Pyometra in dogs (i.e. infected uterus) is an emergency, because it can make dogs extremely sick and may even be life-threatening. To teach you more about this condition, integrative veterinarian Dr. Julie Buzby invites emergency veterinarian Dr. Kathryn Williams to the blog. Dr. Williams frequently cares for dogs with pyometra at her emergency clinic, which is why she is so passionate about educating others about how to recognize, and most importantly, prevent pyometra.
One of the things I love about emergency medicine is the variety of cases I see on a daily basis. Even dogs suffering from the same condition can present differently. Nothing illustrates that point better than the cases of Princess and Bella. These two dogs had the same life-threatening disease, but looked very different when they came to my emergency clinic.
The “tail” of two pyometras
Princess was a 10-year-old female Chihuahua who presented to me on the emergency for not wanting to eat, vomiting, and feeling lethargic. When I first started examining Princess, you could tell she was miserable. She had barely eaten in days, and all she wanted to do was sink down on the table.
On bloodwork, Princess’ white blood cell count was extremely low. I was concerned this meant her white blood cells were swarming to somewhere in her body to fight a serious infection. As it turns out, I was right. Princess’ X-rays revealed a dilated uterus, consistent with a severe uterine infection called pyometra.
Bella, on the other hand, was a happy-go-lucky two-year-old female Golden Retriever who presented to my emergency clinic for a suspected urinary tract infection (i.e. UTI in dogs). Her parents reported she was drinking more, urinating more, and had some blood dripping from her vulva. Her appetite was slightly decreased, but the owners figured that was from the discomfort of her UTI.
As I used an ultrasound to get a sterile sample of urine from her bladder, I also saw fluid in her uterus. This raised some red flags in my mind that we might be dealing with more than a UTI. Sure enough, when I examined a swab of the dog’s vaginal discharge under the microscope, I saw white blood cells and bacteria. Coupled with the images from the ultrasound, this meant Bella had a pyometra.
What is pyometra in dogs?
I explained to Princess and Bella’s parents that their dogs had a uterine infection called a pyometra. But not all pyometras are created equal. In fact, there are three main types of pyometra. This explains why Bella and Princess acted so different despite having the same condition.
Closed pyometra
Princess had a closed pyometra, meaning her cervix was closed, trapping pus and bacteria inside her uterus. Dogs with closed cervix pyometra are very sick because the toxins produced by the bacteria build up in the blood stream and can’t escape.
Open pyometra
Bella had an open pyometra, meaning her cervix was open, which allowed some pus to drain out. Dogs with open pyometra tend to have milder signs but still need immediate attention.
Stump pyometra
There is a third condition called stump pyometra, which occurs in spayed dogs. If some ovarian and uterine tissue is left behind during a spay, the hormones from the ovarian tissue can influence the residual uterine tissue. This may lead to a pyometra in the uterine stump (i.e. the leftover uterine tissue).
What causes pyometra in dogs?
As alluded to, the ovaries create hormones (namely estrogen and progesterone) that will influence a dog’s estrous cycle (i.e. heat cycle). During the estrous cycle, the uterus prepares for a potential pregnancy. Meanwhile, eggs in the ovary develop to the point that they could be fertilized if the dog is bred. If no pregnancy develops, the body will go back into a resting phase until it is time for the next cycle to begin. The cervix (i.e. the “gateway” between the uterus and the vagina) may be open or closed depending on the phase of the cycle.
When a dog is in heat (i.e. estrus), the cervix is open to allow sperm in to fertilize the eggs. However, the open cervix not only allows sperm into the uterus, but can allow bacteria to enter the uterus as well. The bacteria can be normal flora that naturally live on the skin, bacteria from a urinary tract infection, or even bacteria from feces.
Additionally, blood flow to the uterus increases and the uterine lining changes in order to support a potential pregnancy. This can cause the lining of the uterus to become more thickened with each cycle. These changes provide the perfect environment for bacteria to set up an infection.
Which dogs tend to get pyometras?
