You might have heard of pyometra before; despite being common, it is one of the most deadly diseases that we vets come across.
What is Pyometra?
Pyometra literally means ‘pus in the uterus’. It occurs in about 25% of unspayed female dogs before the age of 10. In essence, pyometra is a uterine infection. It occurs because repeated cycles of oestrogen and progesterone, experienced by female dogs undergoing normal cycling, increases the thickening of the uterine wall. And, unlike humans, dogs don’t shed the lining of the uterus at the end of their season if they’re not pregnant. Instead, over time, the lining thickens, trapping fluid and mucus – sometimes called a mucometra. A mucometra is not dangerous, but if bacteria get into the uterus they find the perfect environment in which to replicate. A massive infection follows.
What are the Signs of Pyometra?
Pyometra almost always occurs relatively close to the end of the last season- usually 4-6 weeks after they stop bleeding. Dogs are usually three years or older, although pyometra has occasionally been diagnosed after just one season in some dogs. Affected dogs get gradually more ill: they may go off their food, become lethargic, or vomit. They often have an increase in thirst and urinate more than often as well. Owners may notice them licking at their back end more than normal.
Cloudy discharge from the vulva is sometimes apparent, but an absence doesn’t mean that pyometra isn’t possible – in fact, the more severe forms of pyometra occur when the cervix is closed, and the pus isn’t able to escape. Discharge can also be intermittent, or dogs can stop having discharge because the cervix closes – this is often seen as an improvement for many owners but is almost always followed by deterioration in their condition.
How is Pyometra Diagnosed?
In entire female dogs displaying symptoms at the right stage in their cycle, an ultrasound scan should always be performed. Ultrasound is easy to do and in well-behaved dogs usually allows a diagnosis without the need for anaesthetic or sedation. Vets will also need to examine the dog as a whole, take your dog’s temperature, and may recommend that blood tests are performed to check kidney and liver function.
How can Pyometra be Treated?
There are two options for treating pyometra. Surgery is usually recommended, as this is a permanent solution. The surgery is like a spay – the ovaries and uterus are removed through an incision in the abdomen. Unlike a normal spay, however, the uterus is heavier and full of pus, which could certainly kill the dog if any of it was to leak. This makes it a far riskier surgery than a normal spay.
Medical management is also possible. For this, dogs are given injections of an abortion agent, and antibiotics. This causes the body to stop the cycle and the infection will start to clear. Medical management is not always successful, and there is a high chance that the pyometra will reoccur on the next cycle. However, it sometimes saves a risky surgery and allows the uterus time to recover so that a spay can be planned for the usual window of opportunity between seasons.
Can pyometra be prevented?
Preventing pyometra is as simple as spaying dogs that are not going to be used for breeding. Without the ovaries constantly cycling from oestrogen to progesterone, the lining doesn’t build up and pyometra isn’t possible. In young dogs, the ovaries can be taken alone. The hormones won’t have had time to damage the uterine lining. As dogs age, however, a full ovariohysterectomy (ovaries and uterus removed) is often more sensible, as it leaves no risk of a later pyometra.
My dog has been spayed, can she still have a pyometra?
It’s technically possible for a dog to get pyometra after she has been spayed, in one very rare circumstance. Affected dogs usually suffer with Ovarian Remnant Syndrome. They have a small piece of ovary left behind after their spay. The cycle from that remnant can be enough to cause any remaining uterus to undergo the changes that lead to pyometra. This can lead to what is called a ‘stump pyometra’ . When the tiny bit of uterus that’s left behind because it’s attached to the cervix gets a pyometra.
Is Pyometra a Life or Death Situation?
Yes. Many cases of pyometra are severe enough that prompt treatment is the only thing that can save them. If you suspect your dog is suffering from pyometra, you should take your dog to have an examination with a vet immediately.
Discussion
I have a chihuahua, she is a rescue so her age is an estimate but they put her between 10 and 12 years. Her vulva is swollen, but there’s no discharge and she seems generally well otherwise, apart from her showing some aggression when looking at her back end (she’s normally very even tempered). she’s not in season because her last heat was a little over a month ago (early october). I am planning on taking her to the vet anyway, but I was wondering how serious this is and if I should get her to urgent care?
