Hydrocoele and groin Hernia both present with swelling in the Scrotum and can have similar symptoms. Whereas Hydrocoele occurs as a result of excess fluid accumulation in the layers surrounding the testis, a hernia is caused by protrusion of intra abdominal contents like fat and intestine into the groin and Scrotum due to weakness or gap in the muscles.

Hydrocoele presents with painless enlargement of the Scrotum and is usually unilateral. The swelling is confined to the Scrotum only and on examination, it is possible to get above the swelling. On examination, the swelling fluctuates and on putting a torch to the scrotum, a reddish glow is seen which is known as trans illumination which confirms the presence of fluid within.

On the other hand, a hernia presents with a gradually increasing swelling which starts in the groin and later may extend into the scrotum. It is associated with a dragging pain or heaviness in the groin. The swelling may increase on coughing and straining and usually disappears on lying down.

The treatment of both hydrocoele and hernia is by surgery but the approach is different. Whereas hydrocoele surgery is done through the scrotum, hernia is approached from the abdomen. Hydrocoele surgery is possible only by the open approach but hernia can be treated by both open or laparoscopic surgery. Hernia surgery makes use of a prosthesis known as a mesh to reinforce the tissues but in hydrocoele surgery, no such prosthesis is used.

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