Pouch of Douglas

Pouch of Douglas is a peritoneal fold present behind the uterus. It lies between the uterus and the rectum. It is present only in females.

How is it formed?

All our visceral organs are carefully packed inside and covered by a membranous layer, called the peritoneum. As this membranes covers the internal organs of the body, it may form folds as it spread.

One such fold is the pouch of douglas, which is formed when the peritoneum covers the uterus and then climbs upwards to cover the rectum behind.

Pouch of douglas is also called cul de sac.  This area is the bottom most portion of the peritoneal cavity, therefore, when any fluid oozes in the peritoneal cavity, it tends to get accumulated here.

Causes of Fluid in the Pouch of Douglas

Any cause of inflammation in one or more pelvic organs may lead to oozing of inflammatory fluid from it. This fluid may get collected in the pouch of douglas.

Below are listed the common conditions that cause it-

Pelvic Inflammatory Disease

This is the commonest cause of having fluid in POD. So, it’s important to get investigated and rule out the possibility of having PID.

What is PID?

This is a broad term used for any infection in the female reproductive tract. Commonly, the cervix, uterus or the fallopian tubes get infected.

The commonest infections causing it are chlamydia and gonorrhea. However, after childbirth, miscarriages, or any procedural instrumentation done over the uterus, the pelvic organs may get infected by many more bacteria residing in the vagina.

What Makes You Prone to Get PID After Procedures Done in the Vaginal Canal?

Normally, the cervix creates thick mucoid layer that serves as a protection for inner organs, not letting any bacteria or other organisms climb in. However, during any procedures done lower down, this barrier breaks up, allowing easy access for bugs to climb up and infect pelvic organs.

Signs

  • A dull, but constant, pain down there. This may be there for weeks before you finally note it.
  • Discharge from the vaginal canal may be there in some cases. This may be scanty to profuse. It may look like a menstrual bleed that’s more dirty brown and always foul smelling.
  • Pain and burning during urination.
  • Pain during sex. You may also bleed after sexual activities.
  • Low back ache is very common.
  • In severe cases, fever, with or without chills.
  • Abnormal uterine bleeding in between menses or after sex.
  • Increased levels of total white blood cell counts.

Your doctor may examine you well and order a couple of test, including cervical swab, to make the diagnosis.

Ultrasound Findings

  • Fluid present in Pouch of Douglas
  • Organs may show no change in early stages. Later stages, there may be an adnexal mass, involving the ovary and tube, which are often indistinguishable due to inflammatory changes.
  • In chronic cases, there maybe thickening of various ligaments holding the uterus.

Treatment is treating the infection with the help of appropriate antibiotics. It usually takes a long course of combination pills of the infection to resolve. The fluid in POD is absorbed back on its own with time.

Tubo Ovarian Abscess

Abscess is essentially a collection of pus. Following PID or chronic infections like Tuberculosis, a pus pocket may get formed in the Fallopian tubes.

There is pain in the lower abdomen of the affected side. The patient may have pain, fever, nausea and blood work may show an increased TLC .

Inflamed tube oozes out fluid that gets collected in the pouch of douglas. This may show up in ultrasound.

Hydatidiform Mole

This is a condition in which a mass consisting of many fluid filled cyst like pockets occupies the uterus, or rarely the tube. The structure may or may not accompany a fetus.

It is formed when after fertilization of the egg, proper implantation and placenta formation is not seen. Instead of placental tissue, we see abnormal cysts developing around the fertilized egg.

Since the structure is not normal, an inflammatory response is triggered against it. Inflammatory fluid oozes out and may be seen in the pouch of douglas.

Ectopic Pregnancy

Implantation of a fertilized ovum anywhere else than the normal uterine cavity may be termed as ectopic pregnancy.

The commonest location is the Fallopian tube.

Endometriosis

Here, the uterine lining that gives menstrual flow every month, may be present else where than the uterine cavity. This abnormally placed lining also bleeds when the women menstruates. Some blood may get collected in the cul de sac.

Endometriosis may occur in the pouch of douglas itself. In such conditions, apart from heavy bleeds every month, dyspareunia, that is, pain during sexual activity, is another common symptom.

Peritonitis

Inflammation of the peritoneum due to any underlying disease may cause it to ooze out fluid, which may get collected in the cul de sac.

Ruptured Ovarian Cyst

It is common for cysts to get formed in the follicles of the ovaries during reproductive ages. Any such cyst, which has grown big in size, may rupture spontaneously. Fluid may get collected in the pouch.

Medical Advice (Q&As) on “Causes of Having Fluid in the Pouch of Douglas

  1. Sylvia

    Pls there seems to be a hard lump on my cervix and another just at the tip of my cervix. It is slightly painful to the touch. I have the urge to urinate frequently sometimes with a burning sensation. I feel severe pain s in my lower abdomen, lower back, my two ovary sides and the worst is I feel a movement in my lower abdomen especially when I run. I had an ultrasound scan today and it said “fluid collection seen in Pouch of Douglas”
    What could it be?
    Is there anything to worry about?

    Reply
    1. Yinka

      I’m 30. I have having irregular period and diagnosed for PID which I have been on antiobiotics. I had pelvic scan and the result shows-
      that the uterus is pear shape anteverted and normal in size for nuliparous
      It measures about 39mm*32mm*33mm L*W*AP diameters
      The outline is smooth with homogeneous echopattern
      The endometrium is thin and hyperechoic
      No intra and/or extra uterine gestational sac seen
      No myoma is noted
      Pouch of Douglas consist of fluid collection.
      Pls can you explain this result to me and will the fluid in the POD not hinder me from conceiving.

