If you shine a torch at a mirror in the dark you have a chance of reflecting the light back into your own eyes and blinding yourself. That's like backscatter. When a flash source is close to the lens it can reflect directly back from particles in the water (that we normally don't even see) and the picture ends up with loads of round blobs of white light of varying intensities depending on how much light was reflected back.
By using a strobe positioned off to one side, away from the lens, the reflected light path bounces clear of the camera lens so you don't get those spots...the backscatter. There is a bit of a learning curve involved with strobes though...... how much power to use.....aiming them correctly. If you have a system that can directly connect ettl through the casing between camera and strobe - like the Ikelites do - then the power settings become automatic. You still need to point them at the right place though.
If you ONLY have an internal flash....getting very close tends to reduce backscatter, but some cameras have issues with shadow as well, if the case blocks the internal flash in part of the area.