About the disease

The Douglas space (also known as the recto-uterine pouch) is situated between a woman’s uterus and rectum. An abscess can develop if there is a perforation in the diverticulum of the colon or as a result of a ruptured appendix. Sometimes, an abscess may develop in the Douglas space as a side effect of treatment for diffuse peritonitis. In most cases, the prognosis for an abscess of the Douglas space is good. If the patients are treated in time, there are rarely any serious complications.

An abscess of the Douglas space does not manifest itself as clearly as appendicitis does. For example, the patient does not feel acute pain during palpation. This can be explained by the fact that the Douglas space is not connected to an anterior abdominal wall. As such, the patient feels only heaviness and dull pain in the lower abdomen. The pain can be ascribed to many causes, which is why it is difficult to diagnose an abscess of the Douglas space right away, unlike appendicitis or perforation diverticulum of the colon.

Although having problems with the diverticulum of the colon increases the risk of developing an abscess of the Douglas space, it is usually caused by an infection. Being diagnosed with diffuse peritonitis or appendicitis in the past can also provoke this kind of abscess. Following simple dietary recommendations can prevent the appearance of an abscess of the Douglas space.

Symptoms

• Feeling of heaviness in the abdomen
• Nausea
• Pain in the lower abdomen
• Frequent urination
• Diarrhea in some cases
• Constipation in some cases

Diagnosis

• During a general examination, the doctor will palpate the patient’s abdomen to rule out the possibility of appendicitis. The doctor will find out if the patient has had a fever or has vomited in the past few hours.
• The doctor will ask the patient if they or anyone close to them has suffered from food poisoning lately.
• A blood test can reveal an infection.
• A digital rectal examination, or vaginal examination in women, is the most effective way to diagnose an abscess of the Douglas space. These tests can show if there is any softening of the rectal wall.

Treatment

• Transvaginal or transrectal open surgery to drain the abscess is the most common treatment for an abscess of the Douglas space. 
• The infiltrated area is drained, thus relieving the discomfort in the patient’s lower abdomen.

Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko