Uterine Flushing to Cure Pyometra in Dogs

Uterine Flushing to Cure Pyometra in Dogs

 

What is Uterine Flushing?

When an unspayed dog goes into heat, the uterine lining swells to prepare for pregnancy. If swelling persists after the heat cycle and becomes infected, a condition known as pyometra occurs, which is a serious uterine bacterial infection that can be fatal. In addition, infections or retained tissues can occur in the uterine lining after parturition of puppies. When tissue is retained in the uterus, it requires flushing to remove necrotic tissue, bacteria, and retained tissues for treatment of the infection. Without removal of these infected materials, treatment will not be successful and a fatal infection can develop. Uterine flushing is performed under anesthesia by your veterinarian.

What is pyometra?

Pyometra, or pyometritis (in Greek, pyo means pus and metritis means uterine inflammation) is a disease that’s seen more often in unspayed dogs over the age of five – but it can occur at a younger age as well.

There can be many causes of pyometra, yet the main one is a combination of hormonal changes that happen within the heat cycle of your dog. Every heat cycle, there’s a natural reduction of white cells from the uterus to allow for safe sperm passage, causing a lapse in protection that can decrease the ability to fight infection. In most dogs,  these heat cycles usually occur twice per year.In nature, most dogs would breed and either produce puppies, abort or not conceive because of another underlying condition, lack of nutrition, stress in the environment, etc.When dogs continue to go through estrus (heat) without being bred, their progesterone levels remain elevated for eight to ten weeks – this thickens the lining of the uterus in preparation for pregnancy. The entrance to the uterus is the cervix, which remains tightly closed, except during estrus when it can allow bacteria that are normally found in the vagina into the uterus.In a normal, healthy uterus, the environment isn’t susceptible to bacteria, but when the lining continues to thicken with every estrus, some dogs will have a tendency to produce cysts that can start to expel large amounts of fluid. When progesterone levels are high, it decreases the ability of the muscles of the uterine wall to contract, which inhibits the ability to naturally discharge the fluid and bacteria inside.

The unhealthy uterine cavity will continue to fill with discharge. And the dog’s body temperature, along with the absence of circulating air inside the uterus, creates perfect conditions for bacterial growth. This bacterial growth can lead to an infection of the uterus, or pyometra.

Pyometra is a secondary infection that occurs as a result of hormonal changes in the female’s reproductive tract. Following estrus (heat), the hormone progesterone remains elevated for up to two months and causes the lining of the uterus to thicken in preparation for pregnancy. If pregnancy does not occur for several consecutive estrus cycles, the uterine lining continues to increase in thickness until cysts form within the uterine tissues (a condition called cystic endometrial hyperplasia). The thickened, cystic lining secretes fluids that create an ideal environment for bacterial growth.

In addition, the muscles of the uterus cannot contract properly either due to thickening of the uterine wall or the high levels of the hormone progesterone. This means that bacteria that enters the uterus and fluids that have accumulated cannot be expelled.

During estrus, white blood cells, which would normally protect against infection by eliminating bacteria, are inhibited from entering the uterus. This normal occurrence allows sperm to safely enter the female’s reproductive tract without being damaged or destroyed by these immune system cells.

The combination of these three factors can often lead to life threatening infection.

How do bacteria enter the uterus?

The cervix is the gateway to the uterus. It remains tightly closed except during estrus, when it relaxes to allow sperm to enter the uterus.

“If the cervix is open or relaxed, bacteria can easily enter the uterus.”

If the cervix is open or relaxed, bacteria that are normally found in the vagina can easily enter the uterus. If the uterus is ‘normal’, the uterine environment prevents bacterial survival; however, when the uterine wall has become thickened or cystic, due to cystic endometrial hyperplasia, perfect conditions exist for bacterial growth.

What else can cause changes in the uterus?

