Free fluid on pouch of Douglas

[Adhamilton]

Had ultrasound scan and free fluid was seen on the pouch of Douglas What does this mean ?? Any help would be great thank you 😊

[claudia_91 Moderator Endometriosis UK]

Hi there, I hope that you are feeling okay after your scan. Are you seeing your GP or consultant soon to discuss your results? They'll be able to explain what the cause of the fluid in the Pouch of Douglas could be.

I had the same result during an ultrasound before being diagnosed with endo. In my case it was an indicator of inflammation, but this is only something that can be confirmed by a medical professional. Hope you get some answers soon 😊

[Lindle]

It means what it says. The pouch of Douglas is the lowest point of the abdominal cavity and acts like a cup to collect the peritoneal fluid that constantly circulates to keep everything moist. So it is normal to have some. If there is an larger amount than considered normal then it can indicate inflammation which as we know is the main characteristic of endo. So it's not unusual for this to be reported.

[Adhamilton in reply to Lindle]

Thank you so much for your reply you have such good knowledge of Endo I had a hysterectomy 2017 due adenomyosis I still have both ovaries 5 months later went back and had more surgery due to pelvic pain.they removed adhesions from bowel pelvic wall etc 3 years later I’m now in so such pain again my ultrasound showed free fluid on pouch Douglas waiting to see gynaecologist 28th October. I have been off work 20days as I have been in so much pain the pain is on left side again plus pelvic bone area and right side been so dizzy nausea headache struggling to eat etc.

[Lindle in reply to Adhamilton]

Are you in a specialist endo centre and did you retain your cervix?

[Adhamilton in reply to Lindle]

I’m with an endometriosis specialist and no had cervix removed when had hysterectomy.

[Lindle in reply to Adhamilton]

Do you mean a tertiary specialist endo centre as that is the only place you should be treated.

Rectovaginal endo is almost always left sided and the most common location for deep endo is the uterosacral ligaments, affecting the end where they attach to the cervix. The US ligaments support the uterus at the back and run from the cervix then either side of the POD and rectum to their attachment at the sacrum. When the cervix is removed the US ligaments are cut and reattached to the vault to support the vagina. Deep endo within the ligaments can't always be seen as it starts within then develops into thickening before DIE nodules develop. We are finding more and more women in this situation having deep endo stitched into the vault and suffering severe pain after hysterectomy. Message if you need more info. x

[Meworange in reply to Lindle]

Hi could I pm you pls with my report as my surgeon didn't quite explain to me what he did at the surgery u sound very knowledgeable around this area. Thanks

[Nikkky in reply to Lindle]

That’s really helpful info Lindle. I’m wondering whether to have an MRI to see if deep endo can be seen on that, rather than pushing for another laparoscopy. I worry that it might not be seen during a laparoscopy, especially if it’s in the ligaments. Thanks

[Carrodise in reply to Lindle]

Sorry to hear of all your pain adhamilton and the other women posting here all suffering from this condition. I wondered Lindle if you might have suggestions for my similar situation.

I have just been diagnosed with some ‘mild nodular thickening suggestive of deep infiltrating endo’ in the the US ligaments of pouch of douglas via a MRI that happened after a diagnostic and treatment laparoscopy that involved diathermy for endo visible on the surface there and elsewhere. However the gynae Dr disputes the mri finding that it is deep infiltrating endo and wonders if its scar tissue or post-lap inflammation. I started Synarel drug i after this due to the pain remaining (prescribed in Australia where I am) and its the only relief I have found from the pain, but cant be taken for longer than 6 months.

I havent had a hysterectomy op yet but my Dr is proposing a radical -full hysterectomy including cervix removal because i have responded well to Synarel and I have adenomyosis.

It sounds like Lindle you know of a few cases where this hysterectomy op has resulted in worse pain like adhamilton is unfairly suffering from, so would caution against it or at least try yo retain the cervix?

(The thought of endo being sewn into the pouch of douglas fills me with utter horror as it would replicate or worsen the pain i already have with the existing adenomyosis).

Is there any information on the web you could direct me/us to about this situation where endo might be in this area but a radical hysterectomy is proposed?

[Lindle in reply to Carrodise]

My now-retied excision surgeon Mr Ashwini Trehan had a sub-specialism in this and wrote a useful paper on it. I did actually look for it to post here but it now seems only to be available as a paid-for article but I have the full article. Send me a message and I can try to get it to you. x

[Peenie123 in reply to Adhamilton]

I’m in your situation - post hysterectomy with left pelvic pain after 6 months- that was 14 months ago now-( op Jan 2020) Consultant referred me to Gastro and Gen surgery and discharged me from gynae so now starting the process again at a neighbouring hospital, trying to get a diagnosis of Endo or otherwise/ it’s battle and I wish you all the best xxx

[Nikkky in reply to Peenie123]

I had left sided pain within weeks of having my hysterectomy and was told it was adhesions but it’s got worse over the last 4 years. I went back to the consultant who had done my hysterectomy (who is listed as an endo specialist but has never disclosed this to me) and she completely dismissed that it was a gynaelogical cause. She immediately went down the route of inflammatory bowel disease and tested for that. Test was negative but I knew it wasn’t IBD as I’ve had tests for that in the past and I recognise my pain as endo pain. I’ve had it for years so I know how it feels!! I’m now also in the position of having to start the process again. It’s exhausting and frustrating so I do empathise with you.

[Carrodise in reply to Nikkky]

This pain sounds horrible and unfair after you have had this major operation, sorry to hear about this Nikkky and Peenie. Ive been shuttled between a gynae and gastroenterologist for symptoms, its difficult. The only pain relief I have found was with Synarel, a short-term drug solution available in Australia. Maybe there is something similar in the UK that could help make the pain more bearable for you.

[Nikkky in reply to Carrodise]

Hi Carrodise, is it a drug that puts you into a chemical menopause?

[Carrodise in reply to Nikkky]

Yes, nafarelin, for endo but seems to be used for other purposes eg vascular swelling, IVF. It might not usually be prescribed after hysterectomy, as there are osteoporosis risks , but if there is endo there then maybe it is worth asking about- i asked my dr for it having done some research, as i was desperate. Hope you find some relief soon. 🙏

[Nikkky in reply to Carrodise]

Thanks Carrodise, I’m pleased it is working for you. I was put on a similar drug in the past (for 6 months) and it did help but unfortunately I still had pain from adhesions. This type of drug isn’t an option for me now as I’m going through the menopause, brought on as a result of the hysterectomy. I need to have oestrogen replacement to help with my severe menopause symptoms but also try and prevent the oestrogen from making my endometriosis worse. It’s so complicated! Best of luck

[Adhamilton]

Thank you so much for all your reply’s it really help to have all this information from you all I will keep you all posted with my progress x 😊 I do try to keep smiling it’s hard I know the pain is exhausting