The Douglas room, anatomically also "Excavatio rectouterina“Called, denotes a small cavity in the lower pelvis of the woman. As the Latin term reveals, the space is between the uterus, i.e. the uterus, and the rectum, the last section of the large intestine. In the male, the space extends to the urinary bladder due to the absence of the uterus and consequently does not become a Douglas space, but "Proust room" called.
The space is still within the abdominal cavity, surrounded by peritoneum, the so-called "peritoneum". In humans it represents the deepest point of the abdominal cavity. The space is limited from below by the peritoneum, from the front by the uterus and the upper sections of the vagina and from behind by the rectum. At the top, the Douglas space is open to the abdominal cavity with its intestinal loops and abdominal organs, which extends to the diaphragm. For this reason, the Douglas space can be involved in all pathological changes in the abdominal cavity, while at the same time it is in close spatial relationship to the vagina and the uterus.
The Douglas space does not have its own function for the body, it is merely an anatomical feature. Due to its location as the deepest point of the abdominal cavity, it is often affected by malignant and inflammatory processes.
Anatomical differences in women and men
In women, the Douglas space describes the gap between the rectum and the uterus and is the deepest point of the abdominal cavity when standing. In Latin it is therefore also referred to as the Excavatio rectouterina ("rectum-uterine cavity"). The urinary bladder lies in front of the uterus. Between the uterus and the urinary bladder there is another pocket-shaped depression called the excavatio vesicouterina ("bladder-rectal cavity").
Does the man have a Douglas room too?
The Douglas space is the colloquial clinical term for the lowest point of a woman's abdominal cavity while standing and is also used in medical terminology as Excavatio rectouterina designated. It is located between the uterus (uterus) and the rectum and represents a depression that can reach the back of the vagina.
Of course, a man also has a deepest point of the abdominal cavity when standing - however, this is not called the Douglas space but the Proust space. In medical terminology, it is also known as the rectovesical excavation. The Proust space is located between the male urinary bladder and the rectum.
Function of the Douglas space
In healthy people, the Douglas space is a free cavity within the abdominal cavity and therefore has no function of its own.
In women, it separates the rectum and uterus from each other. Its walls are lined with peritoneum. This consists of a thin layer of cells, a so-called epithelium. The peritoneum continuously secretes a thin film of liquid which, like a lubricant, makes it easier for the organs to slide past each other during various movements. It is also traversed by a network of blood and lymph vessels and nerves. They are important for defense against disease and sensitivity to pain.
In the so-called peritoneal dialysis or peritoneum dialysis, a procedure in which the peritoneum takes over the filter function of the kidneys, the Douglas space is used as a fluid reservoir.
How can you feel the Douglas room?
Normally, the examiner palpates the Douglas space via the rectum or the rearmost section of the intestine.
The patient lies on his side with his legs bent. The use of gloves and lubricants make the examination as painless as possible. The Douglas space is located in front of the rectum. Therefore, the examiner can now examine it from the inside by palpating the anterior wall of the rectum. Alternatively, the Douglas space in women can also be palpated via the back wall of the vagina as part of a gynecological examination.
Douglas space pain
Douglas space pain can have different causes. Because of the location of the Douglas space, they are usually perceived as abdominal pain.
Initially, pain affecting the Douglas cavity is mainly felt by women during sexual intercourse. This irritates the back wall of the vagina, which can be directly adjacent to the Douglas space in the upper third. Common causes are pain caused by diseases of the surrounding organs. Mostly these are rectum, uterus, ovaries and vagina. Pain in these organs can radiate into the Douglas space.
The wall of the Douglas space consists of peritoneum, which can become inflamed. This inflammation is called peritonitis.
Inflammation within the abdomen, such as appendicitis, can lead to the formation of a so-called Douglas abscess. Here, purulent substance from the actual inflammation gets into the Douglas space and encapsulates itself there.
The neighboring organs, especially the uterus and rectum, can break into the Douglas space. This so-called intestinal hernia is also called Douglas cele in the Douglas space. If it pushes forward, it can usually be felt on the back wall of the vagina.