I would definitely get her seen ASAP if she’s not neutered. There’s an old axiom – any sick entire female dog has a pyo until proven otherwise!
Hello Joe & David, We recently adopted a 9 y.o. purebred maltese who was bred (8 litters) before she became our elderly pet. We understand 9 is pretty old for a non-spayed Maltese. She has an early stage murmur, no teeth, and is in heat every six months or so. What would your risk-benefit analysis be, for/against spay surgery for a dog this age, in this condition? She has no risk of future pregnancies in our care. Are there any other variables you would need to consider to weigh risk vs. benefit? Thank you!
Hi Arthur – Joe isn’t on the comments at the moment so I’ll pick that one up.
It sounds like this basically boils down to the risk of surgery vs the risk of a pyometra. Now, the older a dog is, the higher the pyo risk, and at that age, I think there’s probably about a 25-30% chance of her getting a pyo (back of the envelope figures!). However, given her underlying health issues, if she does get a pyo, then her chances of surviving it are significantly poorer than for a younger, otherwise healthier dog. The risk of death from the anaesthetic is much lower (almost certainly less than 2%) but not zero.
Personally, I think I would probably spay her if she was mine, but it’s not a simple black and white decision. I think the next logical step would be to talk to your vets, get a full physical and potentially pre-op bloods run, to see if you can narrow down the risks any further. Then you’ve got a bit more information to make a decision with. Hope that helps!
My girl dog was spayed 3 weeks ago open surgery, she now has Pyometra why, I had her spayed so this didn’t happen.
They now say she needs another operation within 8 weeks if she survives in the short term
I’m so sorry to hear that – it’s really, really rare. Assuming she had a full spay (ovariohysterectomy), the most likely explanation is a “stump pyo”; this is a rare complication following surgery, almost always due to secondary infection. If you’re worried about why, I would ask your vets if there were any risk factors – but assuming that there weren’t, sadly things sometimes go wrong. I do hope she pulls through though!
I have a 8 yr old shih tzu is having a brownish watery discharge and is fairly lethargic… however she isn’t that active anyway so I can’t tell if it’s more than normal lol I don’t remember her doing this before …..just curious if this is pretty common or it’s something to get checked out
No, not normal – vet ASAP!
My 10 month old female golden retriever has questionable pyometra or mucometra. She had her first heat and here we are 4 weeks later with vaginal bleeding. Her vet took x rays and urine and blood work. Urine came back with high white blood cells but blood work came back normal. Xrays showed enlarge uterus. Vet put her on clavamox 375 mg for 10 days then wants to spay. I asked why not an immediate spay and she said the surgery would be better if some of the infection was cleared. I’m not sure I agree with this as all the literature says immediate surgery. Any thoughts would be appreciated. She has been on oral antibiotics now for 24 hours
In an open pyometra, sometimes medical management is effective and gives a much easier (and safer) surgery, so I’d imaging that’s what your vet is planning. If she responds to the medication, great; if not, then definitely spay sooner.
My female shepherd 2 years old got spy 4 weeks ago , and now she is bleeding for her vagina, I took her to the vet and he say she is probably anemic . I’m worry I don’t she is anemic I feel like she has some infection. What is your opinion
The vaginal bleed is a concern, but anaemia may still be a factor – she could be anaemic because of the bleed, for example. However, both do need investigating.
I have a 7 year old pit bull she is pregnant and she has had 2 seizure out of no were. I’m very worried about her. I have been off work for a month. I really need help with her. Any suggestions
Well first things first, get her checked over by your vet to see if there’s an obvious physical cause – like low blood calcium (fairly well recognised in late pregnancy, and potentially life-threatening), liver disease, etc. Then you’ll have a much better idea of WHY she’s fitting and what to do about it!
The vet did not follow the protocol you mentioned. I asked if we could give her a little more time the discharge had pretty much stopped she was feeling alot better and perky. The vet said the sooner the better or she’d die. I didn’t get to you and an answer in time. I should of done what my heart said and kept her on the antibiotics till the discharge stopped and she was stronger. Which is exactly what I told the vet the morning I dropped her off.
