Pyometra

The Pyometra is a very rare side effect of various abdominal diseases in women. If it is recognized in good time, it usually does not cause any further health problems. What is unfavorable, however, is that it is often not diagnosed and treated in good time in the case of elderly patients - with often fatal consequences.

What is Pyometra?

The pyometra is a congestion of purulent secretion in the uterus. It comes about through a closure of the cervical canal (cervix). Pyometra is not an independent disease and usually arises in connection with other diseases of the female urogenital tract. Most of the documented pyometra cases are in postmenopausal women.

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It does not appear to be as common in younger women. It occurs together with bacterial inflammation of the vagina and uterus: the pathogens that enter via the vagina rise to the uterus and can even cause fallopian tubes and ovarian inflammation. Most of them are Escherichia coli, staphylococci, chlamydia, enterococci and streptococci. Inflammation of the uterine lining (endometritis) occurs in the uterus.

If the cervical canal is narrowed or even closed, the purulent fluid builds up in the uterus. Abdominal tumors, abdominal infections and mechanical contraceptives such as pessaries and IUDs have a positive effect on pyometra. The pus in the uterus should be drained as soon as possible to prevent uterine rupture. If the pathogens spread through the bloodstream, there is an acute danger to life.

causes

In older patients, pyometra usually occurs in connection with malignant cervical carcinoma. Younger women sometimes get it after surgery that damaged the cervix. Cervical inflammation, uterine scraping, foreign bodies, uterine polyps that produce necrotic tissue and degenerative myomas can also be responsible for the occurrence of pyometra.

Hole congestion and uterine inflammation can also cause the accumulation of pus. Cases of spontaneous pyometra have also been documented. Women are particularly at risk in whom the uterine mucous membrane has been altered by myomas (benign tumors), carcinomas or polyps. Pyometra also occurs frequently when there is an increased risk of uterine inflammation. This is particularly the case with women who have recently given birth and women who have passed menopause.

In the latter, the uterine mucous membrane offers less protection against invading bacteria due to the lowered estrogen level. The use of mechanical contraceptives also increases the risk of pathogens spreading within the uterus. The same applies to infection with sexually transmitted diseases (gonorrhea).

Older patients usually experience increased, possibly purulent discharge, pain in the abdomen and - if the inflammation has spread further - fever and certain symptoms that indicate a cervical obstruction. Younger women complain of prolonged menstrual periods, intermenstrual bleeding, spotting, and foul-smelling discharge.

If the pus builds up in the balloon-like swollen uterus up to the fallopian tubes and ovaries, there is danger to life. If at least part of it flows into the vagina, it can still lead to peritonitis, abscess formation and acute abdomen (extreme colic-like pain in the lower abdomen). Depending on the type of causative agent, pyometra can be accompanied by symptoms such as burning sensation and pain when urinating and frequent urination. In older patients, it occurs without any symptoms.

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Diseases with this symptom

• cervical cancer
• Vaginitis

• Uterine rupture
• Hole congestion

• Endometritis
• Oophoritis

Diagnosis & course

Examination of the abdomen reveals increased sensitivity to pressure. Palpation of the uterus causes severe pain for the patient. The severely swollen uterus can be seen well on ultrasound, MRI and CT. A smear from the cervix provides information about which pathogens are involved in the disease process. In addition to the typical bacteria, there are also Staphylococcus aureus, Bacteroides fragilis and germs that are typical of uterine tuberculosis.

If the cells of the cervical mucous membrane are examined, the doctor can find out whether the patient also has uterine cancer or cervical cancer. A urine sample can rule out the presence of kidney inflammation (symptoms!). A blood test gives the general indication that there is inflammation in the body.

With timely diagnosis and adequate treatment, there is a good chance that the patient's condition will improve. The problem with those affected at an advanced age, however, is that by the time the diagnosis is made they are sometimes already in critical condition and rapid intervention is required (mortality with pyometra is 30 to 100 percent).

Complications

A pyometra occurs when pus accumulates as a result of inflammation of the uterus, which can cause various complications. The most dreaded but rare complication is when too much pus accumulates in the uterus, causing it to tear. The pus that has accumulated can then pour into the abdominal cavity and infect other organs.

First of all, the peritoneum becomes inflamed (peritonitis) as it surrounds the abdominal organs and thus protects them. However, the infection can spread further and thus also contaminate and inflame the abdominal organs such as the intestines. This creates severe abdominal pain (acute abdomen), which is life-threatening and should therefore be treated surgically as soon as possible.

