Pelvic Ultrasound, what exactly is that?
So, you’ve received an appointment for an ultrasound of your pelvis (US Pelvis) and aren’t sure what to expect. Keep reading!
Ultrasound pelvis is a medical imaging examination that uses ultrasound (high-frequency sound waves) to visualize the gynecological organs.
These organs include the uterus (womb), endometrium (the innermost lining of the womb that sheds during menstruation), and ovaries.
We also tend to examine the areas around your uterus and ovaries for anything else that might pop up. The scan is usually in two parts or two approaches: transabdominal and transvaginal. The former literally means looking from the abdomen, while the latter means looking from the vagina.
Disclaimer
All information provided in this article belongs to the author and does not represent that of the NHS or any other organisation. Please contact your GP or local hospital for information about your ultrasound or other health condition.
Required Preparation
The primary preparation required of you for a pelvic ultrasound is that you attend your appointment with a full bladder. While we appreciate this is not the easiest thing to do and is only sometimes possible, trying to adhere to this will make your examination more detailed.
Although, with some individuals, a partially full bladder will suffice. We commonly ask that you empty your bladder and drink at least 1 litre of water about an hour before your appointment or a bit more if you feel dehydrated. This will usually get your bladder full enough for your pelvic ultrasound.
Full Bladder? But why?
So, why the full bladder? The anatomy of the pelvic organs is such that the urinary bladder is anterior to (at the front of) the uterus, with the ovaries to the sides of the uterus.
Since the bladder is like a very strong ‘balloon’, filling it up will stretch it across the pelvis, gently move the bowel out of the way, and nicely bring the uterus and ovaries to be positioned right behind it. Because the urine is obviously liquid, and the way ultrasound works, liquid allows ultrasound beams to travel through it. Any structure behind that fluid entity, the uterus and ovaries, will become well ‘illuminated’. The full bladder serves as a window to see what’s behind it.
Why Ultrasound Pelvis?
Common reasons for an ultrasound pelvis referral are due to menstruation-related concerns. This could be prolonged or painful or heavy menses and unusual menstrual irregularities. Some other reasons could be due to pelvic pain, fertility, or early pregnancy-related issues. Your doctor will help you decide if you need a pelvic ultrasound based on the symptoms you’ve presented with and your laboratory test results.
Special Requirement
It is important to note that the sonographer/sonologist/radiologist to examine you can be of any gender. So, if you have a particular preference, please call the ultrasound department as soon as you get your appointment confirmation. They can let you know if your request can be accommodated. This is usually only sometimes possible in some departments, by the way.
Duration of the Examination?
The entire examination, from the moment you walk into the scan room until you leave the department, is less than 30 minutes. It could even be much quicker! This depends on several factors, including but not limited to how full your bladder is and how easy it is to see your pelvic organs.
During your Appointment
While in the ultrasound room, the sonographer will introduce themself and explain the examination to you. A healthcare assistant/chaperone will also be with you during your appointment. You will be invited to lie down on the examination couch and asked to lower your bottom clothing to your hips and top clothing up a bit above your belly button.
This part of the examination will usually be the transabdominal aspect. However, if you have questions about the examination or are unsure of why you are having the examination, then please let the sonographer know before starting.
Transabdominal Scan (TAS)
A bit of ultrasound gel will be added to the surface of your lower tummy or to the sonographer’s ultrasound device (probe). Then, the ultrasound probe will be placed on your lower tummy (pelvis) and moved around by the sonographer while they examine your organs and acquire some necessary images.
The sonographer might need to apply some pressure on your tummy (despite your full bladder) to improve the contact between your organs and the ultrasound probe, thus providing better visualisation and image quality. If this gets too painful, could you let your sonographer know? After this, your sonographer will ask you to visit a nearby restroom to empty your bladder. Relief at last!
Transvaginal Scan (TVS)
Just so you know, specific consent is required for this aspect. Remember, you are in complete control! You can either agree or refuse to continue with this examination aspect based on your reasons, and you are not generally obliged to share the reason with the sonographer. Consent, in this case, can either be verbal or written. Your sonographer or healthcare assistant in the room will generally work you through this.
The transvaginal approach (or transvaginal scan or TVS) is the next part of the examination, mostly done as one appointment/examination. In some occasions, the sonographer can decide, using their professional discretion, that a transvaginal scan is not needed if all the required organs have been clearly imaged transabdominal.
However, this is only sometimes the case; specific clinical indications will require a transvaginal scan to closely examine the endometrium and other pelvic organs. In the UK, transvaginal ultrasound can be offered to individuals above the age of 16. This is according to the recommendations of The British Medical Ultrasound Society (BMUS) 2022.
A special probe is used for the TVS. The probe would have been appropriately disinfected before your examination, and a probe cover added with some sterile ultrasound gel.
These are all to keep the examination as aseptic as possible. Upon one more verbal consent, a few inches of the probe’s top end will be gently introduced into the vagina, and the sonographer will mainly focus on the ultrasound monitor while examining the different pelvic organs. Most people find this examination painless but a little uncomfortable. As always, you should let the sonographer know or ask them to stop the examination at any point you feel too uncomfortable or in pain.
After your Examination
The sonographer will inform you when the examination is completed as the probe is removed. They will give you some privacy to get yourself sorted and ready. The sonographer will take a few minutes to review all the images acquired before composing your examination report.
This will be done after you have left the examination room, so please do not expect to get your report right away. You should ask the sonographer how to get your result if they haven’t already told you that.