      Reply
      1. Buddy M.D. Post author

        Fluid gets collected in the pouch when you have an infection.

        As you take antibiotics, your infection would heal up and the fluid would also dry up. Once complete treatment has been taken, pregnancy is likely to be safe.

        Reply
      2. Ayisha Mustapha

        Hi….please I have been diagnosed with PID after having a pelvic scan…everything was normal apart from having scanty fluid in the pouch of Douglas… I had been injected with ceftriazone and gentamycin…I was later given doxycycline and cefuroxime 250mg for 5 days…
        Please do u think this is enough to cure the disease??

        Reply
        1. Buddy M.D. Post author

          Commonest cause of having fluid there is some pelvic infection. In this light, the antibiotics are likely to work. However, you need to follow up with a repeat scan to confirm the results.

          Reply
  2. Sammy

    So I went to the gyno today because Ive had normal periods but in between periods I had very dark brown/black slimy discharge (lasting 5 days at a time and very heavy, like a second period but much darker nad thicker consistency) and cramping no matter if i have my period or not.this has been going on for 3 month now. My Gyno did a vaginal ultrasound and took a little swab to send to the lab. I haven’t had intercourse in over 6 month, and have a history of endometriosis. but she said it was not that. she did see fluid in my pelvis area, I assume in the pouch of Douglas. I am wondering should I go see my generalist as well to get blood work done (iron-deficiency because of heavy period?) might I have something more concerning that can not be detected with a quick vaginal ultrasound and a little swab? ive got cancer issues in my family (colon, intestine).
    trying to not be paranoid but ebut im a little worried it might be something to investigate further.

    Reply
    1. Buddy M.D. Post author

      Unlikely to be malignancy.

      There appears to be some issue in your uterus. If it’s not endometriosis, may be you have a fibroid or some other problem in the uterus. Your gyne would be able to find that out.

      However, it’s not a bad idea to see a generalist to correct anemia. You are very likely to be having that.

      Reply
  3. margaret

    I have pain in my lower abdomen,i did an ultrasound 2yrs back saying mildfluid in pod n submucosocal fibroid 24mm*26mm,was prescribed antibiotics but I haven’t conceived what could be d problem.

    Reply
    1. Buddy M.D. Post author

      To assess fertility, you need to be thoroughly examined by a gyne. There are many factors that may be contributing to difficulty in conception.

      Your hormonal levels, condition of tubes, present size of the fibroid, need to be checked.

      Mild fluid in POD is likely to have been resolved by the antibiotic course. The small fibroid may have grown in size. It’s location is also important. Where exactly in the uterus is it located?

      A big sized fibroid or fibroids interfering with common sites of conception may make it difficult for the egg to implant.

      Reply
  4. Fiza

    I hve pain in lower abdomen so i got ultrasound n cme 2 knew hvng fluid pouches douglas.by it im not getting periods regularly n getting weight aftr doing walking n diet.can u advise me wht 2 do 2 cure this.i heard dat cant get pragnancy too

    Reply
    1. Buddy M.D. Post author

      Can you let us know the full ultrasound report? Any cyst in the ovaries? What medication were you given?

      Reply
  5. Busayo

    My menses flow for just two days and no drop the third day while on fourth day few drops. The quantity starts decreasing right from the first day. I started noticing this from 2009. Recently I was diagnosed for having mild fluid in the pouch of Douglas and questionable pid. I urinate often Doctor did scan for me and said my endometrial isn’t smooth. Is there a cure for this and can i still have a regular menses

    Reply
    1. Buddy M.D. Post author

      Your age?

      You may be having some hormonal problem, giving you a rough endometrium as well, that’s interfering with proper menses. You need to see a gyne for full evaluation.

      Reply
  6. Busayo

    I’ll be 30,I do experience itching too, abdominal pain, irregular menses, and sometimes I bloat from the vaginal. I have used clotrimazole insertion several times but no difference. I was diagnosed of mild fluid in the pouch of Douglas and questionable pelvic inflammatory disease

    Reply
    1. Buddy M.D. Post author

      You need to go for an ultrasound lower abdomen, to assess the condition of the ovaries.

      PID would require a course of antibiotics to go.

      Reply
  7. Dora

    Obscuring bowel gas is noted in the lower abdomen. A small amount of fluid, within Normal limits, is seen in pouch of Douglas. Incidentally, an extrarenal pelvis is noted on the right side. What is wrong with me? Am I running any risk? Thanks for answering my questions.

    Reply
  8. ruth

    My menses flow rounds up at the, fourth day, bled on the 6th day during sex, I hope there is no problem.

    Reply
  9. Vivianne

    I have a problem i went for ultrasound and found that I have a mild fluid in Douglas pouch and am on medication may this cause me not to conceive

    Reply
  10. RR

    I have severe backache during periods which increased over and above the usual pain. Continuous bleeding starts after sighting clots for 3-4 days though periods is regular every 28 days and have never missed periods. Went to gynecologist and did scan result of which is fluid in pouch of Douglas and to consider PCOD. I have never had PCOD and mother of two never missed my periods. So how is PCOD possible and how to treat the fluid accumulation

    Reply
    1. Buddy M.D. Post author

      PCOD patients usually have some menstrual irregularity, excess hair growth, acne, and obesity. Do you have any of them? Did they check your hormonal levels?

      Reply
  11. Ashneer

    What causes fluid in pod? If it’s infection then can’t it be treated at home ? I mean by home remedy ?
    Recently I did my ultrasound n minimal fluid in pod is observed … n recently I experienced pain in right part of lower abdomen .. plz suggest something

    Reply
    1. Buddy M.D. Post author

      This indicates an infection somewhere in your pelvic organs. It’s strongly suggested that you take antibiotics for this. Don’t delay. This would only given the infection a chance to spread.

