a psychosomatic genesis of the symptoms comes into question. The exact nature of this relationship and the relevance of this cause is currently the subject of research.

Do you want to know what psychosomatics exactly is? - Then read our article about Psychosomatics

Symptoms of epididymitis

The symptoms usually develop slowly in the course of the disease. Depending on the age of the person affected, various causes, such as a urinary tract infection, come into consideration.

While sexually transmitted diseases are the most common cause in young men, recurring urinary tract infections are the underlying cause in older men.

In diagnostics, testicular torsion must always be excluded, in which the vascular supply is clamped off by the rotation of the testicle.

In addition to inflammation of the epididymis, the testicle is usually also involved (orchitis).

In addition to securing the urinary tract, antibiotic and analgesic treatment is essential in therapy. If therapy is started soon, complications (abscess, blood poisoning) or consequential damage, such as infertility, rarely occur.

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