Because of the additive effect of years of heat cycles, middle-aged or older intact female dogs are more prone to developing pyometra. However, it can also occur in young dogs. Typically, dogs will begin to show signs of a pyometra about one to two months after they were in heat.
What are the symptoms of pyometra in dogs?
As you noticed in the stories of Princess and Bella, the signs of a pyometra can vary significantly from dog to dog. Some of the more common symptoms include:
- Decreased appetite
- A lethargic dog
- Fever
- Increased thirst in dogs
- Increased urination
- Brown, red, or white vaginal discharge which may have a foul odor
- Distended abdomen (a pot bellied dog)
- Vomiting
- Diarrhea
If a dog is showing these signs, immediately contact your vet or head to the emergency clinic for an emergency vet visit. Left untreated, pyometra can lead to sepsis, a ruptured uterus, and even death due to the toxic effects of the bacteria.
How is pyometra diagnosed?
At the emergency clinic or your vet’s office, the vet will use a variety of diagnostics to determine if pyometra is present. These include:
Baseline bloodwork
The complete blood count (CBC) may show a high white blood cell count if the immune system has dumped more white blood cells into the bloodstream in response to the infection. Or, like Princess, the white blood cell count may be low if all of the white blood cells are being pulled out of the bloodstream and sent to the uterus. Your dog may also have a low red blood cell or platelet count from the infection.
In addition to using the CBC for diagnosing a pyometra, the results of the CBC and chemistry profile will also help determine how stable the dog is for surgery. Sometimes the bloodwork may indicate there are other treatments the vet can perform to help reduce risks during surgery.
X-rays
The vet may be able to visualize the distended uterus on X-rays. It will appear like a grey “snake” that runs between the region of the bladder and the region of the kidneys.
Ultrasound
This is an excellent tool to determine if pyometra is present. On ultrasound, the uterus will be full of fluid and the vet may see inflammation around the abdominal organs (i.e. peritonitis).
What is the treatment for pyometra?
Once the vet diagnoses your dog with a pyometra, the discussion will quickly turn to treatment. Surgery is the preferred method for treating pyometra. There is a medical treatment option as well but it is far from ideal.
Pyometra surgery in dogs
Prior to surgery, the veterinary team will give your dog IV fluids to help rehydrate her and stabilize her blood pressure before undergoing anesthesia. Then the veterinarian will surgically remove the uterus and ovaries, thus removing the source of the infection. The surgery is essentially a spay. However, it carries more risks than a routine spay because patients with pyometra tend to be extremely sick.
There is also the risk of the diseased uterus opening during surgery and releasing pus and bacteria into the abdomen. The veterinarian will take great care to prevent this from happening. Plus, he or she will flush the abdomen with sterile saline after removing the uterus to try to reduce any bacteria that might be present. As an additional layer of safety, the veterinary team will often administer antibiotics during and after surgery. This is a way to address any bacteria that might have entered the blood stream.
The video below shows images of a normal uterus and a pyometra (infected womb). A word of warning, if images of internal organs are unsettling, please skip this video.
Medical treatment for pyometra
In the cases of highly valuable breeding animals in the early stages of pyometra, medical management is sometimes an option. The vet can use prostaglandins, a type of hormone, to open the cervix and cause the uterus to contract in an attempt to eliminate the infection. However, this is risky and comes with unpleasant side effects.
The uterus could rupture and release infected material into the abdomen, which is sometimes fatal. Also, the side effects of prostaglandins can include abdominal pain, vomiting, panting, and a high heart rate.
Treatment usually involves multiple days of hospitalization. Plus, the dog needs to be bred on the next cycle to try to reduce the risk of reoccurrence. Even with this treatment, it is possible that pyometra may occur again in the future. So it is best to spay her when her owners are no longer using her for breeding.
How do you prevent pyometra in dogs?
While it is good that there are ways to treat pyometra, it is still a life-threatening condition. Sadly, not all dogs with pyometra will survive, which is unfortunate because pyometra is almost always preventable.