      Reply
  12. Muriel

    Hello I am 37 year old with a history of uterine fibroids. I also had a myomectomy about 5 years ago .I had unexplained infertility and after a failed IVF treatment I got pregnant and miscarried at 7 weeks and now have a 15month old who was born at 30 weeks gestation . For the past 4 months I experience pain outside of my menstrual cycle and have had in between bleeding for the last 2 months . My recent ultra sound scan shows a large fibroid occupying the whole pouch of Douglas .I was told that fibroids don’t cause bleeding in between periods ( although I am not convinced this is so ). I am in constant pain and have been given no explanation or reason for my constant pain . I was given Esmya 5mg tablets to start on for 3 months to help shrink the fibroids which I haven’t taken due to the long list of side effects and I’m breast feeding in addition to the fact that I was not given an explanation as to what is causing my pain and bleeding which is what worries me more than the fibroids . Is there any thing more I can get done to get to the bottom of this .

    Reply
    1. Buddy M.D. Post author

      Something needs to be done about that big fibroid. If you can’t go for the pills, you’ll need a surgical resection. Blood loss this way cannot be afforded.

      Reply
      1. Muriel

        Thank you for your response . I was given the option to try for a second pregnancy as well . I don’t know if that a good idea. As the poll would definitely be out of question in pregnancy .

        Reply
        1. Buddy M.D. Post author

          You need complete treatment first. This may take time, around a year or two. It’s better not be go for conception before that.

          Reply
  13. Yinka

    I’m 30. I have having irregular period and diagnosed for PID which I have been on antiobiotics. I had pelvic scan and the result shows-
    that the uterus is pear shape anteverted and normal in size for nuliparous
    It measures about 39mm*32mm*33mm L*W*AP diameters
    The outline is smooth with homogeneous echopattern
    The endometrium is thin and hyperechoic
    No intra and/or extra uterine gestational sac seen
    No myoma is noted
    Pouch of Douglas consist of fluid collection.
    Pls can you explain this result to me and will the fluid in the POD not hinder me from conceiving.

    Reply
  14. Elizabeth

    Uterus Normal 6.5 cm in greatest span , endometrial strip 6.3mm No fluid , No focal abnormalities, normal ovary size, Fluid in Cul -de- Sac … Should I worry ? Dr. Advised no treatment … Should I seek a 2nd opinion.

    Reply
      1. Elizabeth

        I had Experienced A-sharp pain and got a tranvaginal ultrasound. The doctor reviewed the images and said it was nothing to worry about… no treatment needed . That I was good to have children any day…. she just said a string of pearls … that it was not a concern to the point for treatment or infertility issues .

        Reply
  15. Gloria

    I went for an ultra sound scan and I was told I have free fluid in the pouch of Douglas, and I was started on antibiotics. But during the last days of the dose, my lower abdomen is always extending after I have eaten food and I also have vaginal discharges that are mucoid.

    What may be the problem?

    Reply
  16. Ayomide

    Am 33Years, I went for scan my uterus is very bulky and anteverted in shape, with heterogeneous echo pattern and measures about 104mm*64mm*63mm in length, width and AP diameter. The endometrial plate is not visible.
    Palpable mass noted within uterus, no adnexae mass noted. Moderate free fluid found in the POD.
    Impression intrauterine myoma (ii) PID pls what antibiotics can I take to cure this? I want to conceive.

    Reply
    1. Buddy M.D. Post author

      You’ll be given antibiotics to treat PID. Apart from this, your doctor may suggest going for a DnC. This is a small operative procedure, which would scrape off the myoma.

      Reply
  17. Retha

    I got spontaneous complete abortion on 2 of this month and I m still bleeding, Though got trapic tab and pause injection even today. I’m still bleeding. Scan report says minimal fluid in pouch of Douglas. And a small cyst left ovary. Please let me know why.

    Reply
    1. Buddy M.D. Post author

      It is common to bleed for a few days consequent to spontaneous abortions.

      However, if you bleed heavy, you need to see your doctor. The dose of medicines being given may be adjusted.

      What was the reason for abortion?

      Reply
  18. Tammy

    Had LSH 7 days ago, fibroids were causing abdominal pressure, pressing into my back on the right side and a lot of other things.
    Three days ago I began to have low back pain to the point I had to take medicine for it.. Would like to know if the pouch of Douglas would have anything to do with this.. I’m mobile not doing too much just a little at a time but the back pain is lingering around..

    Reply
  19. Tammy

    No bleeding and the back pain has pretty much subsided. I’m just trying to get my gait back since I don’t have the pressure and abdominal bulging anymore, i looked 4-5 months pregnant. I’m adjusting..

    Reply
    1. Buddy M.D. Post author

      Just give it time. Your ligaments might by pulling and giving you the pain, as they adjust themselves in the new space provided.

      A heating pad may be used to alleviate pain. However, do not over use.

      Reply
  20. Faith

    How long does it take fluid in the pouch of Douglas to go away and please I would love to know the type of antibiotics to use. Thanks for your response.

    Reply
    1. Buddy M.D. Post author

      10 to 15 days, approximately. The fluid gradually reduces in amount as your infection gets treated.

