What is the cause of fluid accumulation in the pelvic cavity (pelvis)?

From the Guidelines

Fluid in the pelvis should be promptly evaluated and treated by a healthcare provider to prevent potential complications, as it often indicates an underlying pathological process. The approach to managing fluid in the pelvis depends on the underlying cause, which may include infection, inflammation, malignancy, or gynecological conditions 1. Common symptoms of pelvic fluid include lower abdominal pain, bloating, changes in bowel or bladder habits, and in women, menstrual irregularities.

Causes and Symptoms

The causes of fluid in the pelvis can be diverse, ranging from pelvic inflammatory disease (PID) to malignancies or gynecological conditions 1. Symptoms can vary but often include pain, changes in bowel or bladder habits, and in women, irregular menstrual cycles.

Diagnostic Approaches

Imaging studies such as ultrasound, CT scan, or MRI are crucial for detecting fluid in the pelvis 1. The choice of imaging modality may depend on the clinical suspicion and the need for detailed visualization of pelvic structures. For instance, MRI of the pelvic floor can provide comprehensive information about the pelvic compartments and is particularly useful in cases of severe or recurrent prolapse, enteroceles, and defecatory dysfunction 1.

Treatment Options

Treatment of fluid in the pelvis varies based on the cause. For infections such as PID, antibiotics like cephalosporins or metronidazole may be prescribed 1. Anti-inflammatory medications may be used for inflammatory conditions, while surgical drainage may be necessary for significant fluid collections. In some cases, particularly for small, asymptomatic collections, watchful waiting with follow-up imaging may be an appropriate approach 1.

Importance of Prompt Evaluation

The presence of fluid in the pelvis is significant because it often indicates an underlying pathological process that needs addressing. The fluid itself can cause symptoms by putting pressure on surrounding organs and structures, potentially leading to complications if left untreated. Therefore, prompt evaluation and treatment by a healthcare provider are essential to prevent potential complications and improve outcomes.

From the Research

Fluid in Pelvis: Prevalence and Clinical Significance

• The prevalence of peritoneal fluid accumulation in healthy men and postmenopausal women was investigated in a study published in 2013 2.
• The study found that peritoneal fluid was identified in 39 of 1017 (3.8%) healthy men and 52 of 310 (16.8%) healthy postmenopausal women.
• The mean total volume of fluid accumulation was 3.0 ± 2.7 mL in healthy men and 2.3 ± 2.0 mL in postmenopausal women.
• The study concluded that a small amount of peritoneal fluid accumulation is occasionally observed in healthy men and postmenopausal women on pelvic MRI, and that pelvic peritoneal fluid accumulation of less than 10 mL is not considered to be of clinical significance in men and postmenopausal women.

Causes and Diagnosis of Fluid in Pelvis

• A review of pelvic congestion syndrome published in 2020 3 discussed the difficulty of diagnosing the condition, which can cause chronic pelvic pain.
• The review noted that the diagnosis of pelvic congestion syndrome should remain on the differential for chronic pelvic pain, and that endovascular treatment with interventional radiology may be a effective treatment option.
• A study published in 2016 4 discussed the diagnostic work-up for patients with ascites, which is the accumulation of fluid in the peritoneal cavity.
• The study noted that ascites can originate from various diseases, including hepatic, malignant, cardiac, renal, and infectious diseases.

Treatment of Complicated Intra-Abdominal Infections

• A retrospective study published in 2015 5 compared the clinical efficacy of ceftriaxone plus metronidazole in treating complicated intra-abdominal infections.
• The study found that the success and failure of the treatment regimen were associated with preoperative low albumin, old age, and preoperative tachycardia.
• A multicentre, open-label, randomized comparative study published in 2010 6 compared the efficacy of tigecycline versus ceftriaxone sodium plus metronidazole for the treatment of hospitalized subjects with complicated intra-abdominal infections.
• The study found that tigecycline monotherapy was non-inferior to a combination regimen of ceftriaxone sodium plus metronidazole with respect to treating subjects with complicated intra-abdominal infections.