Disclaimer: This article is intended for licensed therapists. Do not perform these techniques until after first consulting a medical physician and a certified lymphedema specialist
As an Occupational Therapist, I occasionally encounter patients experiencing scrotal edema.
In many ways scrotal edema can be more limiting than other forms of lymphedema, because of the extreme pain and sensitivity associated with it.
For people with a significant amount of scrotal edema, they may be unable to get out of bed, unable to tolerate any kind of sitting, and be unable to walk.
With the COVID-19 pandemic, there have been increased cases of scrotal edema, and the reasons are still unclear.
In this article, I’ll first discuss the causes for scrotal swelling, and proceed to provide tips to reduce and manage scrotal edema.
What causes penis and scrotum swelling?
You might think an enlarged scrotum is the cause of swollen testicles. This is not the case. Scrotal and penis swelling may be caused by many factors, but most include increased fluid or edema trapped inside the scrotum.
Congestive Heart Failure
Congestive Heart Failure or CHF may be one cause of increased swelling in the legs, feet, or abdomen. As a congested heart pumps less blood to the kidneys, water retention develops. This leads to swelling in the feet, ankles, and sometimes scrotum.
Lymphedema
Scrotal swelling can also be caused from increased lymph or edema that becomes blocked from the lymphatic ducts. This is different than CHF and is most commonly caused by an infection.
Scrotal swelling may also be caused by surgery, neoplasm, lymph node removal, radiation, surgical treatment of cancer, sepsis, or unknown causes.
In many cases, lymphedema treatment and therapy may not work and surgery may be considered. This is usually performed by a urologist and plastic surgeon.
Therapy techniques to reduce male genital swelling
Treatment for scrotal swelling may include lymphedema and manual lymph draining. These treatment approaches are relatively new. They’ve been around since the 1930s but have only been used as a treatment approach since the 1980s.
Today, the research for scrotal lymphedma is very limited, and treatment is poorly implemented.
Contraindications
Management of lymphedema is contraindicated for patients who have
- Congestive heart failure
- Receiving cancer treatments
- Chronic inflammation
- Thyroid dysfunction
- Active infection
Additional precautions should be taken if the patient has a malignant tumor, cardiac disease, or Renal Failure.
Manual lymph drainage, compression, wrapping, and elevation
One approach to treat scrotal lymphedema includes compression and wrapping. For people with severe scrotal edema this approach may not be appropriate due to skin irritation and increased risk for pressure sores.
According to a journal article published from the University of California, the following techniques may be helpful for patients with mild scrotal lymphedema:
Manual lymph drainage
- Identify the inguinal nodes of the lower abdomen or pubic areas and upper legs.
- Begin Manual Lymph drainage in a circular motion starting from the distal penis to the base of penis if the patient does not have a catheter.
- If the patient has a catheter or skin breakdown, drain fluid from the penis to scrotum using gentle pressure.
- Next, perform manual lymph drainage for the scrotum. Start from the center or midline of the scrotum and gently massage using circular motions to the left and right inguinal nodes. Continue for 5-10 minutes or to the patients pain tolerance.
- Train family, caregivers, or nursing to perform these techniques every hour or as frequently as possible during the day.
Note: If the patient has skin sensitivity on the scrotum use the squeeze method by applying pressure.
wrapping
- Use a breathable non-elastic threading such as mollelast. (2-3 rolls of 6x4cm)
- Add proffer #3 as a light compression bandage (part of the multilayer compression bandaging system, on top of mollelast)
- Wrapping should be removed after 2 hours by nursing or family/caregivers.
Elevation
Positioning can be very difficult for patients experiencing scrotal edema, because the scrotum isn’t a joint and moving the scrotum can be extremely painful.
- I would recommend after applying the mollelast to position the patient, so movement in bed isn’t causing friction to the skin.
If the patient is in a hospital bed, position the bed in trendelenburg, so the edema can travel toward the heart. Elevate the head of the bed for comfort.
- Elevate the scrotum with memory foam or use a towel roll wrapped in a pillow case.
- If the patient is able to walk, provide compression shorts or ask an OT to create a custom scrotal support sling.
One study found that continual use of compression garments, good skin hygiene, and a support sling helped reduce penis and scrotal swelling significantly within one week. It also helped one patient return to sexual activity and rehabilitation.
Active and passive Exercises to reduce scrotal swelling
Providing a home exercise program is another effective method to reduce scrotal edema.
Sarah bush has a great printable resource for lower extremity exercises to do in or out of bed. You can find her home exercises program here.
Exercises may include:
Active, active assistive, or passive…
- Hip flexion/extension
- Hip abduction/ adduction
- Hip internal/external rotation
- Squats
These exercises may help decongest the lymph and promote movement through the lymphatic ducts.
Pelvic floor exercises may also be beneficial. You may want to refer your patient to a pelvic floor therapist as an additional resource.
Resources to help patients and caregivers
Educating patients, family, and caregivers is extremely important, because acute scrotal lymphedema requires constant attention.
Many male patients and family members may feel embarrassed or ashamed to assist or have someone else assist with manual lymph drainage.
It may also be difficult to train nursing on manual lymph drainage when they have never done it before.
Discuss with the patient privately concerning these techniques before training family and caregivers as some patients may not wish to proceed.
I’ve provided a downloadable PDF below for patients and family members.
Additional resources that may be helpful for patients might include:
- Pain management
- Mindfulness
- Coping strategies for depression
- Pelvic floor specialist referral
Toileting and showering tips
Toileting and showering with scrotal edema can be extremely painful and difficult. Be sure to read my other post below that discuss this in greater detail.
I hope this was helpful. Feel free to comment or contact me about any other questions you might have related to this topic. And Feel free to subscribe below for more OT related tips.
David is the lead editor of OT Focus. He has been practicing as an Occupational Therapist since 2013. He specializes in acute care, hand therapy, and ergonomics.
