Nowadays, due to the development of ultrasound technology, ultrasound reports are becoming more and more detailed and comprehensive, and pelvic effusion has also become a common part of the report. Many women get excited and nervous when they see the words “fluid in the rectum” and “pelvic fluid” on the ultrasound report, thinking that they have a big problem. Is there really a problem? When you consult your doctor, many of them may explain that fluid in the rectal fossa means fluid in the pelvis, and fluid in the pelvis means pelvic inflammatory disease. What follows is a series of treatments with antibiotics. When the ultrasound report finds that the “fluid” is gone after treatment, the patient feels that the doctor is really good, but after a while, it may reappear again, and then it is time to start the endless treatment again.
Is pelvic fluid an inflammatory condition? Why is there fluid in the pelvis? In the human body, the “utero-rectal fossa” is the lowest point of the peritoneal cavity when lying down, and the fluid in the abdominal cavity will flow into this lowest place when lying down, and the volume of this “fossa” is very small, as long as there is 2-3 ml of fluid, through ultrasound examination, it can be detected in the The presence of “fluid” can be detected in the rectal fossa of the uterus by ultrasound.
The peritoneum has absorptive and secretory functions. Under normal conditions, there is a small amount of plasma in the peritoneal cavity to reduce friction between the abdominal organs. If a large amount of fluid is secreted in a pathological state, ascites can occur. The peritoneum also has a defensive function, containing white blood cells and some antibodies in the peritoneal fluid. Because the female abdominal cavity is connected to the outside of the abdomen through the umbilical end of the fallopian tubes, outside pathogens and even tiny particles from the outside may enter the abdominal cavity through the pathway of vagina-cervical-uterine cavity-fallopian tube, and in order to defend against the invasion of outside objects, the female abdominal cavity needs to secrete a certain amount of peritoneal fluid to fight against the invading foreign bodies. On the other hand, because the surface of the ovaries is not covered by peritoneum, every month the ovaries will ovulate and when the follicles rupture, they will discharge follicular fluid into the abdominal cavity and collect in the rectal fossa of the uterus, forming as little as a few milliliters or as much as 10 milliliters. Similarly, every month when menstruation occurs, menstrual blood can enter the fallopian tubes from the uterine cavity and “flow backwards” into the abdominal cavity. Therefore, it is generally normal to see a 20-30 mm “fluid collection” in the rectal fossa of the uterus detected by ultrasound. This “fluid” may be normal abdominal fluid (used as a defense), follicular fluid after ovulation, or a small amount of menstrual blood flowing backwards. If a small amount of “fluid” (20-30 ml) is detected in the rectal fossa for the first time, there is usually no need to be overly nervous, let alone to “treat” it immediately.
The main pathological causes of pelvic effusion
The common causes of pathological pelvic fluid are pelvic inflammatory disease, tuberculous pelvic inflammatory disease, ectopic pregnancy, and malignant tumors of the ovaries and fallopian tubes.
Pelvic inflammatory disease
Pelvic inflammatory disease refers to inflammation of the upper genital tract and its surrounding tissues, mainly endometritis, tubal inflammation, tubo-ovarian abscess, and pelvic peritonitis, among which tubal inflammation is the most common and mostly occurs in women of childbearing age.
The symptoms of pelvic inflammatory disease may vary depending on the severity of the inflammation and the extent of the lesion. The main symptoms include lower abdominal pain (one or both sides, may be persistent, aggravated by activity or sexual intercourse), lumbar pain, fever, increased vaginal discharge, etc. If the condition is severe, there may be chills, high fever and other systemic symptoms. The acute inflammatory stage is mainly treated with antibiotics and Chinese medicine. Pelvic abscess is not effective for antibiotic treatment and can be treated with surgery.
Tuberculous pelvic inflammatory disease
Among female genital tuberculosis, tubal tuberculosis is the most common, usually bilateral, with thickened and enlarged fallopian tubes. Tuberculosis of the fallopian tubes is often combined with pelvic peritoneal tuberculosis. The peritoneum and pelvic organ surfaces are covered with corn-like tuberculosis lesions, producing a large amount of exudate that accumulates in the pelvic cavity.
Ectopic pregnancy
Ectopic pregnancy is caused by a fertilized egg that has settled outside the body of the uterus, most commonly in the fallopian tube. If the tubal pregnancy miscarries or ruptures, the tubal wall will rupture and bleed, and blood will accumulate in the rectal recess of the uterus and form a pelvic fluid collection. Ultrasonography can only show pelvic fluid and cannot show if the fluid is blood. Patients with ectopic pregnancy tend to have irregular vaginal bleeding, lower abdominal pain and a positive urine pregnancy test.
Malignant tumor of ovary and fallopian tube
Malignant tumors of the ovaries and fallopian tubes occur and ascites is usually high. Ultrasound and magnetic resonance examination reveals an occupancy in the adnexal area, and tests such as tumor indicators help in diagnosis and differential diagnosis.
To sum up, if a small amount of pelvic fluid is found by ultrasonography during gynecological physical examination, it can be combined with medical history, symptoms and physical signs in detail to clarify whether the fluid is normal or abnormal. If abnormal effusion is diagnosed, the cause of the effusion should be clarified and removal of the cause is the key.
4 common causes of pelvic inflammatory disease
The female reproductive tract has a certain defense function against bacterial invasion. The response to invading pathogens is related to the type, quantity, virulence and immunity of the organism, and only when the balance between bacterial virulence, quantity and immunity of the organism is out of balance does it increase the chance of pelvic inflammatory disease. The common causes of pelvic inflammatory disease are the following.
Infection after intrauterine surgical operations
After abortion, curettage, tubal lavage, hysterosalpingography, hysteroscopy, IUD and IUD removal, if the surgical disinfection is not strict, pre-existing reproductive system infection, lack of personal hygiene after surgery, and sexual intercourse, can cause upstream infection of endogenous bacteria in the lower reproductive tract.
Not paying attention to menstrual hygiene
During menstruation, the endometrium peels off, the blood sinuses in the uterine cavity are open and clots are present, which is a good condition for bacteria to breed. If you do not pay attention to hygiene during menstruation, use sanitary napkins or toilet paper with substandard hygiene standards, or have sex, you will give bacteria the opportunity to infect the upper cavity, leading to pelvic inflammatory disease.
Direct spread of inflammation from adjacent organs
For example, appendicitis and peritonitis are involved in the pelvic cavity through direct spread.
Puerperal infection
This refers to local or systemic infections caused by pathogens attacking the reproductive tract during the puerperium, which may be related to poor hygiene during pregnancy, premature rupture of fetal membranes, severe anemia, obstetric surgical operations, postpartum hemorrhage, etc.