As we’ve discussed, hormones play a significant role in the thickening of the uterine lining and opening of the cervix that predisposes dogs to pyometra. So, the best method of prevention is getting rid of those hormones by spaying your dog when she is young and healthy. This approach has a much better chance of a good outcome than waiting on the surgery until your dog has a life threatening infection.
What is the ideal time to spay my dog?
In terms of the exact timing of the spay, that is something you should discuss with your dog’s veterinarian. Previously, many vets recommended having a dog spayed by four to six months old. However, that is no longer necessarily the case, in part due to a 2020 study conducted by UC Davis.
This study looked at the rate of occurrence of pyometra, mammary cancer, other types of cancer, joint problems, and urinary incontinence in dogs as it related to age at the time of the spay or neuter in 35 dog breeds. In some cases, the recommendation is to wait until after 6 months old, 11 months old, 23 months old, or occasionally, not to spay or neuter that breed at all. It will be interesting to see if these recommendations impact the number of pyometras I see.
Should you still have an older dog spayed?
This data from the UC Davis study can be helpful if you have adopted a puppy or young dog. But what if you adopted a middle-aged or older intact female dog. Is it still worth getting her spayed? When considering a spay for senior dogs, it can be easy to wonder, “Is my dog too old for anesthesia?” or “Is my dog too old for surgery?” This is a discussion you should have with your veterinarian since he or she knows your dog’s unique situation.
However, in general I think that it is still a good idea to have your older dog spayed. As an emergency veterinarian, it breaks my heart to see so many dogs just like Princess who are sick, or even dying, from pyometra—a condition that could have been prevented by a spay.
A happy ending for my pyometra patients
Now that I have made my case for why I am so “pro-spay,” let’s wrap back around to Princess and Bella. The veterinary team started both of them on intravenous fluids prior to surgery. Bella was more stable initially, while Princess, being much sicker, took a bit longer to stabilize. Thankfully, both did well under anesthesia and came through surgery without any complications.
Even though Princess was extremely sick when she came into the hospital, she recovered quickly once we removed her infected uterus. And although Bella was much less sick, she still felt better after surgery. Both dogs were happily reunited with their parents and went home with pain medication and antibiotics.
I am so glad that Princess and Bella both did so well after their pyometra surgery. Unfortunately though, not all dogs with pyometra are that lucky. So if I could leave you with one final word of advice, it would be this—please spay your dog! If you have concerns about anesthesia, timing of the surgery, etc. don’t hesitate to talk it through with your veterinarian. He or she is there to help you make the best decisions possible for your dog.
What questions do you have about pyometra?
Please comment below.
Hi, my pug ‘Suzie’ has been diagnosed with Pyometra. She’s an older pug of 11 and is not doing great. She has been on intravenous meds for the last 6 days. We just got her blood work back and she is low on haemoglobin and RBCs as well as platelets. She has stopped eating and throws up almost immediately after drinking water. Being a pug, the vets are a little skeptical on taking her to surgery and putting her under anaesthesia until she’s stable.
Do you have any tips of how we can get her fit for surgery? Please do respond to us if you get a chance. We are holding out hope for our girl, she is quite the fighter! Thank you.
Dear Sayli,
I am sorry Suzie is dealing with this worrisome condition and she is not doing very well. Without playing a personal role in her medical care it is hard to make specific recommendations. It may be best to have her hospitalized for a couple days so your vet can give IV fluids and injectable medications. Hoping she can stabilize and move forward with this much needed surgery. Wishing you all the best and praying for a positive outcome for your sweet girl.
My female pit Nala, had pyrometers surgery about 10 days ago and since then her appetite is back, she’s drinking, she’s having normal bowel movements but still has more frequent urination than what’s normal for her. However, today I noticed some blood and white, I’m assuming this might be pus, coming from her vaginal area. I called the emergency vet clinic that did her surgery and they want me to bring her in, however I’m without a vehicle until later in the afternoon. Nala’s appetite and demeanor remain the same, is this something I should be concerned about until I can get her in or is this normal all together?