She made it threw surgery fine. But not the night. When I picked her up something didn’t seem right with her body. Rigor mortis had set in completely. But when they carried her her head hung down. She was cold it was cold outside near freezing. 31/2 hours later after I finally got her home a big enough grave dug. When I lowered her on it it was the same thing with her body. And from the set of her face and jaws she didn’t just die in her sleep. I farm and ranch. And don’t remember ever seeing that before in a dog or other animals in full rigor mortis?
My 13 yr old female came down with open pyometra. She has been treated with 2000mg of ammoxicilan and the discharge has pretty much stopped.. she’s lively and feeling well. She never did have a tempature or fever. Is immediate spaying necessary?
If she was just treated with antibiotics, the probability is that as soon as the antibiotics stop, the symptoms will recur. If there is still ANY discharge, it means the pyo isn’t resolved, just suppressed. If she had the full treatment protocol (with aglepristone or other hormonal medications) then there’s a fair chance that you can delay spaying until everything settles down – but again, only if the discharge stops completely, showing that the infection is fully resolved.
Hi doc, I have a Shih Tzu, 7 months old. The last few days she vomitted and her stomach was also hard. The vet prescribed us a few vitamins that could help. But last night we noticed a greeny discharge from her vagina. I’m really worried because when i searched for the symptoms it showed me Pyometra. As of now she barely wants to eat nor drink. Her poop is normal. She had a fever the last few days. She hasn’t vomitted today, her last vomit was day ago. She also has low energy, she’s always asleep. And there is no sign of pain when peeing, and no blood. Only greeny discharge
Yeah, back to the vet ASAP!
My intact female border collie is 2 years and 4 months. I’m considered spaying as I have no plan to breed. Weighing the pros and cons. If I do it right away, would she need full hysterectomy or just remove ovaries ?
At that age, the chances of significant uterine disease are negligible, so either procedure would be absolutely fine. The laparoscopic (keyhole) ovary-only procedure also usually has a faster recovery time, if that’s a factor!
On balance, I’d say that most skeletally mature females will benefit more from neutering than they lose, in terms of protection from pyometra and mammary tumours alone.
Thank you. This is good insight !
Female Irish wolfhound, 8 yrs old in October. Recovered from may 2021 diagnosed idiopathic autoimmune anemia, still on cyclosporine 50 mg mondays and fridays. Now diagnosed UTI and bladder stones. Not spayed; no heat cycle for over a year. Small lump on one teat for a year with no growth. Appointment to remove stones and vet suggesting removal of lump and spay all the same time. Seems like a lot and concerns with anesthesia. She was not tested for liver shunt as pup. Any advice appropriated. Surgery scheduled next Thursday.
I’d definitely be advising pre-operative bloods, but I think the surgery recommended by your vets does sound appropriate. If she’s reached 8 without any signs, it’s pretty unlikely she has a clinically relevant shunt! The stones in her bladder if they won’t dissolve or pass do need to come out; as to get into the bladder, the abdomen must be opened, a spay at the same time is reasonable. At her age, the risk of a pyometra dramatically increases, and given that she’s on immunosuppressants, I think a spay is probably wise at this point given that the surgeons are already going to be “in there” anyway. And 50% of mammary masses in female dogs are malignant tumours, so taking that off isn’t a bad idea either! Most of the risk from anaesthesia is in the induction and recovery phases; while a longer anaesthetic does increase the risk, it’s not as much more as we often think.
That’s my thoughts, but of course I’ve only seen the summary of her history: if you’re concerned, though, I’d definitely ask to talk to the vet about it and check that they are confident that this is best for her.
My little frenchie had surgery for pyometra just over two weeks ago, now she has the same colour discharge and is acting very much like she was before the op. Lethargic and depressed, Is this a sign it has come back and what are the options and the chances she will be ok
Once the uterus is removed, the pyometra itself cannot come back; however, infections of the cervix can persist after surgery and need aggressive treatment. Definitely take her back to the vets ASAP! Fortunately, most of these secondary infections are relatively easy to treat medically, although sometimes further surgery is required. Unfortunately, when there is that much pus in the uterus (as in a pyo), you can easily get pockets of infection elsewhere. Good luck with her!
I have a Golden Retriever, we are waiting the 18 months before spaying to ensure her growth. With this being said, she will have had 2 heats on the 3rd heat we plan on mating her to have 1 litter only, to help her shed her uterus lining. Also, we want to keep 1 puppy and her breeder wants one. Will this lessen her chances of the Pyometra once birthing and being spayed? Or will we still have a chance for issues?
