Fluid in Anterior or Posterior Cul-de-Sac

The cul-de-sac is a small pouch in the female pelvis. Courtesy of Wikipedia Commons at http://en.wikipedia.org/wiki/Rectouterine_pouch.

Question: I was told by my fertility specialist that I have fluid in my Cul-de-Sac area. What does this mean? 

Definition of Fluid in Cul-de-Sac

There are two small pouches close to the uterus, one on either side, called the cul-de-sacs. Another term for cul-de-sacs is Pouch of Douglas, named after the Scottish Anatomist James Douglas. 

The anterior cul-de-sac is located between the bladder and the uterus.

The posterior cul-de-sac is found between the uterus and the rectum. They are also called the excavatio recto-uterina (posterior) and excavatio vesico-uterina (anterior). Refer to the accompanying photo to see exactly where they are located.

In women undergoing fertility treatment, fluid in the cul-de-sac (as seen on ultrasound) is a common finding in ovarian hyperstimulation syndrome (OHSS). If the doctor suspects that you have this condition, he or she will likely suggest that you have an ultrasound to check for fluid in the cul-de-sac and measure your ovaries (enlarged ovaries are also common in OHSS). Usually, fluid in the cul-de-sac is not cause for alarm but could be causing discomfort and affecting your fertility. 

This article reviews the possible causes of fluid in cul-de-sac and treatment options. 

Causes of Fluid in Cul-de-Sac

Fluid in the cul-de-sac is common. It can be caused by many different factors.

Sometimes fluid from a ruptured cyst or follicle can accumulate there. Other times, fluid in the cul-de-sac could indicate more severe problems (see below for possible causes).

Here are some possible causes of fluid in the Cul-de-Sac:

  • uterine fibroids
  • endometriosis
  • ectopic pregnancy
  • uterine rupture
  • ovarian torsion.
  • pelvic inflammatory disease
  • tubo-ovarian abscess
  • pelvic abscess or hematoma
  • gross ascites
  • following culdocentesis
  • hydatiform mole

Detection of Fluid in Cul-de-Sac

If fluid is found in your cul-de-sac and you are experiencing pain, your doctor may order more advanced testing of the fluid. 

Culdocentesis is a procedure performed which can check for abnormal fluid in the cul-de-sac area. This procedure involves inserting a needle through the vaginal wall to draw off a sample of any existing fluid and analyze it. A numbing agent or anesthesia may be used prior to the procedure. 

A small amount of fluid is normal and is usually not of concern. If the fluid sample shows signs of pus or blood, the area may need to be drained. Sometimes blood can be a result of ruptured cyst or signs of an ectopic pregnancy. The presence of pus could indicate an infection caused by a tear or other conditions. The blood would need to be drained and antibiotics used to treat the infection. 

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