Thank you in advance for your time.
Hi Stacy,
So sorry I didn’t see this post in time to be able to give you a helpful answer. Hopefully Nala is back to her normal self now! Please feel free to give us an update on how the vet visit went.
Hi! I just found this post bc I am going a little crazy trying to figure out all info about Pyometra. My 9 yea Rolf Great Dane has it. Sadly I didn’t know the importance of spaying when not breeding dogs. I learn my lesson. She is schedule for surgery tomorrow and I just so scare because she has her meds but has not made any improvement. She is not wanting to eat and I think the Pyometra has not close as she doesn’t have any discharge. I am anxiously waiting for tomorrow so she has have her surgery. I am also do scare of putting her under anesthesia. I believe she is on home fluids, antibiotics, and a steroid (?). What worries me the most is that she hasn’t pee or poop at all.
Dear Ana,
I am so sorry you were facing this scary situation with your girl. I can only imagine how worried you must have been for her health and well-being. How did things go? Was she able to make it through surgery? Praying all is well and your big girl is still by your side. Wishing you both the best. ♥
my dog has open pyometra having red-white (pink) discharge that lasted for more than a week before I was able to confirm it with an actual veterinarian. the vet suggested surgical procedure does decline even though I want it badly but I don”t have enough money to pay. she suggested an alternative medication I think its the prostaglandin. for a week under medication my dog stopped having its discharge for a 8 days and its not the result we want its abdomen became bigger than usual. now my dog is being prepared for its operation she again has open pyometra I suspect since it has white-green yellow vaginal discharge that is in a larger volume. my question is is it possible for a pyometra to become open and close then open type? is there a sign to determine if there is already a uterine rupture?
Hi Carol,
I am so sorry you are going through this difficult situation with your dog. I am not sure I have any personal experience with a dog’s open pyometra becoming closed and then the cervix opening again. With that being said, anything is possible. An abdominal ultrasound should be able to detect free fluid in the abdomen which could indicate the presence of uterine rupture. How is your pup doing today? Has the surgery been performed yet? Hoping your sweet girl can remain stable and make a full recovery. Praying for a positive outcome!
My dog has pyometra, we could not afford the surgery so she’s been taking antibiotics and has started to eat again and is looking like she’s almost out of the woods. If she makes a full recovery with out the side and just antibiotics, should I take her to go get fixed? Will a vet even do a spay after pyrometer? I’ve read that she can get the infection again in the future, will getting her spayed after she’s all healthy again prevent that?
Hi Elizabeth,
I am so glad your dog seems to be doing better and is on the path to recovery! Yes, I would definitely recommend having her spayed once healthy. If the infection has cleared, then the spay surgery should be routine and be available at any veterinary facility. You are correct that after a dog has developed a pyometra, they are at a higher risk of this occurring again with the next subsequent heat cycle. When a dog is spayed, the routine procedure is to remove both ovaries and the uterus. Since the uterus would be removed, there is no possibility of a uterine infection occurring again. I hope this clears things up a bit. Praying your sweet girl will continue to heal and hoping for a positive outcome.
Hi one more thing, They kept telling me she didn’t need an abdominal ultrasound. That was her Primary. The Er had Fast scan done as well as the primary.
they told me she wasn’t a candidate for surgery.
due to calcium but now im wondering if this was pyometra
just sad
i have a few questions in regarding my dogs death. i very much question pyometra. its been almost a year she has, and im so heartbroken and devastated. i adopted her as a senior. i had it all set up to have her spay and dental done. then she developed a foot infection,so it was put on. hold. Then covid hit.
I took her then of june 2020 for her preop work up. They found she had hypercalcemia. So i did an ultrasound on her thyroid and showed a true parathyroid (small) mass.
So with that being said and a calcium of 15.1 we were told to g
hold off on any surgeries.
We didn’t know her trur age,but a senior.
She would have false heats here and there.
We started her on Aldronate. Her calcium would then hang out between 13.9-15. and her Ionized Calcium was 1.7-1.9.
