Painless thickening and hardening of the scrotum

[Rus-January]

  I have noticed over that last two weeks that my scrotum has
  thickened three of four times times normal, and has seemed
  to actually harden somewhat in the front. The pain is no more
  than normal when I squeeze the sac, and it feels like possibly
  some abnormal level of fluid may be inside, but it is difficult
  to tell where the inner sac ends and the fluid may start. I
  can no longer examine the testicles themselves, since the sac
  is so thick.
  I am on no meds at the moment, although I have been on
  prednisone up until 1991 or so due to either Crohns or UC,
  one of the two which I obviously have but seems difficult to
  get diagnosed. I suffer little complications from it, and
  control it by diet, so it is difficult to believe this is
  related to that, although it is the same general area as
  other problems I have had in the past, none of them involving
  my reproductive plumbing, though.
  I did have hernia repair surgery in 1993 I believe, and since
  then the right side has torn out again, and I thought at first
  that possible my scrotum was filling with blood from the rupture.
  I don't know it that's possible, and now I realize that it's the
  sac thickening instead of filling with blood/fluid.
  Sorry this was so wordy!
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Dear Russ,
It doesn’t sound as if this is an infection or you would have an inflamed red scrotum. You may be retaining water secondary to the predisone or there truly is a recurrence of your hernia, but this would only involve one side of your scrotum.  If the scrotum is thick and edematous, you should be able to squeeze it and leave an indentation on the skin for a moment.  Also, while you are sleeping and have the scrotum somewhat elevated, the fluid in the scrotum may redistribute to other areas of the body. and it  would then be less tick upon awakening. The thickening will them return when you are up walking around.
What I’m trying to show is that fluid pools in the body in dependent areas of the body, the legs, scrotum or sacral area.  If your body is having trouble eliminating its excess fluid, then it may accumulate in these areas.
If this is a recurrence of you hernia, in a like fashion, you may see the herniated abdominal contents return to the abdominal cavity while laying down and thus swelling in the scrotum will disappear.  The swelling in this case is not actually in the skin which you described but rather in a cavity known as the Tunica Vaginalis.  If this is a hernia, at your age, you may wish to have this examined and repaired so that you do not develop an incarcerated hernia.
There are also skin changes that can result from chronic irritation that may also be responsible .
It is difficult to answer your question without a sufficient explanation or exam.  I’m sure you family physician could help you distinguish between water retention and edema of the scrotum versus a recurrence of a hernia.  I would suggest you get yourself examined and then referred to the appropriate physician.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Scrotum