      Reply
  21. Victoria

    Am a lady of 30yrs, started having severe lower abdominal pain which radiates to the back and burning sensation, chills even when the weather is hot, temp BTW 36 -370c, no vagina discharge, nausea /vomiting, loss of appetite, bloating, breast tenderness, dizziness and feeling of fainting, all this started on June. I thought it was pregnancy because I have been trying to conceive after my wedding on March this Year, I had pelvic scan which shows Non gravid anteverted uterus measures 71 mm45 me, 55mm in long, Ap diameter $ transverse diameter. Normal endometrial echo is homogeneous and no sign of fibroid mass seen, both adnexa are free. Urinary bladder wall is normal with clear contents. MILD FLUID COLLECTION in the POUCH OF DOUGLAS, I was given Iv ceftrixone for 2days, levofloxacin 1dly for 10days, azithromycin 1g start then 250mg for 2days, flagyl 400mg for 7days, diclofenac 50mg 2times dly. I took on June when I had the symptoms, had normal 4days menses in a 28days cycle , but this July my menses lasted for just 2days in a 30days cycle still presenting with the same symptoms, carried another scan still the same result but very mild fluid collection. Please, what do I do to tackle this as I want to be pregnant soon, and how long will it take to conceive?

    Reply
    1. Buddy M.D. Post author

      Fluid in pouch of douglas indicates the presence of an infection there. It’s very important to treat it before you conceive.

      You have already taken antibiotics for around 10 days. May be your doctor gives you more of these pills.

      Fluid collected there may take time to resolve. However, you should be free from your symptoms. Any fever, chills or pain would mean you still have the infection.

      Reply
  22. Margaret

    Very few weeks pregnant, pelvic scan just indicated mild fluid in the pouch of Douglas? Haven’t read some of your responses above, I already know it’s an infection, but what should I rather do or what is your medical advise? I patiently await your response. Thank you.

    Reply
    1. Buddy M.D. Post author

      Your gyne is the best person to answer this. She’ll examine you to see if you have any symptoms of infection. If not, no treatment is required. Medicines, in early pregnancy, may harm the baby.

      Only if there’s fulminant infection, you’ll need treatment.

      The baby is securely packed inside the uterus, so don’t worry, he’ll not be affected by minor problems going outside.

      Reply
  23. Aderonke

    I did for scan 6/7/2017 because I was having this feeling that am pregnant but my scan result said this: ( A non gravid, anteverted , normal sized uterus measuring about 62mm x 44mm x 48mm ( longitudinal x Ap x transerve ) with myometrial echo texture. Uterine outline is consistent and of border regularity. Endometrial plate is thickened. No intra or extra uterine gestation seen. No evidence of retained product of conception. Within the cul- de- sac, indicative of pelvic inflammatory disease. Adnexae are relatively free. No obvious gross ovarian lesion noted. Both ovaries are normal in size, shape and echo texture) please what those this means.

    Reply
        1. Buddy M.D. Post author

          You may be having a condition called Endometriosis. Further investigations are required for diagnosis. Your doctor may suggest laproscopy.

          You may be having any menstrual abnormalities?

          Reply
  24. Biodun Ariyo

    Good day,
    I did a pelvic scan and the result shows that the pouch of Douglas contains marked fluid collection….

    What should I do next.

    Reply
    1. Buddy M.D. Post author

      In general, fluid collected in this pouch suggests some infection in the pelvic area. However, there are other conditions too, where fluid may get collected in the pouch.

      Your clinical symptoms need to be correlated to reach a diagnosis.

      Reply
  25. LKD

    I am 49 and have had sciatic- like pain on right side that can radiate down to calf and pain at lateral edge of right sacrum for 2 1/2 years. Pain is usually worse before and during period. No previous history or endometriosis. Lumbar MRI negative. I had a pelvic MRI a year ago and radiologist indicated there was fluid in the cul de sac, most likely from a rupturned cyst. A few months later I was diagnosed with piriformis syndrome and received treatment which gave me little relief. One year later I had a 2nd MRI and same area is showing up and looks exactly the same as what was diagnosed as fluid. Is it possible for fluid in the cul de sac to remain there for a year?? I find it more likely that it was not fluid to begin with and may be something else. I have no abdominal or pelvic pain. I have no indication of an infection…. just sciatic pain and gluteal pain along the lateral right side of sacrum.

    Reply
    1. Buddy M.D. Post author

      It’s essential that you get your female parts examined by a gyne. Just a routine check up at the age of 49. This should include an internal exam, pap smear. Ultrasounds are already done.

      Looks like we are missing something.

      Reply
      1. Lkd

        Thanks! I have had my annual PAP and my GYNO is aware of the situation, she ordered the ultrasound. Just wondered if you may have any other suggestions.

        Reply
  26. Rabbi

    I have been having lower abdominal pain, pain during sex, and whenever I have sex with my partner the semen leaks and I have been finding it difficult to get pregnant and my menses last for three days but the dates always change.
    I went for a gynecological scan and was told I have normal uterus but some fluid found in the pouch of Douglas. Please I want to know what the problem is, but my doctor prescribed cefuroxime 500mg for me.

    Reply
    1. Buddy M.D. Post author

      You may take this antibiotic as prescribed. Also, an ultrasound lower abdomen needs to be done to rule out any chances of endometiosis or any other condition.

      Reply
  27. sarah

    Pelvic ultrasound reads:
    the uterus appears bulky in size, hypoehoic and heterogeneous in appearance large ill-defined calcified sub serosa fibroid with irregular borders extending upward towards the lower abdominal cavity measuring (97.1×99.0)mm in diameter. No pregnancy detected on ultrasound imaging. Pouch of Douglas seen with free fluid. Both ovaries were not visible due to enlargement of uterine fibroid growing within and outside the uterine walls. The endometrial echo was absent. There was volume of dilated serous fluid collection seen within the recto uterine cavity. Please this is the ultrasound results. I only have lower abdominal before and during menstrual period and I never hospitalized or treated PID before.