Another possible cause of Douglas space pain is endometriosis. This disease is widespread and occurs when the lining of the uterus grows outside of the uterine cavity. This is possible throughout the body. Due to its proximity, however, the Douglas area is particularly often affected. Endometriosis is basically benign, but it is fully functional uterine tissue. That is why it takes part in hormonal action and menstrual cycle. Complaints often arise in connection with the menstrual cycle. Symptoms are increased menstrual bleeding and pain, as well as menstrual disorders. It can also lead to infertility. When the menopause is reached, the symptoms subside.
So-called ectopic pregnancy is more dangerous. The fertilized egg does not migrate into the uterus, but leaves the fallopian tubes and falls into the abdominal cavity, where it can grow into place and trigger a pregnancy within the abdominal cavity. Again, the Douglas space, the lowest point in the abdominal cavity, is particularly at risk.
Fluid in the douglas space
Fluid in the Douglas space is a common finding in women and can have very different causes. Because the Douglas space represents the deepest point within the peritoneum, all free fluids of the abdominal cavity collect there when standing and sitting. There does not have to be a disease behind this and not every accumulation of fluid requires therapy. However, the doctor should examine any fluid buildup to rule out disease. In some cases, a harmless cyst that produces fluid is the cause.
Read more on the subject: Cysts on the uterus or ovary
The accumulation of fluid is often a side effect of diseases of the abdominal organs. In the context of inflammation of the peritoneum, the so-called "Peritonitis“, Or the inflammation of organs creates a purulent secretion at the focus of inflammation. Due to the force of gravity, the secretion flows into the Douglas space. Bleeding in the abdomen can also drain into the Douglas cavity. Even with malignant tumor diseases, cells can split off and get into the Douglas space. The peritoneum of the Douglas fir area can be affected by what is known as endometriosis. This is a disease of the lining of the uterus. The tissues of the uterus mistakenly grow outside the uterus and inside the douglas space. Although the disease often does not cause symptoms in those affected, it should still be treated. This can also lead to large accumulations of fluid within the Douglas space.
Puncture of the Douglas space
During a puncture, the doctor punctures an elongated hollow needle into the area to be examined and, if available, aspirates liquid. The liquid obtained is called puncture. This can then be examined in detail in the medical laboratory for its components. A puncture is performed to clarify accumulations of fluid and for a more precise diagnosis.
The Douglas space is not too easy to reach from the outside, which is why a puncture is made through the vagina or the rectum, but sometimes also through the abdominal wall. In men, the room can only be reached directly via the rectum. In order to be able to puncture more precisely, the procedure is controlled by means of CT recording.
With the help of the puncture, a certain pathogen can be determined in the event of an inflammation, to which the therapy and antibiotic treatment can be directed. If there is a suspicion that malignant cells are present in the abdomen (in the context of a tumor disease), these can also be determined in the puncture. If there is bleeding in the abdomen, it can be diagnosed with a puncture of the Douglas cavity.
A puncture can also be used to flush the Douglas space with fluid and clean it if it is affected by inflammation. A puncture is usually done without consequences and under local anesthesia.
Diseases affecting the Douglas space
Common diseases in the Douglas area are:
An inflammation in the Douglas space can develop if the mucous membrane there comes into contact with germs. This is especially the case with inflammation of the peritoneum. Such peritonitis results from the spread of bacteria, viruses and other pathogens into the abdominal cavity. A generalized infection of the body is rarely the cause.
More often, the bacteria enter the abdominal cavity, for example through a damaged intestine. In the case of perforations, bacteria emerge that are otherwise only located within the gastrointestinal tube. As a result of intestinal inflammation such as appendicitis or diseases such as Crohn's disease or ulcerative colitis, ruptures in the intestinal wall can occur. Operations on the abdomen can also lead to the spread of germs. The result is a purulent inflammation of the peritoneum, the purulent fluid of which accumulates in the Douglas space. The liquid can encapsulate itself there and form an inflammatory abscess. Abdominal pain (especially during bowel movements) and fever are common consequences.