Well long story short, February of this year she bleeding when peeing. we did an fast scan. showed bladder thickness. Was put on Clavamox,not bacteria just hematuria.
I took her back in 2 days. they did an abdominal xray. showed bladder stones.
Still peeing blood.
Then her gums started bleeding fresh blood. slightly. Ha they said cause her teeth were bad,well they never bleed before.
Her primary said she didn’t see pyometra on fast scan nor xray.
She then on the 10th day. ahe was cheek puffing. i was then told to bring her to the ER. they saw free fluid in her gut. they pulled off non clotting blood from her gut. i was in disbelief.
the vet said she couldn’t see her bladder let alone know where this bleeding was caused by. And i questioned pyometra to ER vet she said no.
Her platelets went from 306 on February 7th to 148 on February 14th to 65 on the night she passsed as well as her calcium dropping.
Her Death has broken me.
both vets have said no to Pyometra. i hope they would of known. This was Primary and The ER.
Please tell me tgey would have known.
Her WBC was normal
appetite was fine. infact she ate a cupcake and chicken before we went to ER. This cheek puffing had me so scared,and with all the peeing of blood. i panicked i feel like i made the wrong decision to bring her to ER. I hope this vet didn’t lie to me about seeing free fluid in her abdominal area.
She coded. The vet kept saying come in that the dog was making the decision for me. i was in the parking lot.
This vet did offer a necropsy. so we would have an answer.
i just hope no one is lying and they did everything they could. im just sickened. Any info would help.
she never vomited, no diarrhea, her temp did run low. she was usually constipation. but i just cant wrap my head around it.
thank you for listening.
i hope you can help
Thank you again
Jo
Dear Joanne,
I am so sorry for the tragic loss of your senior girl. It is normal to want to understand how things progressed and ponder the “what ifs” while grieving. Of course, since I didn’t examine your dog myself, I can’t make specific conclusions. I will say, I’ve never had a pyometra that didn’t have an elevated WBC on labwork. Also, with finding free blood in her abdomen, I am highly suspicious this may have been a type of cancer called hemangiosarcoma. This cancer can show up very suddenly and unexpectedly with little to no warning signs. It usually causes a mass to grow on the spleen and then at some point the mass ruptures and bleeds out into the abdomen. This bleeding is often times fatal. The issue with hemangiosarcoma is even with ultrasound, it can be impossible to detect it prior to a bleeding event. Like I mentioned before, I cannot be sure this is what happed to your pup, but it is a possibility. Here is a link to an article with more information: Hemangiosarcoma in Dogs: Symptoms, Treatment, and Life Expectancy
It sounds like your vet and the ER did everything they could to help your sweet girl. I am not sure I would have done anything differently. I hope with time you will allow yourself some grace and your heart will begin to heal. May the memories of the good times be a comfort and a blessing.
Hello, my name is Pete and I have my lovely girl Britney (Chihuahua) she was so full of fun and bark. But noticed she wasn’t eating, she would drink plenty and not play at all. Britney was always tired. I took her to the vets and Cofirmed it was not good news as Britney had pyometra and it was about to close and need to operate on her right away. I was advised their may not be chance she would survive. When I received the call my vet confirmed that their was so much bacteria she had fluids and had to drain and flush all the bad stuff out twice and Britney unfortunately was a complicated case, but she had survived the operation. I was advised when she gets home that few days she will feel tired and disoriented. She will then start to become her usual self. Blood discharge may happen for few months and then gets lighter and not to worry. I was over the moon and happy to have my little girl back. However year on, I’ve noticed she has some episodes of blood on her puppy pad. But this happens from time to time. So she would be OK for 2minths and then little drips all sudden. From light to bright red. My emailed my vets 6mnths after the surgery but confirmed this is normal. I’m concerned as year after, she still has tiny bits. She is eating ddi King and playing all the time so no concern there. I have also noticed dogs can have heta cycle after surgery and somtimes the abdominal can swell and go down. Sorry I forgot to mention that she completed her course of antibiotics and inflammation medicine after surgery. I guess wot I need to know is, After surgery can a dog still have any life threatening cases of pyometra returning or and bacteria concerns. Plz help Pete.
