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

Inflammatory process in any of the pelvic organ may cause oozing out of fluid. This fluid may get collected in the pouch of douglas.

Pelvic Inflammatory Disease

This is a broad term that include all infections of the upper female genital tract. Most often, the infections ascend form the cervix or the vagina.

The causative micro- organism climbs up the vagina to enter the uterus, then the tubes an finally the ovaries.

Sometimes, there may be an infection in the appendix or nearby intestines. In such situations, the ovaries or the tubes may get infected directly from these infected organs.

PID presents itself clinically as low abdomen pain with backache. There may be fever, an increase in the total white blood cells of the body.

There may or may not be a discharge from the vagina.

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

Most cases of PID would have some fluid collected in the pouch of douglas.

Treatment is treating the infection with the help of appropriate antibiotics. The fluid is absorbed back with time.

Tubo Ovarian Abscess

Following PID or cases of T.B., pus may get collected in the Fallopian tubes. There is pain in the lower abdomen of the affected side.

The patient may have pain, fever, nausea and an increased TLC.

Inflamed tube oozes out fluid that gets collected in the pouch of douglas.

Hydatidiform Mole

This is a condition in which an abnormal growth occupies the uterus, rarely the tube. The structure may or may not accompany a fetus.

Inflammatory process occurs and fluid 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.


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.

Apart from heavy bleeds every month, dyspareunia is another common symptom of having endometriosis in the pouch of douglas itself. This means having pain during intercourse.


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

Ruptured Ovarian Cyst

Cyst formation occurs in the follicles of the ovaries during reproductive ages. Any 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?

  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.

    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.

  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.

    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.

  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

    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?

  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

    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.

  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

    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.

  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.

  8. ruth

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