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Pelvic Ultrasound

Test Overview

A pelvic ultrasound uses sound waves to make a picture of the organs and structures in the lower belly (pelvis).

A pelvic ultrasound looks at the bladder and:

Organs and structures that are solid and uniform (such as the uterus, ovaries, or prostate gland) or that are fluid-filled (such as the bladder) show up clearly on a pelvic ultrasound. Bones may block other organs from being seen. Air-filled organs, such as the intestines, can make the image less clear.

Pelvic ultrasound can be done three ways: transabdominal, transrectal, and transvaginal.

  • Transabdominal ultrasound. A small hand-held device called a transducer is passed back and forth over the lower belly. A transabdominal ultrasound is commonly done in women to look for large uterine fibroids or other problems.
  • Transrectal ultrasound. The transducer is shaped to fit into the rectum. A transrectal ultrasound may be done to check for problems in men or women. It is the most common test to look at the male pelvic organs, such as the prostate and seminal vesicles. The test may also be done to look for rectal sphincter problems, such as incontinence. Sometimes, a small sample of tissue (biopsy) may be taken with small tools inserted through the rectum during a transrectal ultrasound.
  • Transvaginal ultrasound. The transducer is shaped to fit into a woman's vagina. A woman may have both transabdominal and transvaginal ultrasounds to look at the whole pelvic area. A transvaginal ultrasound is done to look for problems with fertility or pregnancy. In rare cases, a hysterosonogram is done to look at the inside of the uterus by filling the uterus with fluid during a transvaginal ultrasound. Sometimes, a small sample of tissue (biopsy) may be taken with small tools inserted through the vagina during a transvaginal ultrasound.

In all three types of pelvic ultrasound, the transducer sends the reflected sound waves to a computer, which makes them into a picture that is shown on a video screen. Ultrasound pictures or videos may be saved as a permanent record.

Why It Is Done

For men and women, pelvic ultrasound may be done to:

  • Find the cause of blood in the urine (hematuria). An ultrasound of the kidneys may also be done.
  • Find the cause of urinary problems.
  • Look at the size of the bladder before and after urination. This can determine whether the bladder is emptying completely during urination.
  • Check for growths in the pelvis.
  • Guide the placement of a needle during a biopsy or when draining the fluid from a cyst or abscess.
  • Check for colorectal cancer and how it is responding to treatment.

For women, pelvic ultrasound may be done to:

  • Find out what is causing pelvic pain.
  • Look for the cause of vaginal bleeding.
  • Look for pelvic inflammatory disease (PID).
  • Find an intrauterine device (IUD).
  • Look at the size and shape of the uterus and the thickness of the uterine lining (endometrium).
  • Look at the size and shape of the ovaries.
  • Check the condition and size of the ovaries during treatment for infertility.
  • Confirm a pregnancy and whether it is in the uterus. Pelvic ultrasound may be used early in pregnancy to check the age of the pregnancy or to find a tubal pregnancy (ectopic pregnancy) or multiple pregnancy.
  • Check the cervical length in a pregnant woman at risk for preterm labour.
  • Check a lump found during a pelvic examination.
  • Check uterine fibroids found during a pelvic examination. Pelvic ultrasound may also be done to check the growth of uterine fibroids.
  • Guide a procedure to remove an ovarian follicle for in vitro fertilization.

For men, pelvic ultrasound may be done to:

How To Prepare

Tell your doctor if you have had an X-ray with contrast material (such as barium) within the past 2 days. Barium that remains in the intestines can interfere with the ultrasound test.

Wear loose clothes for the pelvic ultrasound. You may need to remove all your clothes below the waist and put on a gown before the test.

If you are having a biopsy or a special procedure during the ultrasound, you may need to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for this test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form .

Transabdominal ultrasound

If you are having a transabdominal ultrasound, your doctor will ask you to drink 4 to 6 glasses of juice or water about an hour before the test to fill your bladder. A full bladder pushes the intestines (which contain air) out of the way of the pelvic organs. This makes the ultrasound picture clearer. If the ultrasound is being done in an emergency situation, your bladder may be filled with water through a thin flexible tube (catheter) inserted into your bladder.

Transrectal ultrasound

If you are having a transrectal ultrasound, you may need an enema about an hour before the test. Tell your doctor if you are allergic to latex so that a latex-free cover can be put on the transducer before it is used.

If a man is also having a biopsy of the prostate gland, he may be given antibiotics for a day before the test.

Transvaginal ultrasound

If you are having a transvaginal ultrasound, tell your doctor if you are allergic to latex so that a latex-free cover can be put on the transducer before it is used.

If both a transabdominal and transvaginal ultrasound will be done, the transabdominal ultrasound will usually be done first.