Hi Pete,
I am sorry you have been through such a rough time with your little pup. What a blessing she was able to make it through surgery and have a full recovery. It is true that dogs can have some bleeding or discharge for a while after this kind of surgery, but I would not expect it to still be happening over a year later. There are many different possibilities of potential complications from spaying a dog and a pyometra increases the chances of complications. When removing the ovaries, if a tiny fragment of an ovary is left behind it can still produce hormones and cause the dog to go through a “heat cycle” even though the uterus is gone. Also, depending on how much of the uterine stump or cervix is left, there is a possibility of this tiny portion of the uterus becoming infected and causing a “stump pyometra”. Another issue that can cause blood-tinged fluid to drip from the vulva is a urinary tract infection. With all that being said, it would be a good idea to have your dog examined by a vet. There is blood work that can be sent to an outside lab to check for the presence of hormones. This test can let you know if there are any pieces of ovarian tissue still present in the body. X-rays or ultrasound can be used to diagnose or rule out a stump pyometra. And urine can be checked either in clinic or sent to an outside lab to determine if there are bacteria present in the bladder. I highly recommend you schedule an appointment for your dog and see what testing your vet thinks is best. If the initial testing doesn’t reveal the answers you need, it is always an option to schedule a consult with a specialist. I am hopeful you can find the cause for this strange bleeding. Praying for a positive outcome for you and your sweet girl. Feel free to leave an update if you have a chance!
hello doc.. my female likely has pyometra. the only physical signs i can notice is that there is a whitish discharge from her vulva but it has no foul smell. she is not lethargic at all and her appetite is normal. i brought her to the vet and they did an ultrasound, and said that her one side of the uterus has some pus around it. they did some bloodwork and said wbc are a little low so she gave her a immunobooster. she also gave her a combination of Co Amoxiclav and Enrofloxacin antibiotics.. my question is would this be enough to treat her pyometra without the prostaglandin treatment?
thanks doc for the reply
Hi Allan,
You are right to be concerned about your pup and this uterine infection she has been diagnosed with. Since I haven’t examined your dog myself, I can’t make specific conclusions. With that being said, I have never successfully treated a pyometra without surgery. I always recommend surgery to spay the dog and remove the infected uterus. I hope your girl will continue to feel ok. Praying for a complete recovery.
I just had to put our Molly Marie down. She had pyometra. Today it hurt so much. husband and I are still in shock. I have sobbed for hours. All Her toys and treats. I have her froggy. Snake and first toy. All next to me. We both talked about it sometimes but never saw the pain we faced today coming.
Dear Wendy,
I am so sorry for your recent loss of Molly Marie. My heart goes out to you as you grieve her absence in your lives. I hope with time your heart will heal and her memory will be a blessing. Praying for comfort and peace.
My 9 year old collie “Pamper” was always full of energy, loved to play or to try to get up in your lap. But one day, as I was leaving for work, she did not get out of her bed to see me off! That evening, when I came home, she came to greet me – as she always did – but I noticed she was not playful, a little sad looking, But the strangest thing was she did not wag her tail. I watched her for a while and became concerned so I called the vet. She told me to bring Pamper in immediately. The vet lifted her tail and I saw some pretty nasty discharge oozing. Unfortunately, this episode has a sad ending as Paper was put to sleep because the infection had spread. I had no idea Pamper had been in such horrible pain. This proved to me that dogs rarely show pain until the very last moments here on earth.
Dear Ellen,
I am so sorry for your loss of Pamper. I am glad you were able to get her to the vet quickly and find out what was wrong. I know you were heartbroken to say goodbye, but glad you were able to give Pamper comfort and peace. You are right that dogs are good at hiding pain and can mask it very well. I hope you will find comfort in knowing you made a loving choice to take her pain away. I pray with time your heart will heal. May her memory be a blessing and thank you for being willing to share your story with us. ♥