Pelvic Ultrasound

What is ultrasound?

Ultrasound (also known as sonography or ultrasound scanning) is a non-invasive imaging modality that uses high-frequency sound waves (ultrasound waves) to create pictures of the interior of your body from the outside. Although similar in physical properties to the ordinary sound waves, the frequency of ultrasound waves used in this procedure is very high and the human ear cannot hear them. A Doppler ultrasound uses the doppler effect to study the flow of blood in the blood vessels.

What is a pelvic ultrasound?

A pelvic ultrasound (also referred to as a gynecologic ultrasound or pelvic scan) uses the principles of sonography to visualize the organs of your pelvic cavity.

A device known as a transducer (also referred to as a probe or a wand) is moved over the lower abdomen. It emits ultrasound waves that are sent through the abdominal tissue to the organs inside the pelvis. The waves are reflected by the internal organs and the transducer detects the changes in the frequency and direction of the echoes.

These observations are transmitted to a computer that generates black and white images of the organs. The organs generally viewed include-

– Uterus (the womb)
– Cervix
– Ovaries
– Fallopian tubes
– Vagina (the birth canal)
– Urinary bladder

How is the pelvic ultrasound performed?

A pelvic ultrasound can be performed in 3 ways depending upon the approach used-

Transabdominal ultrasound (TAS) – The approach is through the abdomen.

Transvaginal ultrasound (TVS) – The approach is through the vagina.

Trans-perineal ultrasound– The approach is through the perineal area.

Transrectal ultrasound – Performed in males to detect abnormalities in the male pelvic organs.

These approaches can be employed in isolation or as a combination in a single patient to get better results.

What are the indications for a pelvic ultrasound?

A pelvic ultrasound yields black and white images of the organs enclosed in the female pelvic cavity and detects any abnormality in the structures thus visualized. Your physician may order a pelvic ultrasound if you present with-

– Non-specific pelvic pain
– Palpable pelvic masses

Disorders of menstruation:

– Painful menses (dysmenorrhea),
– Delayed menses,
– Cessation of menses (amenorrhea)
– Heavy menses (menorrhagia)
– Abnormal vaginal bleeding (can be pre-menopausal or related to pregnancy)
– Infertility issues (infertility ultrasound)

In male patients, a pelvic ultrasound can be used to detect abnormalities of the urinary bladder, prostate and seminal vesicles.

What can a pelvic ultrasound detect?

A pelvic ultrasound can help detect the following diseases-

– Pelvic inflammatory disease
– Uterine fibroids/endometrial polyps
– Location of an IUCD (intrauterine contraceptive device)
– Endocrine disorders including PCOD (polycystic ovarian disorder)
– Uterine or ovarian malignancies
– Ectopic pregnancy

A doppler ultrasound can detect abnormalities in the blood vessels supplying the pelvic organs in both males and females.

What are the contraindications of a pelvic ultrasound?

There are no contraindications for this procedure. However, a transvaginal ultrasound is not performed in late pregnancy. It is also not indicated if you have never been sexually active.

Can I undergo a pelvic ultrasound if I am pregnant?

Yes, it is safe to undergo a pelvic ultrasound if you are pregnant. No ionizing radiations are used in this procedure and thus, there is no risk to the fetus. You can also safely undertake this procedure if you are breastfeeding your child.

Can children undergo a pelvic ultrasound?

A pelvic ultrasound is a non-invasive, painless and risk-free procedure. Children of all ages including neonates and infants can be subjected to this test.

What are the risks involved?

A pelvic ultrasound is a non-invasive, painless and safe procedure. It does not use ionizing radiations, hence safe for pregnant females and children. However, you may feel slight discomfort when the transducer is moved over your abdomen specially if it is already tender. Insertion of a probe vaginally or rectally may cause uneasiness but should cause no pain.

During TVS and rectal sonography, a latex sleeve may be used before insertion of the transducer into the vagina or the rectum. Latex allergy can be a complication in individuals prone to it.

Do I need to fast before a pelvic ultrasound?

There is no need to fast before a pelvic ultrasound test.

How should I prepare for a pelvic ultrasound?

No specific preparation is required before you go for a pelvic ultrasound. Inform your doctor if you suffer from any allergy. Latex allergy can be encountered if you are undergoing TVS or transrectal sonography. Remove any jewelry or any other item that may interfere with the test. Wear loose-fitting comfortable clothes to the hospital.

How is a pelvic ultrasound performed?

A pelvic ultrasound is performed on an out-patient basis. No sedation is required, and you will be conscious throughout the procedure. A sonologist (a person expert in conducting sonography) will perform this examination. The sonologist will jot down in detail your medical history and the details of your period. This information will be conveyed to the radiologist/physician to interpret the findings and co-relate them clinically. A pelvic ultrasound consists of the following steps-

– You will be explained the steps of the procedure in detail.

– You will be asked to consume copious amounts of water. This will help your urinary bladder to fill up and push the bowel up and away from the pelvic region. This takes about an hour.

– You will be asked to remove jewelry or any other item which may hamper with the examination.

– You will be given a hospital gown to wear.

– You will be asked to lie down on a padded examination table in the supine position. (on your back). However, during the test, you may be asked to change positions and hold your breath for short intervals of time.

– The sonologist will apply a warm, non-sticky gel on the transducer probe and your lower abdomen to enhance the quality of the images.

– The probe will be moved over your abdomen. It will emit ultrasound waves through your abdominal wall into your pelvic cavity and detect any changes in frequency and direction when these waves are reflected by your pelvic organs.

– These findings are transmitted to a computer that generates black and white images of your internal organs and blood vessels.

During this procedure, you may feel mild discomfort when the probe presses against your skin. You may also feel the urge to urinate as your bladder is full. This should not be painful though.

How is transvaginal and trans-perineal ultrasound performed?

Transvaginal ultrasonography– You will be asked to void urine before undergoing this procedure. A stack of towels may be used to elevate your pelvis. The sonologist will use lubrication and a latex sleeve to cover the probe before introducing the probe gently in your vagina.

You may insert the probe yourself. Ensuring privacy and your comfort, the probe will be moved sideways and up and down for wider coverage. You may feel slight discomfort when the probe presses against your cervix. The rest of the procedure is the same as its transabdominal counterpart.

Trans-perineal approach– The probe is moved over the perineal area. (the area between the vagina and the anus).

How long does the procedure take?

The actual procedure of a pelvic ultrasound takes half an hour to one hour. However, an hour of preparation may be required before the test is performed (it includes filling up the bladder of the patient which can take up to an hour).

What precautions do I need to take after a pelvic ultrasound?

You do not need to take any precautions once the pelvic sonography exam is over. You can continue with your routine activities immediately after the test.

When will I get the results of my pelvic ultrasound exam?

You can get the result of a pelvic ultrasound within 24 hours. In the cases of an emergency, the results are available immediately.

What is the cost of undergoing a pelvic ultrasound in India?

A pelvic ultrasound can cost INR 500-1500 in India.

What are the other uses of a pelvic ultrasound?

A pelvic ultrasound provides real-time images of the pelvic organs. It can, therefore, be used as a tool to guide minimally invasive procedures such as paracentesis and biopsies from the pelvic organs.

What are the advantages and limitations of a pelvic ultrasound?