If you've had an ultrasound, you may have learned that there's fluid in your cul-de-sac area. The cul-de-sac sits just behind the vagina.
This article explains why fluid can sometimes collect there, and how your healthcare provider might diagnose the reason for it. Takeaway Paper Bag
On either side of the uterus sit two small pouches. These are called the cul-de-sacs. The anterior cul-de-sac is the space between the bladder and the uterus. The posterior cul-de-sac is between the uterus and the rectum. This latter cul-de-sac is also known as the pouch of Douglas, named for the Scottish physician James Douglas.
Yes. It's known as the rectovesical pouch. It's between the rectum and bladder.
Fluid can fill the cul-de-sac for many reasons. Sometimes a ruptured ovarian cyst or follicle leaks fluid. Sometimes there's a more severe problem. These are some possible causes:
If you are having fertility treatment, fluid in the cul-de-sac can be a symptom of ovarian hyperstimulation syndrome (OHSS)—a condition where high doses of fertility hormones make your ovaries swell.
If your healthcare provider suspects you have OHSS, they may suggest an ultrasound to check for fluid. During the ultrasound, they can measure your ovaries.
Usually, fluid in the cul-de-sac is not a cause for alarm. In some cases, though, it can cause discomfort or affect your fertility.
Fluid in the cul-de-sac is diagnosed by doing a transvaginal ultrasound. A culdocentesis may also be done.
A transvaginal ultrasound will show whether there is fluid behind the uterus. A wand is placed into the vagina to take more detailed ultrasound images. If fluid is found and you are having pain, you may need more tests.
Before transvaginal ultrasound became widely available, this procedure was used to check for fluid in this area. Now, it is mostly used to remove a fluid sample for testing.
In a culdocentesis, a needle is inserted through the vaginal wall to draw a sample of fluid. A numbing agent or anesthesia is often used. Your healthcare provider will use an instrument to hold your cervix in place so the needle enters in the right spot.
A small amount of fluid in the cul-de-sac is normal. But if the sample shows signs of pus or blood, the area may need to be drained.
Blood in the fluid could mean a cyst has ruptured or there is a tear. It could also be a sign of an ectopic pregnancy. Pus could mean you have an infection.
Fluid is removed for testing with a very thin needle that is inserted through the wall of the vagina. If the test is abnormal, culdocentesis will be done to remove the fluid. If there is pus in the fluid, your healthcare provider may prescribe antibiotics for the infection.
Two small pouches called cul-de-sacs are located on either side of the uterus. Fluid sometimes builds up in these pouches. A little fluid is normal, but if it contains pus or blood, or if it's causing pain, there may be a bigger health problem.
Infection, pregnancy complications, or health conditions such as endometriosis or fibroids could be the cause. It's also possible that a cyst, a follicle, or the uterus itself has ruptured. In some cases, fertility treatment can cause the extra fluid.
An ultrasound can usually detect the fluid. You may also need a culdocentesis, where a sample of the fluid is drawn out with a needle so it can be tested. Depending on the cause, the fluid may need to be drained or treated with antibiotics.
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By Nicole Galan, RN Nicole Galan, RN, is a registered nurse and the author of "The Everything Fertility Book."
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