    Reply
  28. Suzzy

    I’ve been feeling pains in my lower right abdomen coupled with nausea, stomach pain and my heart beats fast. I went to the hospital next was told to go for an ultrasound. And these are the results
    Uterus: Retroverted in position and shows uniform myometrial echoes measuring (101.3 × 30.6 × 53.0)mm, and shows an intramural myoma measuring (38.8×35.9×33.9)mm. No defined gestational sac seen

    Ovaries; Both not Appreciated.
    Adnexa: scantly fluid seen in the POD
    Pouch Of Douglas: Scantly fluid noted.
    Comment: intramural myoma and scantly fluid in the POD. Correlate with clinical findings.
    Pls help me out.

    Reply
    1. Buddy M.D. Post author

      Needs to be followed up by a gyne.

      You’ll be given a course of antibiotics for the fluid found there. Hormones may be given to reduce the myoma.

      Reply
  29. Chichi Prince

    Good morning, I was diagnosed of PID and was told I maybe not be able to give birth please how true is that? and is my partner in danger too?

    Reply
    1. Buddy M.D. Post author

      Usually, women with PID conceive after they are treated for the infection.

      Situation where there’s a problem are ones where the fallopian tubes gets blocked due to infection. When you have PID, bacteria can get into the fallopian tubes or cause inflammation of the fallopian tubes. This can cause scarring in the tissue that makes up your fallopian tubes.

      Reply
  30. Marina

    Hello.
    I was diagnosed with PID 3 months ago and given multiple antibiotics. Was diagnosed with hydrosalphinx which later calmed down. All the while I had luliquid in the Douglas Pouch measured first at 12 cm, then 4×4 cm, and is now 3,8×12 cm. I no longer have signs of an infection and the abdominal pain is still there but gets better as time goes by. I am told that the red blood cells in my urine come from the liquid (culture is negative) and that the liquid can dissolve in time. Bloodwork shows no inflamation. Is it possible for the liquid to take so long to dry out (now on my 4th mont) or will it have to be removed? The symptoms are getting milder, but are several months too long or is it normal? Thank you very much for your assistance and advice.

    Reply
    1. Buddy M.D. Post author

      This really takes too much of time to resolve, 5 to 6 months. However, follow up scans may be done to actually see if the fluid is reducing or not. Also, has the hydrosalpinx resolved completely.

      Reply
      1. Marina

        Yes, I was told today by the ob gyn that the fluid is still there but is reduced, and that they would leave it to resolve itself over time. They also saw some “sand” in the bladder.

        Reply
        1. Buddy M.D. Post author

          May be you can give it some time to resolve by itself. Be observant. If you find some symptom, like ache lower down, discharge, burning during urination etc., you may inform your doctor.

          Reply
  31. Tessy

    Morning sir,I had miscarriage last year August when my pregnancy was 4weeks and my doctor advice me to do evacuation which I agreed but before then I did a pelvic scan and the says “About 2 well defined echo penicillin solid masses measuring 48mm×44mm (antero-fundal,subserous)and 34mm×26mm (posterior, intramural)are noted within the corpus uteri. Features are suggestive of MULTIPLE UTERINE FIBROID. Both ovaries appear normal. The adnexae are free bilaterally. Seizeable echo free fluid collection is noted within the pouch of Douglas indicative of patient on menses /PID.
    Since after the evacuation have not been able to conceive .my doc said I should repeat the pelvic scan again bcos the previous pelvic scan was done September 2015.And here is present pelvic scan result:The uterus is bulky with smooth outline. There are fundo-anterior and fundo-posterior intramural fibroids. They measure30mm/34mm and 28mm/31mm respectively. Endometrial layers well defined. The ovaries are normal in sizes.No free pelvic fluid is seen. And this is also my Hvs and urine mcs result :urine culture (yielded no bacterial growth after 24hrs of incubator at 37°c),Hvs culture (yielded scanty growth of E.coli after 48hours of incubator at 37°c.senitivity :ciprofloxacin+++,streptomycin +++,sparfloxacin+++,ladicef+++,ofloxacin+++.My question is that can this infection be the cause of delay of pregnancy after the evacuation? Please I really need ur advice.

    Reply
    1. Buddy M.D. Post author

      Well, the fibroid may also be interfering with implantation of the fertilized egg.

      They are located at places where the fertilized egg may plan to get implanted. So, their presence may be hindering your pregnancy.

      Reply
  32. Tessy

    I am having symptoms like vaginal discharge, abdominal pain anytime am close to my ovulation even after and during this time always have pain during sex.

    Reply
  33. Eunice

    Hello, I did a pelvic scan on the 12th September 2017 and it says;
    Nongravid anteverted uterus with uniform myometrial echopattern. It measures 56*35*27mm in L*W*AP Respectively. The endometrial layer is thickened. There is a left Adnexae hypoechoic cystic mass of about 23*18 mm in size with no septation or debris seen within. this is taken for a physiological ovarian cyst. The right Adnexae is free and normal in appearance. The general uterine outline is regular and consistent. The pouch of Douglas contains some fluid collections? PID
    Conclusion
    *Acyesis
    *left functional ovarian cysts.
    pls could there be anything wrong with me like pelvic inflammation. The last time I was supposed to see my menses there’s was alot of stretchy discharge like ovulation discharge instead of menses and two weeks later I spotted blood that lasted for 5days to me it was like my menses But it was too light. And could u please interpreted the result for me. Thanks

    Reply
    1. Buddy M.D. Post author

      What are your symptoms? Any pain lower down, backache, fever discharge from vagina or foul smell from there, pain during intercourse?

