What is the Pouch of Douglas?

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  • Written By: Mary McMahon
  • Edited By: O. Wallace
  • Last Modified Date: 10 December 2018
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The pouch of Douglas is the lowest area of the peritoneal cavity in women. It is a small extension of the peritoneal cavity which lies between the uterus and the rectum. This structure is named after Dr. James Douglas, a Scottish physician who worked in the 18th century and was especially interested in this area of the anatomy. Several other anatomical features are named for Dr. Douglas, recognizing his contributions to the understanding of human anatomy.

Terms such as “rectouterine pouch” and “cul de sac” are sometimes used to refer to the pouch of Douglas. The structure is long and narrow, open at the top and closed at the bottom. Because of its position at the bottom of the peritoneal cavity, it can serve as a drainage point for fluids in the cavity. This can lead to medical problems; malignant growths may spread to the pouch of Douglas, and women can experience discomfort if the pouch of Douglas fills with fluid, pus, and other materials.

Due to concerns about the fact that the pouch of Douglas can act as a collection point for materials in the peritoneal cavity, a doctor may recommend examination of the area if a woman has a medical issue which involves the peritoneal cavity. The examination can be used to determine whether or not the pouch of Douglas has become involved, and to identify emerging complications which could threaten reproductive health, such as infections which could penetrate the uterine wall.


In a procedure known as peritoneal dialysis which is sometimes used to treat kidney failure, the peritoneal cavity is regularly bathed with a dialysate solution which may be introduced through the pouch of Douglas in women. In this case, a catheter is placed into the structure and is used as a semi-permanent port to introduce dialysate fluid and to allow for drainage of the fluid.

In a procedure known as culdoscopy, an endoscope is introduced to the pouch of Douglas through the vagina for the purpose of examining the interior. This may be done for the purpose of preparing for a procedure such as a fluid drainage, or to look for signs of abnormalities which could be involved in a medical diagnosis. The structure can also be visualized with a medical imaging study such as an MRI scan if a doctor suspects that a woman has endometriosis, adhesions, or other abnormalities inside the pouch of Douglas.


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Post 14

My daughter was diagnosed with PID - Pelvic Inflammatory Disease after an ultrasound was done on her. She has a normal sized non-gravid uterus and collection of fluid in pouch of Douglas?

Post 13

I have seen only minimal fluid in the pouch and one tube is blocked after an SSG test. Can someone let me know what are the chances I can get pregnant?

Post 11

My sister-in-law has undergone tests for the pouch of Douglas. In that report, they have mentioned not free of fluid in the pouch of Douglas. What does that mean? She is 23 and hasn't been pregnant. Can anyone clarify?

Post 9

I have a complex cyst in my right ovary and minimal free fluid is also present in the pouch of Douglas. During periods my lower abdomen hurts a lot, especially the left part and it lasts for a long time. I also vomit a lot during this time. Please suggest something.

Post 7

I have just been told that i have fluid in my pouch of douglas, but my doctor has said that there is nothing i can do about it. it causes a lot of pain and is extremely uncomfortable down there! i would like to know if i should get a second opinion?

Post 6

I have just been told that I have a cyst in the Pouch of Douglas. What does this mean?

Post 5

i have been scanned many times and was told i have fluid in my cul de sac. i have taken many medications but the fluid is only reduced. what do i do?

Post 4

After my laparoscopy yesterday I was told I have quite extensive endometriosis, including in a type of "pocket" area behind the womb and I'm wondering if this is the Pouch of Douglas? If anyone has any info which would be helpful, I'd be grateful to hear it.

Post 3

@CopperPipe -- You're right, a collapsed cyst can be a cause of fluid in the pouch of Douglas.

Other potential causes include endometriosis, although more than fluid in the area is needed for a diagnosis of endometriosis.

Finally, fluid in the pouch of Douglas can also occur after ovulation as just a normal part of the menstrual cycle.

If you have any pain in the area, or suspect that you may have fluid in your pouch of Douglas, you should consult your doctor, just in case.

Better safe than sorry!

Post 2

What can be some causes of free fluid in the pouch of Douglas?

I've heard that it can be the sign of a cyst that has collapsed, but wasn't sure.

Does anybody know?

Post 1

It is important to differentiate between the pouch of Douglas and the pouch of Morrison.

While the one is in the peritoneal cavity, the other (Morrison's) is between the liver and the right kidney.

This pouch can also fill with fluid and become infected, just like the pouch of Douglas, and in some cases can require urgent surgery for endometriosis.

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