Pyometra

PYOMETRA

These two pictures shows a pyometra, it is easy to see the filling of the uterus especially in the right horn and the cysts

 

What is pyometra?

It was once though pyometra was just a uterine infection. Pyometra is an infection / a hormonal abnormality with or without the precense of a secondary bacterial infection in the uterus. It is a serious and life threatening condition that must be treated promptly and aggressively.

 

During estrus (“heat”), white blood cells are removed from the uterus to allow safe passage of the sperm. This lapse in protection often leads to infection. Also following estrus (“heat”), progesterone levels remain elevated for 8-10 weeks and thicken the lining of the uterus in preparation for pregnancy. If pregnancy does not occur for several estrus cycles, the lining continues to increase in thickness until cysts form within it. The thickened, cystic lining secretes fluids that create an ideal environment in which bacteria can grow. Additionally, high progesterone levels inhibit the ability of the muscles in the wall of the uterus to contract.

 

Pyometra occurs most commonly in intact female dogs that have not been pregnant. The problem can occur at any age, but is usually seen in dogs who are six years of age or older.

 

Are there other situations that cause the changes in the uterus?

Yes. The use of progesterone-based drugs can do this. In addition, estrogen will increase the effects of progesterone on the uterus. Drugs containing both hormones are used to treat certain conditions of the reproductive system.

 

How do bacteria get into the uterus?

The cervix is the gateway to the uterus. It remains tightly closed except during estrus. When it is open, bacteria that are normally found in the vagina can enter the uterus rather easily. If the uterus is normal, the environment is adverse to bacterial survival; however, when the uterine wall is thickened and cystic, perfect conditions exist for bacterial growth.

In addition, when these abnormal conditions exist, the muscles of the uterus cannot contract properly. This means that bacteria that enter the uterus cannot be expelled.

 

When does it occur?

Pyometra may occur in young to middle-aged dogs; however, it is most common in older dogs. After many years of estrus cycles without pregnancy, the uterine wall undergoes the changes that promote this disease.

The typical time for pyometra to occur is about two to eight weeks after estrus (“heat cycle”).

 

What are the clinical signs of a dog with pyometra?

Symptoms of pyometra often include lethargy, depression, fever, lack of appetite, vomiting, excessive thirst, frequent urination, a distended abdomen (due to the enlarging uterus), as well as weakness in the rear limbs due to the enlarged uterus. But also remember that fever, lethargy, anorexia, and depression may not be present.

 

The clinical signs depend on whether or not the cervix is open. If it is open, pus will drain from the uterus through the vagina to the outside. It is often noted on the skin or hair under the tail or on bedding and furniture where the dog has laid. The body’s response to the secondary infection is to increase fluid production and white blood cells to the uterus, which continues to flow out of the vagina. This is called an open pyometra, because the cervix is open, allowing fluid and accumulated debris to be flushed from the body through the vagina.

 

If the cervix is closed, pus that forms is not able to drain to the outside This condition is called closed pyometra, because the cervix does not allow the accumulated material to exit through the vagina. It collects in the uterus causing distention of the abdomen. The bacteria release toxins that are absorbed into circulation. These dogs often become severely ill very rapidly. They are anorectic, very listless, and very depressed. Vomiting or diarrhea may be present.

Toxins from the bacteria affect the kidney’s ability to retain fluid.

Increased urine production occurs, and the dog drinks an excess of water. This occurs in both open- and closed-cervix pyometra.

 

In worst-case scenarios, the uterus can rupture and empty all of its contents into the abdominal cavity. When this happens, the animal usually dies of septic peritonitis and/or acute kidney failure from uremic poisoning within about 48 hours, even with very aggressive medical intervention.

 

A normal uterus in an average-sized dog weighs just some grams. But when pyometra is present, the organ can weigh up to nearly 2 kilo due to the accumulation of fluid and diseased tissue.