      Reply
  34. Tinaye Mwari Milambo

    Hi Doctor, I’m 25 years old and was diagnosed with PID in January this year 2017. I was having pain during sex, lower abdominal pain especially on my left side, backache, nausea and general body weakness. A pelvic ultrasound revealed that there was a moderate collection of free fluid in the POD. Since then I’ve been on different combinations of antibiotics to try and combat this but it comes back afterwards. It’s 8 months now, and I’m worried. What can I do to find a lasting solution?

    Reply
  35. Eunice

    I only have this frequent milkish stretchy discharge with mild or no smell, its been more than a month now buh comes and go. I’ve no pain except that of 13/09/2017 which seemed like ovulation pain. I’ve not had sex since these symptoms began but I don’t av pain during intercourse.

    Reply
  36. Hoora

    I am trying to get pregnent from 4 months having intercourse regularly but we are not getting result now from 3 days I am suffering from stomach pain at upper side of stomach then my physician suggest me to go for ultrasound where i got to know in report MILD FREE FLUID IN POUCH OF DOUGLAS so now I need to know what exactly it is and Is cause of this I am having pain or not getting pregnent even

    Reply
    1. Buddy M.D. Post author

      This may be an infection. However, we need to confirm. You gyne would like to examine you and order a few blood tests and a cervical swab, which may be sent for culture.

      Infection in the pelvis is a very common cause that interferes with pregnancy.

      Reply
  37. Moyo

    I was diagnosed with PiD last year,after series of test it showed no infection. I did anothe sacn with showed the fluid in POD increased from 2cm to 11cm and blood test showed little bacteria in blood .. I was given antibiotics to treat both. Went for blood test and scan twice which den showed fluid has reduced and blood test came out clear.
    For the past two months my menstation is light and last 2days.
    I had itching down dere and increased amount of white
    cheesy discharge 2days ago with lil pain in lower abdomen., I ve done hvs test (result not out).
    Doc can PID reoccur… ? And is there a permanent solution. Am scared.
    I turned 30 this year.

    Reply
  38. Portia

    Please, I was having lower abdominal pain, vaginal discharge and severe lower back pain. I went for scan and the result was, the uterus measures, 6.1cm×3.9cm×3.9cm, the endometrial stripe is of uniform wall thickness, no focal mass, collection gestation seen. No adnexal mass seen. Minimal fluid in pod seen. The visualized urinary bladder is normal. No urinary stones, urinary bladder wall thickening.Impression was, minimal fluid in pod? Otherwise normal pelvic scan.

    Reply
    1. Buddy M.D. Post author

      You appear to be having an infection in some of your pelvic organ, may be the uterus or tubes. Need to be be on antibiotics as early as possible.

      Reply
  39. Moses Theresa

    Hi doc, I was diagnosed of PID and kidney infection. This is my 3 time of treatments. And each time I feel pain on just one of my ribs on the left side and upper part of my back. Please is there no permanent cure for the stubborn infection? Am getting worried please.

    Reply
    1. Buddy M.D. Post author

      Apart from antibiotic courses, lifestyle amendments would help. Avoid alcohol and smoking. These lower our immune powers.

      Boost up your immunity by taking plenty of fresh fruits, vegetables every day. Drink plenty of water, this would wash off all germs from your urinary tract on a regular basis.

      Also, cleaning well down there is very important. Always clean from front to back, never the other way round, to avoid contamination of the vaginal opening with fecal matter. Washing with ample water down there is a better way to keep the area germ free.

      Reply
  40. Sandra

    I am 58 with a prior history of Endometriosis with the treatment of cauterization. I have had two pregnancies. I have been in menopause for 8 years. I get frequent bladder infections and have kept on top of these with scopes and antibiotics. I have suffered over the years with pain even after menopause. When I get this pain my bowels get messed up. I just had a cat scan and ultrasound of this area and all that comes up is I have a small amount of free fluid in the Pouch of Douglas and a few tiny peripheral echogenic foci are seen which may represent ovarian calcifications in both ovaries, normal arterial and venous flow seen within Free Fluid. Small simple amount seen within the posterior cul de sac.

    My question is, would this Free Fluid be enough to upset my bowels and keep this heavy feeling down in my groin area. Does endometriosis still flare after menopause and this could be my issue? Right now I feel like I’m going through ovulation. I do not get any discharge and everything else seems to be fine except for pain and bowel upset. I am so frustrated with all the years of pain and discomfort. Thanks so much in advance for your time.

    Reply
    1. Buddy M.D. Post author

      A small amount of fluid is not enough to explain your symptoms. It’s very likely to be a flare up of endometriosis.

      Yes, you may get Endometriosis after Menopause.

      Endometriosis. as you understand, is having inner uterine tissue outside the uterus. This may occur over the ovaries, tubes, intestine or else where.

      This abnormally placed tissue secrete just like your uterine tissue. However, while the uterine secretions escape out via the vaginal canal, secretions caused by endometrial tissues are trapped in the pelvic area and produce pain and inflammation.

      After menopause, female estrogen levels drop down, but doesn’t become zero. There’s still some estrogen in the body which helps this tissue to grow and secrete.

      You may have to go for complete surgical resection of the organ to get relieved.

