Pyometra is a very rare concomitant of various abdominal diseases in women. If it is detected in time, it usually does not cause any further health problems. However, it is unfavorable that in the case of older female patients it is often not diagnosed and treated in time – with often fatal consequences.
What is pyometra?
Pyometra is a congestion of purulent secretions in the uterus. It occurs because of an obstruction of the cervical canal (cervix). Pyometra is not a disease in its own right and usually develops in association with other diseases of the female genitourinary tract. Most documented cases of pyometra affect patients after menopause. It does not appear to be as common in younger women. It occurs along with bacterial inflammation of the vagina and uterus: The pathogens that enter through the vagina ascend to the uterus and can even cause inflammation of the fallopian tubes and ovaries. They are usually Escherichia coli, staphylococci, chlamydia, enterococci and streptococci. In the uterus, uterine mucosal inflammation (endometritis) occurs. If the cervical canal is narrowed or even blocked, the purulent fluid accumulates in the uterus. Pyometra is favored by abdominal tumors, pelvic infections and mechanical contraceptives such as pessaries and IUDs. 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 acute danger to life.
Causes
In older patients, pyometra usually occurs in association with malignant cervical cancer. Younger women sometimes get it after surgical procedures in which the cervix was damaged. Cervical inflammation, uterine excision, foreign bodies, uterine polyps producing necrotic tissue, and degenerative fibroids may also be responsible for the occurrence of pyometra. Pitting and uterine inflammation may also be culprits of pus accumulation. Cases of spontaneous pyometra have also been documented. Women in whom the uterine mucosa is altered by fibroids (benign growths), carcinomas or polyps are particularly at risk. Pyometra is also common in women at increased risk of uterine inflammation. This is especially the case in women who have recently given birth and in post-menopausal women. In the latter, the uterine mucosa offers less protection against invading bacteria due to decreased estrogen levels. 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 lower abdomen and – if the inflammation has already spread further – fever and certain symptoms that indicate cervical obstruction. Younger women complain of prolonged menstrual bleeding, intermenstrual bleeding, spotting and foul-smelling discharge. If the pus accumulates in the balloon-like swollen uterus up to the fallopian tubes and ovaries, there is a danger to life. If at least some of it drains into the vagina, peritonitis, abscess formation and acute abdomen (extreme colicky pain in the lower abdomen) may still occur. Depending on the type of causative pathogen, pyometra may be accompanied by symptoms such as burning and pain during urination and frequent urination. In older patients, it also occurs without any symptoms.
Diseases with this symptom
- Cervical cancer
- Vaginitis
- Uterine rupture
- Lochia congestion
- Endometritis
- Oophoritis
Diagnosis and course
Examination of the abdomen reveals increased tenderness. Palpation of the uterus causes the patient severe pain. The severely swollen uterus is easily seen 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, Staphylococcus aureus, Bacteroides fragilis and germs typical of uterine tuberculosis can also be found there. If the cells of the cervical mucosa are examined, the physician learns whether the patient is also suffering from uterine cancer or cervical cancer.A urine sample can rule out the presence of kidney inflammation (symptoms!). A blood test gives a general indication that there is inflammation in the body. With timely diagnosis and adequate treatment, there is a good chance of improvement in the patient’s condition. However, a problem with those affected at an advanced age is that they are sometimes already in a critical condition at the time of diagnosis and rapid intervention is required (the mortality rate for pyometra is 30 to 100 percent).
Complications
Pyometra occurs when pus accumulates as a result of inflammation of the uterus, which can lead to several complications. The most feared but rare complication is when too much pus accumulates in the uterus, causing it to rupture. The accumulated pus can then spill into the abdominal cavity and infect other organs. Initially, this leads to inflammation of the peritoneum (peritonitis), as this surrounds the abdominal organs and thus protects them. However, the infection can spread further and thus also contaminate the abdominal organs such as the intestines and inflame them. This causes severe abdominal pain (acute abdomen), which is life-threatening and should be treated surgically as soon as possible. The inflammation can also spread systemically, causing life-threatening sepsis. In the case of uterine inflammation, this is called puerperal fever. In addition, the triggering bacteria can produce toxins that can destroy the kidney or liver. Other more common complication could be the back up of the pus into the fallopian tubes, causing inflammation of the fallopian tubes (salpingitis). Further, it may travel to the ovaries and inflame them as well (oophoritis). This can lead to disturbances in the menstrual cycle, which can even lead to infertility if the eggs are involved.
