Preface
Case 1: Xiao Zhang’s pelvic ultrasound revealed pelvic effusion. She immediately became anxious and thought she must have pelvic inflammatory disease and needed to go to the hospital for some medicine.
Case 2: Xiao Liu went to the gynecology clinic because of vulvar itching. After physical examination and auxiliary tests, the doctor told her that she had pelvic inflammatory disease and vaginitis, and she asked the doctor with the pelvic ultrasound checklist she had just done: My ultrasound did not show pelvic fluid, how did you say I had pelvic inflammatory disease?
Since ultrasound is available, I believe many women of childbearing age are aware of “pelvic effusion”, but is pelvic effusion a sign of pelvic inflammatory disease? Is it necessary to treat pelvic effusion? Here I will give you some knowledge about “pelvic effusion”.
Pelvic effusion
Although pelvic effusion has always existed, it is only since the availability of ultrasound that more or less fluid is found in the pelvic cavity of women.
The production of pelvic fluid
When the body is standing, the pelvic cavity, as the lowest part of the pelvic and abdominal cavities, may develop pelvic effusion when any situation in the pelvic and abdominal cavities that may cause fluid to leak out.
Classification of pelvic effusion
Non-pathological.
1)Post-ovulatory, when normal women of childbearing age ovulate, oocytes and follicular fluid are discharged together and a small amount of pelvic fluid is produced. When ovulation promotion therapy is performed, multiple follicles can be discharged at the same time due to the effect of drugs, and the pelvic fluid produced by them increases accordingly.
2) History of related surgery: Hysteroscopy and tubal lavage were performed within a short period of time, and fluid was injected into the uterine cavity during the surgery to investigate the patency of the fallopian tubes, and the fluid entered the pelvic cavity along the fallopian tubes and accumulated in the pelvic cavity to form pelvic fluid.
The above two conditions are normal and do not need to be treated.
Pathological.
1) Pelvic inflammatory disease: Pelvic inflammatory disease is an infectious disease of the upper female reproductive tract, mostly occurring in women of childbearing age, and mainly includes endometritis, tubal inflammation, tubal-ovarian abscess, and pelvic peritonitis. Tubitis and tubo-ovarian abscesses are the most common. Due to inflammatory exudation, tubal inflammation and tubo-ovarian pus can be formed and pelvic effusion can occur. In severe cases, the fallopian tubes are significantly thickened and curved, and the fibrinous purulent exudate increases, causing adhesions with surrounding tissues.
2) Ectopic pregnancy: the fertilized egg is found in a place other than the uterine cavity is called ectopic pregnancy, the most common one being tubal pregnancy. If the tubal pregnancy miscarries or ruptures and bleeds, blood accumulates in the rectal recess of the uterus and forms pelvic effusion. In this case, the patient often presents with pain on one side of the lower abdomen, menopause, irregular vaginal bleeding, and a positive urine pregnancy test.
3) Rupture of ovarian cysts: The most common type is rupture of luteal cysts, which are physiological cysts of the ovary and most of them will disappear naturally in 1-3 menstrual cycles. However, sometimes they may rupture and bleed, often manifesting as abdominal pain on one side after ovulation, strenuous exercise or intercourse, and fluid accumulation in the pelvis after rupture to form pelvic effusion.
4) Malignant tumors of ovaries and fallopian tubes: Malignant tumors occurring in the ovaries and fallopian tubes are usually accompanied by more pelvic and abdominal fluid, and occupying masses can be detected in the adnexal area at the same time by ultrasound.
Diagnostic criteria of pelvic inflammatory disease
In mild cases, pelvic inflammatory disease is asymptomatic or mild. Common symptoms are lower abdominal pain, increased vaginal discharge, and persistent abdominal pain that worsens after activity or sexual intercourse. In severe cases, fever or even hyperthermia, chills, headache, and lack of appetite may occur.
The minimum diagnostic criteria are the presence of lower abdominal pain in sexually active young women or those at high risk for sexually transmitted diseases, and empirical antibiotic treatment if other causes of lower abdominal pain can be excluded and the gynecological examination meets the minimum diagnostic criteria (painful cervical lifting, pressure in the uterus or adnexal area).
There are also additional and specific criteria. One of the specific criteria is mentioned: vaginal ultrasound or magnetic resonance examination showing thickening of the fallopian tubes and fluid in the fallopian tubes with or without pelvic effusion.
It can be seen that pelvic effusion is not a necessary condition for the diagnosis of pelvic inflammatory disease.
In summary, pelvic effusion is not a sign of pelvic inflammatory disease. If you find pelvic effusion on ultrasound, there is no need to panic and review whether you have recently ovulated or had surgery. If the answer is no or if you have uncomfortable manifestations, it is necessary to go to your gynecologist and find the cause of pelvic effusion by combining medical history and physical examination and treating it symptomatically. Non-pathological pelvic fluid does not need to be treated, just wait and see what happens.