      Reply
  41. Ramy

    I’m 19. I’ve been having discharge from my vagina for years now. About 5 years ago I started my menstrual cycle. I was having the discharge but I began using a panty liner because I was made to believe vaginal discharge is normal due to ovulation. Since I wasn’t sure and I’ve been experiencing itching and discharge everytime when I’m not in my menses I visited my gynecologist yesterday. The ultrasound scan revealed a normal uterine size of (7.79×4.96×5.92)cm. Anteverted and homogeneous in echo pattern. Empty endometria cavity with thin lining. Normal ovaries. Significant volume of free fluid seen in Pouch of Douglas. His impression was Pelvic Inflammatory Disease. I was given drugs to take. Should everything be fine when I’m done with my medication? Or since it has been five years now I shoul be worried.

    Reply
    1. Buddy M.D. Post author

      Since all your pelvic organs look normal, as visualized on ultrasound scan, you’re likely to be alright after medications.

      Reply
  42. Estelle

    Hi, I’m 26 years old. I treated PID 5 years ago but when I went for another scan, I was told it was an ovarian mass. The doctor said I should neglect it since I don’t have any symptoms. Presently, I missed a month period, I have being having cramps for about 2 weeks yet I’m not on my period and I haven’t been sexually active for about 3 months. I have never missed a period before, my discharge turned stringy and brownish and later returned to normal. I am yet to visit a gynaecologist though. Do you think it’s something to be worried about?

    Reply
        1. Buddy M.D. Post author

          You may, if you’ve been sexually active recently.

          It may be due to the mass. Needs to be investigated for diagnosis.

          Reply
  43. Anita

    Hello,

    I am 29 and I’ve been trying to conceive for 7 months now.I’ve been on depo for 5 years and I have an 8 year old daughter.To flush out depo from the system i’ve used some herbal concoction once in a while since Feb.I’ve been experiencing severe abdominal pain for 5 months now which come once or twice in a month after long call.This promptef me to seek medication and below are the findings:

    Urinalysis:No infection seen.urine clear.
    Pelvic ultra sound scan:uterus retroverted,non gravid,normal in size and echogenicity,no fibroids seen.
    Endometrium with normal wall thickness.
    Myometrium echo pattern appearing normal,no obvious mass lesion seen.
    Both ovaries seen an normal,no adrexial mass seen.
    No free fluid seen at POD.

    What could be the cause of me not conceiving now that everything seem okey?

    Reply
  44. remmie

    Hello doctor, on 20th of August, I had pain and bulging on the right side of my lower abdomen. I could feel the bulge at my navel and it lasted for over 30mins, then milder pains afterwards. I had a scan which says I have 2 subserous myoma and clear fluid in Douglas pouch. My Dr diagnosed fibroid degeneration and was placed on Augumentin, metronidazole and dictofenac. I got relieved, about 2days ago I started feeling pains on the same side of my lower abdomen and also a serious backpain. I want to know is it possible to ave fibroid degeneration twice within a month interval. Thanks.

    Reply
  45. Anna Emmanuel

    For Over Six Years Now My Mestration As Been Skiping, I Will Only See It Two Or Three Times In A Year, And I Always See White Fluid From My Private Part. Is Afacting Me With Different Sickness, What Is The Solution Please.

    Reply
  46. Fatima

    Hello doc,
    For a very long time I’ve been experiencing menstrual irregularities,sometimes I have cycles of 30 to 31 days and during each months I observed my period doesn’t flow freely (well) it last about 2-3days at times .on the onset it’s usually dark brownish in color before the day expires its changes to a bright red and i noticed there are traces of small clots in it. I’m just 29 and have never conceive for once,this has been plaguing my mind for a while. pls help me out,I don’t want to be a barren.
    About 2 years ago I went for a scan to find what is actually wrong with me.the result stated thus; The uterus is non gravis,anteverted,of normal size with uniform of myometrial echo-pattern. It measures about 65mm x 33mm x 41mm in LXTXAP diameter respectively. Endometrial plates appears normal,No uterine lesions noted,There is an anechoic spherical density noted in the right adnexa measuring about 35mmx33mm in size it’s not septated and has well defined border,Left adnexa is free.No fluid in POD and general uterine is consisted…. So I went for another one today to clarify the previous result and this is also what I came back with ; non gravid anteverted uterus measuring 88x68x32mm[LXTXAP],Endometrial echotexture is in proliferative phase. Adnexa bilaterally free.There is a non septated right ovarian cyst measuring 37x52mm and there is fluid in the pouch of Douglas….pls what I need to do and if there is any medication that can help me.thanks in anticipation

    Reply
    1. Buddy M.D. Post author

      Slight hormonal problem may be there, related to the right adnexal cyst. Any symptoms, like pain in abdomen, etc.?

      Reply
      1. Fatima

        Yes I do have sharp pain around my ovulation and menstrual period and in the abdominal pelvic I did it was discovered I also have appendicitis.thanks for your quick and kind response

        Reply
  47. Rida

    Hi! I have moderate quantity of pelvic free fluid noted in Pouch of Douglas, previously they found a cyst in my left ovary around May 2017, which hasn’t seen this time
    Everything else is normal just free fluid noted in Pouch of Douglas. Is it due to that cyst which has gone away?

    Reply
      1. Rida

        Yes I’m having irregular menstrual cycle since May 2017 but before that I never ever had any problems with my period, never missed always regular.

        Reply
        1. Buddy M.D. Post author

          It may be due to the cyst that has gone away. However, other causes of having fluid there, like infection, need to be ruled out.

          Reply
  48. Rosina Boateng

    Please doctor I went to the hospital to do pelvic scan n I was told am having a scanty fluid in my pouch of Douglas….I have been given drugs though but is there any food that I should eat or avoid to cure it?

