Pyometra or Uterine infection in Dogs

Uterine infections (pyometra)

Question: Jessica, my 3 1/2 year old Irish Setter, seems to have an infection in either the uterus and/or anal glands. Bloodwork has come back okay except for a slightly elevated WBC. Was on Keflex & Ampicillin-not responsive. Cultures taken:switched to Baytril doing better. Her stools however still have a very foul, terrible smell. Firm but odorous. Continues to lick herself a lot both anal and pee areas. Baytril prescription runs out in two days-symptoms still present. Is there anything else I could be doing for her? Your thoughts. Thank you

Answer: P-

Uterine infections (pyometra) in dogs are very serious and it is important to be certain that this is not Jessica's problem. Pyometra is fatal if it can not be eliminated by medical or surgical treatment. It is unusual for antibiotics alone to work effectively for a uterine infection. In most cases, either surgical removal of the uterus, or treatment with prostaglandins and antibiotics in combination is necessary in order to resolve uterine infections. Prostaglandins stimulate muscular contractions of the uterus and help it to clear infections by expelling infectious material. It can be hard to be certain that a uterine infection is present, but X-rays will show the enlarged uterus in some cases. Ultrasound examination is a good tool to diagnose this disease, if it is available as a test option. High white blood cell counts are usually associated with pyometra but some dogs have normal or even low white blood cell counts with this disorder. Increased drinking and increased urination are a sign of bacterial toxins associated with pyometra. If these signs are present it is very important to aggressively treat this disorder.

Just in case, it would be very unusual for a spayed female dog to have pyometra, as the uterus is removed during a normal spay (ovariohysterectomy) procedure.

Infection of the anal sacs is usually possible to detect by expressing the contents of the anal sacs and examining them. Most anal sac infections are responsive to antibiotic therapy, at least temporarily, but sometimes it is necessary to remove the anal sacs to resolve the problem long term, as recurrences of infection are pretty common.

Bladder infection, bladder stones and skin infections can also lead to licking of the vulvar or anal areas. Ruling out these disorders might be necessary if the anal sacs and uterus seem to be OK on further examination.

Antibiotic administration will sometimes cause loose stools, an increased odor to the stools or diarrhea. This is more common with cephalexin (Keflex Rx) than enrofloxacin (Baytril Rx), in our practice. However, almost any antibiotic can cause digestive symptoms in a few patients.

It seems likely to me that you are going to have to have further testing done for Jessica, to try to determine the exact cause of the problem that she has. If uterine infection and bladder stones can be ruled out by X-rays, ultrasound and other lab work, then it may be necessary to look for skin disease or other problems. Again, it is very important to be reasonably certain that the problem is not a uterine infection as that is the most life-threatening of the disorders your vet is considering. I think that a recheck is the best next step and then consideration of referral for an ultrasound exam if there is any question remaining of the possibility that a uterine infection is present. If your vet has an ultrasound machine and is adept at ultrasonagraphy then a referral would not be necessary, of course.

Mike Richards, DVM 4/11/2000

Pyometra

Q: Hi Dr. Mike, I really like your site, it is very informative. Unless I missed it, you have no info about pyometras though...... I do know the signs of pyometra on average, but this seems to be a special case.... My 11 year old intact bitch, who has never been sick a day in her life, acquired anal problems last year, and due to her age the Veterinarian didn't want to do surgery, and recommended prednizone, as she could think of nothing else to help. This I did not want to do, but as she became so itchy with the site, we had to do something. She has been doing fine with this for a year now. Well, she always was regular in her heat cycles, every 5 months, but since the pred introduced she hadn't had a cycle in about nine months. In late July she went through what seemed to be a heat, but only known by the males we have. She had no discharge, but every other sign there is. About three weeks after that she was rushed to the vets, and a barium series showed and proved that she was very constipated. A very expensive enema....<G> The same thing happened the next week, only worse, but she cleared up faster. On the x-rays we noted that there might be a splenic tumor, but this seemed to disappear with elimination. Last week, she threw up a major hairball, with fecal matter included, so I think the "growth" has been explained. She had lost appetite, and a change in diet, re more fiber and such, since then and was doing well in the defecating department. But her lost appetite has worried me and then her increased thirst and urination. I was at the time assuming it was from being set back from all that has gone on, and still getting the pred. Then tonight I noticed that she has been licking at her vulva and found a greenish stain in her feathers around the area. It is irritating her badly, so she will get a bath tomorrow and see if this helps. My question is, finally, since it has been 7 weeks since her pseudo heat, could this possibly be an open pyometra? I had always understood that signs should have shown up much earlier than now, but with all that has been going on, maybe I had missed them. But again I would think that she should be much sicker than she is. The other night, she had a bad spell, we felt maybe a reoccurrence, with a mild temperature. We gave her 3cc of penstrep and she has been fine since and even wanted her supper tonight. Am I grasping at straws here, or could it be symptoms of a pyometra?? The greenish discharge, which I have only evidenced on her feathers, really worries me. Thank you for your time. I am sorry for dragging it out, but thought you should know all the details, as you cannot see the poor girl. She is quite happy and content tonight which is confusing me to no end. Sherry

A: Sherry- Any time there is a discharge from the vulva of an intact (unspayed) female dog outside of the normal discharges seen in the estrus (heat) period, pyometra is possible. Since pyometra (uterine infection) can be life threatening in dogs it is always a good idea to check on this with your vet. I have seen open pyometras (a uterine infection in which drainage occurs) which have gone on for several weeks before the infection became serious enough to cause other visible signs so I don't think that this is a particularly unusual situation when the cervix is open and the pus can drain from the uterus. Eventually these usually cause significant problems, just like the closed pyometras in which the pus can't escape, though.

Hopefully this has all been resolved by now but if not, please consider taking her to your vet for an exam.

Mike Richards, DVM

Last edited 12/05/02