Nicole Galan, RN, is a registered nurse and also the author of "The every little thing Fertility Book."" data-inline-tooltip="true">Nicole Galan, RN
Anita Sadaty, MD, is board-certified in obstetrics-gynecology. She is a clinical assistant professor in ~ Hofstra Northwell college of Medicine and founder the Redefining wellness Medical." data-inline-tooltip="true">Anita Sadaty, MD
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Anita Sadaty, MD, is board-certified in obstetrics-gynecology. She is a clinical assistant professor in ~ Hofstra Northwell institution of Medicine and also founder that Redefining health Medical.

You are watching: What does free fluid in the cul de sac mean


Your gynecologist or fertility specialist may report the an ultrasound has detected complimentary fluid in her cul-de-sac area. This is one area just behind the vagina. Find out the different causes and concerns around this finding.


Cul-de-Sac Anatomy

There room two tiny pouches close come the uterus, one on one of two people side, dubbed the cul-de-sacs. The anterior cul-de-sac is located in between the bladder and the uterus. The posterior cul-de-sac is found in between the uterus and the rectum.


They are also called the excavatio recto-uterina (posterior) and excavatio vesico-uterina (anterior). An additional term for cul-de-sacs is pouch of Douglas, called after the Scottish anatomist James Douglas. 


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causes of liquid in Cul-de-Sac

Fluid in the cul-de-sac have the right to be brought about by numerous different factors. Sometimes liquid from a ruptured cyst or follicle deserve to accumulate there. At various other times, fluid in the cul-de-sac can indicate more severe problems. Below are some feasible causes of liquid in the cul-de-sac:


Following culdocentesisIncreased ovarian permeability due to estrogen influenceOvarian torsionPelvic abscess orhematomaTubo-ovarian abscessUterinerupture

recognize in Fertility treatment

In women undergoing fertility treatment, fluid in the cul-de-sac (as seen on ultrasound) is a common finding in ovarian hyperstimulation syndrome (OHSS).


If your healthcare provider suspects the you have actually this condition, they will certainly likely imply that you have an ultrasound to examine for fluid and also measure your ovaries, as enlarged ovaries are also common in OHSS.


Usually, fluid in the cul-de-sac is not a reason for alarm but could be leading to discomfort and also affecting her fertility.


Diagnostic experimentation

Transvaginal ultrasound is the procedure that is supplied to show whether there is liquid behind the uterus. Liquid will show up well on ultrasound. If fluid is found in her cul-de-sac and also you space experiencing pain, your medical care provider might order an ext advanced trial and error of the fluid.



Culdocentesis involves inserting a needle through the vaginal wall surface to attract off a sample of fluid to analyze. A numbing agent or anesthesia may be provided prior to the procedure. You will have actually a pelvic exam and your healthcare provider will host the cervix with an instrument to insert the needle in the correct place.

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A little amount of fluid in the cul-de-sac is normal and also is generally not that concern. If the liquid sample shows indications of pus or blood, the area may need to be drained. Sometimes blood have the right to be a result of ruptured cyst or indications of an ectopic pregnancy.