    Reply
  49. Suchita soreng

    Recently I did ultrasound of abdomen& found minimal f luid is seen in pod. I have pain in left side abdomen below last rib feeling discomfort. Many times itching on labia major since last 3 to 4months. l feel pain when l stretch left hand upwards.

    Reply
    1. Buddy M.D. Post author

      You need ot follow up with a gyne for diagnosis.

      This could be a pelvic infection or there may be a mass in your left side adnexa.

      Do you have regular menses? How many kids?

      Reply
  50. caroline

    am 31years,i have alot of pain at lower abdomen,and back pain,i went for abdominal pelvic ultra sound and found uterus is normal 149cc,both adnexa are clear,ovaries are normal the POD gas massive free fluid collection in it.impression was PID.what does this mean

    Reply
    1. Buddy M.D. Post author

      You’re likely to be having some infection in your pelvis. Follow up with a gyne. You need antibiotics at the earliest. Delay in treatment would give time to the infection to spread.

      Reply
  51. Bina

    I m 26 yrs old n 49kgs 2 years back i was diagnosed with pcos then i took POP for 6 months then I stopped medication n again menses didn’t come itself so again i took POP then COCPs given by doctor but due to severe nausea i stopped taking COCPs without informing doctor n then i did not get menses n now I m taking homeopathic medicines since 1 & half month for pcos n I didn’t get my menses after 24/7/2017.from 2 days i m having very mild pain in right side waist only.then i went for sonography n it showed minimal fluid in POD & rt ovary 19cc lt ovary 12 cc.do i need to be worried about minimal free fluid in POD? 1 year back sonography showed rt ovary 19cc lt ovary 23 cc n mild cervicitis and at that time doctor did not give any antibiotics for cervicitis

    Reply
    1. Buddy M.D. Post author

      Are you married/ sexually active?

      Did you get normal menses even once after the course of pill you took?

      Reply
      1. Bina

        Yes i m married n yes i m sexually active n I noticed pain in right side waist during intercourse prominent not too much but i can feel that its specific in right side n when i was taking POP n COCPs i was getting my menses but when i stopped taking them menses didn’t come after that n right now from 1 n half month i m taking homeopathic medicine to get my menses n still i didn’t get them n homeopathic doctor said it will take some time for me to get menses but right now i m concern about that fluid in POD…is that the reason of my pain??n i did sonography after i noticed pain…(pain is mild it doesn’t affect my routine but i m just worried about that)

        Reply
        1. Buddy M.D. Post author

          You could be having a mild infection in your doctor. An antibiotic course may be started.

          You need to talk to your doctor about this.

          Reply
  52. naomi

    I am 30 years old. regular 29 days cycle. went for pelvic scan cos am ttc. the result7 says: uterus is normal size and anteverted with regular outline and homogenous myometrial echotexture. it has an AP diameter of about 3.5 cm. the endometrium shows a homogenous thickness. closed internal cervical is. the ovaries are normal in sizes and stromal echotexture. significance fluid collection to a depth of 1.1 cm was noted in the pod. Please what does it mean.

    Reply
    1. Buddy M.D. Post author

      You may be having some pelvic infection. It’s likely that the presence of infection interfering with your conception.

      Appropriate antibiotics need to be given.

      Reply
  53. goo

    Iam 24 years old.. about a month ago i have done a sugery for removal of ectopic preg. without removal of the tube its size was 6cm that make sever internal bleeding and their was mild pain only which make doctors not notice it fast … now I still have the same pain ,pain during sexing and always have foul smelling however I have finished my medication course.. when I make scan it appear that there is minimal fluid in douglas pouch with normality of all internal organs and ovaries.. my doctor didn’t comment and said that is normal
    I don’t know if I still have a serous problem or infection and my conseve in the future will be normal or not?

    Reply
    1. Buddy M.D. Post author

      Apart from fluid in the pouch, you also have symptoms of pain and foul discharge. There are chances that you’re still carrying some infections and antibiotics may be needed.

      Reply
  54. AMATU

    HI, I’M 27 N AV BEEN TRYING TO CONCEIVE FOR THE PAST 2 YRS. MY DOC ASKED ME TO DO AN ABDOMINO PELVIC ULTRASOUND. THE RESULT STATES NORMAL BUT THIS: PERITONEAL CAVITY-NORMAL GUTS, NO DISTENTION. NO ASCITES. ADNEXAE/POD: THERE IS SIGNIFICANT INFLAMMATORY TISSUE REACTION IN BOTH ADNEXAE AS WELL AS IN THE POD CAUSING POOR INTERFACE BTW PELVIC ORGANS. NO FREE FLUID COLLECTION IN THE POD. NO PELVIC MASS. FEATURES OF CHRONIC PID.I’M ALSO ASKED TO DO VAGINAL LAB TEST WHICH I STILL AWAIT. I DONT AV ABDOMINAL PAIN THOUGH I AV ITCHY VAGINAL WHICH GOES VERY RED AFTER ITCHING N PAINFUL IF I AV SEX AT SUCH TIMES. BUT NOT REALLY RED IF LEFT UNTOUCHED AND IT HAS BEEN A WHILE NOW, THOUGHT IT WAS YEAST INFECTION. ALSO, JUST FINISHED USING ANTIMALARIA N ANTIBIOTICS. NO ABNORMAL OR FISHY DISCHARGE. MENSES NORMAL, NO MISSED PERIODS, NO PAIN EXCEPT MILD ONE DURING OVULATION. I WANT TO WHAT IS WRONG N WHAT TO DO. I REALLY AWAIT UR RESPONSE. THANKS. GOD BLESS U!

    Reply

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