Inflammation in the small pelvis can also migrate to the Douglas space. The outer wall of the uterus, fallopian tubes and ovaries are particularly affected. The diseases that are known as "Perimetritis"And" Adnexitis "are called, often accumulations of secretions and abscesses form in the Douglas space due to their spatial proximity. A diagnosis can be made using ultrasound, blood and puncture examinations. This inflammation can be treated with drugs or surgery.
Take the self-test: Abdominal Pain - What Do I Have?
Douglas cavity cyst
The term cyst is used to describe a cavity enclosed by an epithelium. It can be filled with different liquids, pus or air. Cysts in the Douglas space usually form on the ovaries. These are usually benign and do not require any therapy. A cyst can develop on the ovaries primarily as a result of hormonal stimulation from the menstrual cycle. This is called a functional cyst. A disturbed hormonal balance seems to increase the formation of cysts on the ovaries.
Read more under the topic: Cysts on the ovaries
Nonfunctional uterine cysts are a number of cysts of different, non-hormonal causes. Since some types can be dangerous, a cyst in the Douglas space requires a doctor's evaluation.
Tumors can be benign or malignant. A malignant tumor can form metastases, i.e. small settlements of its origin in foreign tissue. Tumors of the gastrointestinal tract form a large group of all cancers. You and other tumors of the abdominal cavity, for example on the ovaries, the liver or the pancreas, can form metastases in the peritoneum. If that is the case, one speaks of a "Peritoneal carcinosis'.
The cancer cells spread through the bloodstream or directly within the abdominal cavity by detaching the tumor cells and making contact with the inner abdominal wall. The so-called "Krukenberg tumor“Describes the infestation of the Douglas space with tumor cells, which in most cases originate from signet ring cell carcinoma of the stomach.
With the help of a puncture and a subsequent cytological examination, the malignant cells in the Douglas space can be determined and the suspicion of peritoneal carcinosis can be confirmed.
Other tumors that can spread into the Douglas space originate in the woman's ovary or the endometrium, the lining of the uterus. The endometriosis in the Douglas fir, which affects many women, can in some cases be a precursor to the development of carcinoma.
Endometriosis in the Douglas space
Endometriosis is a common chronic disease that can affect women. Cells of the uterine lining do not settle inside the uterus, but outside it. In affected women, this can lead to severe pelvic pain, especially during menstruation. It is not a malignant change, but in many cases it can also lead to infertility. In extreme cases, adhesions in the abdominal cavity must be removed by surgery in order to avoid possible subsequent organ changes.
Read more on this topic at: Endometriosis
A woman's Douglas space is the lowest point of the abdominal cavity when standing. He is also called Excavatio rectouterina designated. It represents a depression between the rectum and the uterus (uterus). If endometriosis occurs in the Douglas space, additional pain can occur during bowel movements or sexual intercourse. The cause of endometriosis in the Douglas space is suspected to be a transfer of mucous membrane cells via the female fallopian tubes into the lower abdominal cavity.
You might also be interested in: Treatment of endometriosis
Can endometriosis in the Douglas space affect the desire to have children?
Douglas space endometriosis is more likely to affect a woman's fertility. Adhesions within the Douglas space interfere with the absorption of the cracked egg from the ovary into the fallopian tube, so that the egg cannot get into the fallopian tube and thus no fertilization by sperm can take place.
There are also other causes that can lead to infertility in a woman due to endometriosis. For example, the uterus quickly becomes overactive due to endometriosis, which means that the sperm cells that enter during sexual intercourse only remain in the fallopian tube for a shorter time and thus the probability of the egg cell being fertilized is significantly reduced.
You might also be interested in this: Causes of Infertility
Another cause of a woman's possible infertility can be inflammation caused by endometriosis, which in turn causes chronic irritation of the abdominal cavity. The fallopian tubes stick together so that the cracked egg can no longer get into the uterus.
One possible therapy is the surgical removal of ovarian cysts and adhesions within the abdominal cavity. If the operation is carried out successfully, it is highly likely that a woman's fertility can be increased.