When should you go to the doctor?
Pyometra is a serious condition that requires immediate medical attention. Therefore, already at the first initial symptoms such as cramps in the abdomen, abdominal pain or fever should be talked to the gynecologist. Discharge, unusual bleeding and pain during urination are also 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 these symptoms occur, an immediate visit to the doctor is recommended. If there is also a strong fever or an intense general feeling of illness, the symptoms must be clarified in the hospital or in the emergency gynecological clinic. Immediate clarification is particularly recommended if the cause of the pyometra is known. For example, complaints that occur after inflammation of the vagina or after surgical procedures in the intimate area should be treated immediately. Post-menopausal women and cancer patients should have abnormalities such as pain, discharge or fever symptoms clarified quickly. With prompt diagnosis, pyometra can be treated well and usually does not result in major complications.
Treatment and therapy
Treatment of patients with swollen uterus consists primarily of surgically dilating the cervix and draining the pus (drainage). This is followed by irrigation of the uterus with an iodine disinfectant solution. In addition, other diseases occurring together with pyometra must be treated (radiation therapy for cancer, antibiotic administration for uterine inflammation). However, only antibiotics that do not pass into breast milk are administered to young mothers. Patients who suspect that they may have contracted the infection from their partner must also be examined by a doctor and treated accordingly. Women who have had previous uterine inflammation with pyometra should be sure to have regular medical examinations at shorter intervals, as the recurrence rate within two years of diagnosis is 22 to 31 percent.
Outlook and prognosis
In most cases, pyometra can be treated relatively well, resulting in a positive disease outcome. Unfortunately, however, the disease is often diagnosed relatively late, which can complicate treatment. In the worst case, pyometra causes a tear in the uterus if too much pus has accumulated there.In the process, the pus can leak and cause infections and inflammations of the organs. For this reason, early diagnosis of the disease is extremely important. If these inflammations are not treated, it can lead to a life-threatening condition for the patient. It is not uncommon for pyometra to also cause fever and headaches. Similarly, most women suffer from disturbances in the menstrual cycle and thus not infrequently mood swings. If diagnosed in time, treatment is carried out with the help of antibiotics and leads to a positive course of the disease. Partly, pyometra occurs again in the course of life, and renewed treatment also proceeds without complications.
Prevention
In older patients, prevention consists of regular gynecologic and cancer screening examinations. Younger sexually active women can ensure that the natural bacterial flora of the vagina remains healthy by practicing healthy intimate hygiene (no intimate sprays and only soap-free wash lotions). In addition, condoms protect against bacteria and other pathogens.
Here’s what you can do yourself
If 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 to the upper abdomen, such as hot water bottles, cherry pit pillows, or ice compresses, help relieve pain. For severe pain, a lukewarm sitz bath with hay flowers, Bach flowers and similar additives is recommended. Fresh plant drops made from echinacea, chamomile, thyme, saw palmetto or yarrow also have an anti-inflammatory and pain-relieving effect. Further spread of the inflammation can be avoided by avoiding 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. Proven home remedies for uterine inflammation are, for example, Schüßler salts, marjoram oil and dietary supplements that provide the body with important nutrients and minerals. A strong immune system promotes healing of the inflammation and increases overall well-being. In addition, above all, rest and bed rest are important. While the pyometra is being cured, everyday stress and sports should be avoided. If the symptoms persist despite all measures, a gynecologist should be consulted for further clarification to prevent the inflammation from spreading.