The fluid accumulation in the uterus starts leaking out through the vagina. The dog’s natural response is to lick the area clean. Excessive licking can introduce still more bacteria through the cervix and into the uterus.

 

If your female dog has recently concluded a heat cycle and you begin to see some of these symptoms, you should seek care

Obviously, the goal is to catch this condition long before it becomes this serious. Catching symptoms early on is very important in treating pyometra successfully.

 

How is it diagnosed?

Dogs that are seen early in the disease may have a slight vaginal discharge and show no other signs of illness. However, most dogs with pyometra are not seen until later in the illness. A very ill female dog that is drinking an increased amount of water and has not been spayed is always suspected of having pyometra. This is especially true if there is a vaginal discharge or painful, enlarged abdomen.

 

Dogs with pyometra have a marked elevation of the white blood cell count and often have an elevation of globulins (a type of protein produced by the immune system) in the blood. The specific gravity of the urine is very low due to the toxic effects of the bacteria on the kidneys. However, all of these abnormalities may be present in any dog with a major bacterial infection.

 

If the cervix is closed, radiographs (x-rays) of the abdomen will often identify the enlarged uterus. If the cervix is open, there will often be such minimal uterine enlargement that the radiograph will not be conclusive. An ultrasound examination can also be helpful in identifying an enlarged uterus and differentiating that from a normal pregnancy

 

How is it treated?

Pyometra is diagnosed with an examination of the cervix and vaginal discharge, plus X-rays and/or an ultrasound to evaluate the size of the uterus and to rule out pregnancy. Toxicity can develop rapidly in a dog with pyometra, so prompt treatment is really a very important part of successful treatment, especially if the cervix has closed

The preferred treatment is to surgically remove the uterus and ovaries. This is called an ovariohysterectomy (“spay”).

Dogs diagnosed in the early stage of the disease are very good surgical candidates. The surgery is only slightly more complicated than a routine spay. However, most dogs are diagnosed when they are quite ill so the surgery is not as routine as the same surgery in a healthy dog.

Intravenous fluids are often needed before and after surgery. Antibiotics are given for 1-2 weeks.

 

My dog is a valuable breeding female. Can anything else be done other than surgery?

If the owner wants to breed the animal, obviously other options are available, but they present a higher risk to the dog. IV fluids are usually administered for several days, along with antibiotics to treat the potentially life-threatening infection. The uterus and surrounding areas will be irrigated to flush away pus and fluids, and to speed healing.

In cases of open pyometra, prostaglandins are sometimes administered to control cell growth, regulate hormone production, and cause contraction of the uterus to help expel accumulated fluid.

 

Prostaglandins are a group of hormones that reduce the blood level of progesterone, relax and open the cervix, and contract the uterus to expel bacteria and pus. They can be used successfully to treat this disease, but they are not always successful and they have some important limitations.

 

1. They cause side-effects of restlessness, panting, vomiting, defecation, salivation, and abdominal pain.

The side-effects occur within about 15 minutes of an injection and last for a few hours. They become

progressively milder with each successive treatment and may be lessened by walking the dog for

about 30 minutes following an injection.

2. There is no clinical improvement for about 48 hours so dogs that are severely ill are poor candidates.

3. Because they contract the uterus, it is possible for the uterus to rupture and spill infection into the

abdominal cavity. This is most likely to happen when the cervix is closed.

 

There are some important statistics that you should know about this form of treatment:

1. The success rate for treating open-cervix pyometra is 75-90%.

2. The success rate for treating closed-cervix pyometra is 25-40%.

3. The rate of recurrence of the disease is 50-75%.

4. The chance of subsequent successful breeding is 50-75%.

 

What happens if neither of the above treatments is given?

The chance of successful treatment without surgery or prostaglandin treatment is extremely low. If treatment is not performed quickly, the toxic effects from the bacteria will be fatal. If the cervix is closed, it is also possible for the uterus to rupture, spilling the infection into the abdominal cavity. This will also be fatal.