The inflammation can also spread systemically and thus cause life-threatening sepsis; in the case of uterine inflammation, one speaks of puerperal fever. In addition, the triggering bacteria can produce toxins that can destroy the kidney or liver. Another more common complication could be the backlog of pus in the fallopian tubes, causing inflammation of the fallopian tubes (salpingitis).

It can also reach the ovaries and inflame them as well (oophoritis). This can lead to disturbances in the menstrual cycle, which can lead to infertility if the egg cells are drawn into passion.

When should you go to the doctor?

Pyometra is a serious condition that requires immediate medical attention. This is why you should speak to your gynecologist as soon as the first symptoms arise, such as cramps in the abdomen, stomach pain or fever. Discharge, unusual bleeding, and painful urination are warning signs that need to be clarified. As the disease progresses, menstrual pain may occur. At the same time, intermenstrual bleeding and spotting occur and the period lasts longer. If you experience these symptoms, you should see a doctor immediately.

If there is also a high fever or an intense general feeling of illness, the symptoms must be clarified in the hospital or in the gynecological emergency room.Immediate clarification is particularly advisable if the cause of the pyometra is known. Symptoms that arise after inflammation of the vagina or after surgery in the genital area should be treated immediately. Postmenopausal women and cancer patients should have abnormalities such as pain, discharge or fever symptoms clarified quickly. With an immediate diagnosis, pyometra can be treated well and usually does not result in major complications.

Doctors & therapists in your area

Treatment & Therapy

The treatment of patients with a swollen uterus consists primarily of surgically widening the cervix and allowing the pus to drain off (drainage). Then the uterus is rinsed with an iodine disinfectant solution. In addition, other diseases that occur together with the pyometra must be treated (radiation therapy for cancer, administration of antibiotics for uterine inflammation).

However, new mothers are only given antibiotics that do not pass into breast milk. Patients who are suspected of having been infected from their partner must also be examined by a doctor and treated accordingly. Women who have ever had uterine inflammation with pyometra should definitely have regular medical examinations at shorter intervals, as the relapse rate within two years of the diagnosis is 22 to 31 percent.

Outlook & forecast

In most cases, a pyometra can be treated relatively well, so that the disease progresses positively. Unfortunately, however, the disease is often diagnosed relatively late, which can make treatment difficult. In the worst case, the pyometra can tear the uterus if too much pus has accumulated there. The pus can leak and cause infections and inflammation in the organs. For this reason, early diagnosis of the disease is extremely important.

If this inflammation is not treated, it can lead to a life-threatening condition for the patient. It is not uncommon for the pyometra to lead to fever and headaches. Most women also suffer from disorders of the menstrual cycle and thus often from mood swings. With a timely diagnosis, treatment is carried out with the help of antibiotics and leads to a positive course of the disease.

Sometimes the pyometra occurs again in the course of life, whereby a new treatment also runs without complications.

prevention

For older patients, prevention consists of regular gynecological and cancer screening examinations. Younger sexually active women can use healthy intimate hygiene (no intimate sprays and only soap-free washing lotions) to ensure that the natural bacterial flora of the vagina remains healthy. In addition, condoms protect against bacteria and other pathogens.

You can do that yourself

If a pyometra is suspected, the gynecologist should be consulted immediately. The treatment of uterine inflammation can be supported with various home remedies. Cooling or warm applications on the upper abdomen such as hot water bottles, cherry stone pillows or ice compresses help against pain. In the case of severe pain, a lukewarm hip bath with hay flowers, Bach flowers and similar additives is recommended. Fresh plant drops made from coneflower, chamomile, thyme, saw palmetto or yarrow also have an anti-inflammatory and pain-relieving effect.

Further spread of the inflammation can be avoided by doing without underwear at night and wearing hygiene briefs from the pharmacy during the day. In addition, the genital area should be cared for regularly and carefully. Tried and tested home remedies for uterine inflammation are, for example, Schuessler salts, marjoram oil and dietary supplements, which provide the body with important nutrients and minerals. A strong immune system promotes the healing of the inflammation and increases overall well-being.

In addition, rest and bed rest are especially important. While the pyometra is being cured, everyday stress and exercise should be avoided. If the symptoms persist despite all measures, a gynecologist should be consulted for further clarification in order to avoid spreading the inflammation.