The use of progesterone-based drugs can cause changes in the uterus similar to the estrus cycle. In addition, estrogen or synthetic estrogen drugs will increase the effects of progesterone on the uterus. Drugs containing both estrogen and progesterone are sometimes used to treat certain conditions of the reproductive system. Any intact female receiving hormones must be carefully monitored for the development of pyometra.

 When does pyometra occur?

Pyometra may occur in any sexually intact young to middle-aged dog; however, it is most common in older dogs.

“Pyometra usually occurs two to eight weeks after the last estrus.”

After many years of estrus cycles without pregnancy, the uterine wall undergoes the changes that promote this disease. Pyometra usually occurs two to eight weeks after the last estrus (heat cycle).

The Two Types Of Pyometra

There are two types of pyometra: Open and Closed.

Open pyometra occurs when the cervix is open. The open cervix gives the fluid a way to discharge.

Closed pyometra is when the cervix is closed. When the cervix is closed, there is no way for the infection and fluid to discharge – so the uterus continues to fill, leading to toxicity from the bacteria and if enough fluid builds up, the uterus can actually rupture.

This can cause septic infection and even death.Closed pyometra typically ends in surgery because the infection has no place to drain. But in the case of open pyometra, there are several treatment options at your disposal – but the first and most important thing is to first have your veterinarian diagnose your dog.

What are the clinical signs of pyometra?

The clinical signs depend on whether or not the cervix remains open. If it is open, pus will drain from the uterus through the vagina to the outside. Pus or an abnormal discharge is often seen on the skin or hair under the tail or on bedding and furniture where the dog has recently laid. Fever, lethargy, anorexia, and depression may or may not be present.If the cervix is closed, pus that forms is not able to drain to the outside. It collects in the uterus ultimately causing the abdomen to distend. The bacteria release toxins that are absorbed into the bloodstream. Dogs with closed pyometra become severely ill very rapidly. They are anorectic, very listless and very depressed. Vomiting or diarrhea may also be present.Toxins released by the bacteria affect the kidney’s ability to retain fluid. Increased urine production occurs, and many dogs drink an excess of water to compensate. Increased water consumption may occur in both open- and closed-cervix pyometra.

Pyometra Signs And Symptoms

Signs of pyometra can appear anywhere from two to eight weeks after your dog’s heat cycle, but we have seen them as late as 12 weeks.

The signs of open pyometra include:

• Any excessive licking after their heat cycle.
• Vaginal discharge (usually white, yellowish or green but it can also start off clear).
• The dog can seem a little “off” in behavior (if they are usually cuddly, they may become distant, or the opposite: becoming needy rather than their usual independent nature).
• They may be depressed, grumpy with other dogs or people, etc.
• They may drink more often than usual, or become lethargic or picky with their food.

The signs of later stage or closed pyometra include:

• Lethargy/weakness
• Excessive panting
• Increased thirst and water craving
• Anorexia
• Distention of the abdomen
• Vomiting
• Fever often 104 to 106

If your dog exhibits even one of the following symptoms after her heat, seek veterinary help immediately. The most important thing is to catch any of these symptoms early! 

How is pyometra diagnosed?

Dogs that are examined early in the course of the disease may have a slight vaginal discharge and show no other signs of illness. However, most dogs with pyometra are seen later in the illness. A very ill female dog with a history of recent heat that is drinking an increased amount of water should be suspected of having pyometra. This is especially true if there is a vaginal discharge or a painful, enlarged abdomen.

“A very ill female dog with a history of recent heat that is drinking an increased amount of water should be suspected of having pyometra.”

Dogs with pyometra usually have a severe elevation of the white blood cell count and often have an elevation of globulins (a type of protein often associated with the immune system) in the blood. The specific gravity (concentration) of the urine is generally low due to the toxic effects of the bacteria on the kidneys. However, these changes are non-specific and 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 be inconclusive. An ultrasound examination may be helpful in identifying an enlarged uterus and differentiating that from a normal pregnancy. Ultrasound changes that indicate pyometra include increased uterine size, thickened uterine walls, and fluid accumulation within the uterus.