Once she is spayed, at any age, she cannot develop a pyometra, so that isn’t an issue!
The bigger problem is breast cancer (very common in dogs, and about 50% are malignant). Once she has had 3 seasons, spaying no longer provides any significant protection against breast cancer, which is why we usually advise spaying early if you’re not planning to breed.
As you are, obviously that isn’t an option, but it will be important for you to regularly check her mammary tissue for lumps and swellings as she gets older, to catch it early while it;s still treatable if/when it occurs.
Good luck with her, and the puppies!
Hello Doctor,
I have a 9 year old German Shepherd. Never been pregnant. 6 months back I saw a white discharge after heat cycles. Doctor treated her with antibiotic and injection. No discharge post that. Then 6 months later – same thing and same procedure and same result. No discharge post treatment. Dog hasn’t showed any behavioural changes. Should I be worried?
This is consistent with a recurrent open pyometra. The problem with medical management of pyometras (injections and antibiotics) is that research shows it’ll come back after the next season 80% of the time. Open pyometras can be treated, but sooner or later, there’s a real risk that she’ll develop a closed pyo, which is usually fatal without emergency surgery. Personally, I’d be strongly considering getting her spayed ASAP to prevent that from happening.
Hello Doctor! My female dog is 11 years old and she has been having white discharge from her genitals the past three weeks. The discharge is little, non smelly and translucent. The vet doubted it to be pyometra but her condition hasn’t deteriorated in any way. He gave her antibiotics but still the discharge hasn’t stopped. My dog through is not showing any other signs of illness, she is active, has a good appetite and is passing her stools and urine properly. What do you think it might be?
It could still be an “open pyometra” where the pus drains before it can build up – these can sometimes grumble on for weeks and weeks before either resolving or, perhaps more often, dramatically worsening and becoming rapidly life-threatening. Another option might be severe vaginitis, but in an entire dog of that age, I’d be VERY worried about a grumbling pyometra. I’d strongly advise going back and chatting to the vet again.
My bitch has a white discharge coming from her vagina but l don’t think it is foul smelling. She is licking that area more and is very quiet and off her food. I haven’t really noticed any signs of vomiting or urinating more than usual. She hasn’t had a litter but turns 4 soon. She is a Great Dane and so can this affect her more than a smaller breed of dog?
It could be an early pyo, or vaginitis – however, in either case, veterinary treatment is a good idea, especially at her age and breed.
My dog has been bred twice and we are planning not to get her pregnant anymore, will she still can have pyometra?
Yes, she definitely can. Having l had a little doesn’t seem to have a dramatic protective effect against developing pyometra, and some people argue it makes it more likely.
If you’re not planning to breed her again, I would advise considering spaying her.
My puppy is 10 weeks old and have been sprayed….I noticed she had green discharge coming from her private area… What could it possibly be???
That suggests vaginitis, an infection of the vagina. If she was only recently spayed, it might be a “stump infection”. In either case, I’d strongly advise getting her checked by the vet sooner rather than later.
I’m not even sure if I’ll get a reply, but my dog almost died from pyometra two weeks ago. She was only 1.5 years old. She had already went into heat 3 times in the past year. She was put off to be spayed several times because of this and covid. However, I am afraid I am losing trust in her vets and reaching my wits end. She has always struggled with what I believed to be food allergies/skin allergies and even has a balding/red/bloody paw from biting and itching it. I noticed that there is a black mole-like growth inside the paw which is what must be itchy? She would vomit bile ever since she was a puppy in the middle of the night, so I started feeding her more throughout the day, but after this incident with pyometra…I’m starting to worry there is something more serious going on. Is this normal? Does it sound like anything specific? Her vet never even gave her antibiotics to take home after surgery…what should I do?
Allergic skin disease is very common, and might well be what’s going on there. I think the pyometra probably is coincidence – the two conditions aren’t really connected – but it’s impossible to say without further tests. If the relationship with your vets is breaking down, it might be worth asking for a second opinion regarding her skin condition – that’s really uncomfortable and does need addressing. A likely cause is atopic dermatitis, but this is usually manageable nowadays with the modern drugs and drug combinations. Good luck!