Conventional Treatment Options For Pyometra

Aglepristone

This is a synthetic steroid.

Historically, aglepristone has been shown to disengage progesterone’s support of pregnancy by blocking its receptors. By taking over the progesterone receptors, the drug also removes the effect progesterone plays in containing pyometra, allowing the dog’s natural uterus purging mechanism to occur.

This treatment is said to be quick and very gentle, and may help avoid surgery and that’s a good thing. However, your dog may experience inflammation and pain at the injection site.

Prostaglandins

These are a group of hormones that destroy the corpus luteum (a hormone secreting body in the female reproductive system). They have uterotonic effects, reduce the blood levels of progesterone and are known to relax and open the cervix, and contract the uterus to expel bacteria, fluid and pus.

Again, avoidance of surgery is the benefit of prostaglandin treatment, however there are several drawbacks, including:

1. Side effects such as restlessness, panting, vomiting, defecation, salivation, and a painful abdomen.
2. If the treatment isn’t successful, the dog is even sicker and a poorer candidate for surgery and recovery.
3. Many veterinarians believe that because prostaglandins cause the uterus to contract, there’s a risk of the uterus rupturing, which can result in infection and acute kidney failure.

Aglepristone And Low Dosage Prostaglandins

These two treatments are sometimes combined. According to reproductive veterinarians, the two combined treatments offer the best solution, as long as the prostaglandin therapy is given in very low doses.

Estrogens

Estrogens are potentially effective, but come with worrying side effects such as further damage to the endometrium and potential bone marrow suppression. Many vets consider these risks far outweigh the benefits.

Homeopathic Remedies After Spay

Even if your dog ultimately has to undergo surgery, she’ll benefit greatly from getting remedies post-op. They will hasten her recovery. Most vets will be fine with you visiting your dog and giving her these remedies to help her recover faster.

Here’s the protocol:

1. Arnica 1M as soon as she’s awake to help with the physical and emotional trauma. Give this once every hour for three doses, followed by…
2. Bellis perennis 1M for deep abdominal muscle trauma and pain, given every once hour for three doses.

 

First Step: Aconite 1M

Give this remedy as soon as you even suspect something is off. Crush dry pellets and place them right on the tongue or gums. This is the only remedy you will give dry … the rest will be given by liquid.

Now go on to choose the next remedy.

Sepia 1M

For breeders, this dog could be the one who is not very interested in breeding or has a hard time going to term in her pregnancy, either due to abortion or delivering prematurely. She’s not the best mother or she becomes very depressed post-partum.

Often there will be a history of irregular heat cycles. If she has never been bred, then she is the dog who is usually very work oriented and confident, but becomes tired, depressed, worn out looking and worried. She may have had a history of urinary tract infections.

The labia are usually very swollen and the discharge is thick, often lumpy, colored anywhere from white to yellow to green. It’s really itchy – even burning – so you’ll see her licking or rubbing herself on the rug or her bed. If she is nauseated, it’s often in the morning.

Modalities (what makes her better or worse): Better from exercise; she’ll perk up if you take her for a walk; wants to be warm; seeks out the sun or fireplace … may want to be covered up; worse from cold air or drafts.

Pulsatilla 1M

This is the cute, sweet dog who, on a good day, wants attention and to be smothered in kisses – but if she’s sick, she sticks to you like glue! She wants to be carried and even if she’s too big, she wants to sit on your lap, your feet, as close as she can be, clingy and always touching you. She may have been the puppy that had submissive urination or could have had puppy vaginitis.

The discharge is usually very thick but milky or yellow in color and acrid, so the skin around the discharge and her vulva can be red and sore. Because it’s so sore, your dog probably won’t rub herself on the rug or bed as you might see in the Sepia case.

Modalities: worse from the heat or stuffy rooms; you may see her lying down by a window to get open air or even though she is clingy she may want to be outside then come inside then go out again.

Don’t confuse this with restlessness: she just wants to be with you but also needs fresh air.

Pyrogenium 1M

This remedy is for extreme septic states, but if your dog has these symptoms you must work very closely with your veterinarian! In a case with these symptoms, your dog will need to be hospitalized and on IV fluids; she should continue to fully discharge and her vitals should be good.

Pyrogenium is a homeopathic preparation made from rotten meat pus. Yes, it’s disgusting but that’s why it’s used for septic states. It’s a good remedy to have on hand and you can ask your veterinarian to use it.

Uterine Flushing Procedure in Dogs

When retained uterine lining occurs, spaying is usually considered as a primary solution. However, when infection is extensive preventing spay or when other considerations are present, flushing of the uterus may need to be performed in conjunction with administration of antibiotics to combat infection, prior to a spay procedure or to preserve reproductive function in some dogs. Prior to uterine flushing, your dog will need to be fasted from food for 12 hours to allow for safe administration of general anaesthetic. In emergency situations, as is often the case when uterine infection is present, fasting may not always be possible. After sedation and anesthetization, the perineal area is antiseptically cleaned prior to the procedure. A catheter or pipette is passed through the cervix into the uterus to drain pus and provide a vector for flushing with sterile solution. A bovine insemination pipette may be used for this procedure. A laparotomy, midline abdominal incision, may be made to aid in the procedure and locate the uterus and cervix and ensure location of the pipette or catheter for flushing procedure. Solution used for uterine flushing may include saline containing prostaglandin which causes cramping in the uterus, which helps slough off retained materials in the uterus as flushing is being conducted. Other solutions such as povidone-iodine an antibacterial cleanser or Betadine saline may be used. In these cases, prostaglandin will be injected to induce uterine cramping to aid in the flushing process. Fluid is infused into the uterus carefully so as not to cause undue pressure on the fallopian tubes, which could cause infection solution to enter the bloodstream. Access to the uterus through a laparoscopy will allow the veterinary surgeon to manipulate your dog’s uterus as required to ensure adequate placement of flushing device and that flushing material is infused throughout the uterus, including the uterine horns, by gentle manipulation of the uterus during the procedure. The uterus can be massaged this way to mix exudate with the flushing materials. Uterine flushing material and infected materials are then aspirated out of the uterus with a syringe attached to the inserted catheter or pipette. The process of introducing flushing material, manipulating uterus and aspirating contents is repeated as necessary to remove all infected material and exudate. The pipette is then removed from the vagina and the vagina irrigated to flush any infected uterine content out The surgical incision for the laparoscopy, if performed, will be closed. Supportive care will be provided as needed during recovery from anesthesia. Intravenous fluids and antibiotic to address pyometra are provided.

Efficacy of Uterine Flushing in Dogs

Treatment of uterine infection requires the removal of retained tissues and bacteria in the uterus by flushing for successful treatment. Antibiotics alone will not resolve the condition. This condition is very serious and if left untreated the animal’s condition will dissolve quickly, putting her at risk for serious complications that may prove fatal. Success of treatment and recovery depends on prompt treatment to address uterine infection.

Uterine Flushing Recovery in Dogs

Intravenous fluids and antibiotics will be administered for 24 hours post surgery and antibiotics may be given for several days afterward. Dogs with this serious condition may remain hospitalized for 24 hours to several days or more prior to release home, depending on their condition. Vaginal discharge should be monitored for signs that infection is dissipating. If infection remains, or worsens, further procedures may be required. Vaginal discharge should cease within 10 to 14 days. Any sutures from laparoscopy may need to be removed 10 to 14 days post-procedure. Observe your dog for any signs of hemorrhaging or increased illness and seek veterinary attention immediately should these occur.

DR. V.KUMAR,CHENNAI.

REFERENCE-ON REQUEST.

https://www.pashudhanpraharee.com/pyometra-in-dogs/

 

https://vcahospitals.com/know-your-pet/pyometra-in-dogs