How It Is Done

This test is done by a doctor or by an ultrasound technologist (sonographer). It is done in an ultrasound room in a hospital, clinic, or doctor's office.

You will need to remove any jewellery that might be in the way of the ultrasound. You will need to take off most of your clothes below the waist. You will be given a gown to use during the test.

You will lie on your back (or on your side) on a padded table. Gel will be put on your belly to improve the quality of the sound waves. A small, hand-held instrument called a transducer is gently moved over your belly. A picture of the organs and blood vessels can be seen on a video screen.

You need to lie very still while the ultrasound is being done. You may be asked to take a breath and hold it for several seconds during the test.

Pelvic ultrasound takes about 30 minutes. You may be asked to wait until the doctor has looked at the pictures. The doctor may want to do more pictures.

Transabdominal ultrasound

For transabdominal ultrasound, you will need to drink 4 to 6 glasses of juice or water about an hour before the test. Do not empty your bladder until the test is over. If you cannot drink enough fluid, your bladder may be filled with water through a thin flexible tube (catheter) inserted into your bladder.

When the test is done, the gel is cleaned off your skin. You can urinate as soon as the test is done.

Transrectal ultrasound

For transrectal ultrasound, you will be asked to lie on your left side with your knees bent. A digital rectal examination will be done before the ultrasound test. Then a lubricated transducer probe will be gently inserted into your rectum. It will slowly be moved to take pictures from different angles. You may feel some pressure. Water may be put into your rectum to clean the end of the transducer so that clear pictures can be seen.

Transvaginal ultrasound

For transvaginal ultrasound, you will empty your bladder. You will be asked to lie on your back with your hips slightly raised.

A thin, lubricated transducer probe will be gently inserted into your vagina. Only the tip of the transducer is put in the vagina. You need to lie very still while the ultrasound scan is being done.

Transvaginal ultrasound may give more information than transabdominal ultrasound for women who:

  • Are very overweight.
  • Are being checked or treated for infertility.
  • Have a hard time with a full bladder.
  • Have a lot of gas in the intestines. This makes it harder for your doctor to see all the organs in the pelvis.

Transvaginal ultrasound often makes a clearer picture than transabdominal ultrasound because the transducer probe gets closer to the organs being viewed. It is often used in early pregnancy. But transvaginal ultrasound looks at a smaller area than transabdominal ultrasound.

In rare cases sterile saline is put in the uterus through a thin tube (catheter), to allow the doctor to look at the inside of the uterus (hysterosonogram).

How It Feels

If you have transabdominal ultrasound, you will likely feel pressure in your bladder and a strong urge to urinate because your bladder is full.

The gel may feel cold when it is put on your belly. You will feel light pressure from the transducer as it passes over your belly. If you have an injury or pelvic pain, the light pressure of the transducer may be painful. You will not hear or feel the sound waves.

You most likely will have a little pain during a transvaginal or transrectal ultrasound. You will feel pressure from the transducer probe as it is put into your vagina or rectum.

If a biopsy is done during the ultrasound, you may have some pain when the sample is taken.

Risks

There is a slight risk of infection from a transvaginal or transrectal ultrasound. If a biopsy is done, the chance of infection is higher. Call your doctor if you have an abnormal discharge or fever after the test.

Results

A pelvic ultrasound uses sound waves to make a picture of the organs and structures in the lower belly (pelvis).

Pelvic ultrasound in women

Normal:

Your ovaries, cervix, and uterus have a normal shape and size and are in the normal place. No growths, tumours, fluid, or other problems, such as cysts, are present. Small cysts (follicles) in the ovaries of women who are able to have children are normal.

If you are using an intrauterine device (IUD), it is in the uterus.

If you are in the first trimester of pregnancy, your baby ( fetus) is developing inside the uterus.

Your bladder is normal in size and shape. No stones or abnormal growths are present. If the bladder is checked before and after urination, it empties completely. Urine flows normally from the ureters into the bladder.

Abnormal:

Your uterus is big or abnormally shaped because of uterine fibroids. Cysts or tumours are present, such as cancerous or non-cancerous tumours of the ovaries, uterus, or cervix.

The thickness of the lining of the uterus (endometrium), called the endometrial stripe, is greater than normal. In some age groups, a thicker endometrial stripe (also called endometrial hyperplasia) may mean a higher chance of endometrial cancer.

Pelvic inflammatory disease (PID), abscesses, kidney stones, or other problems are present.

An ectopic pregnancy is present.

An abnormal amount of fluid is present in the pelvis.

The bladder has an abnormal shape or a thick wall. A growth or stone is seen in the bladder. If the bladder is checked before and after urination, it may not empty completely during urination.
Pelvic ultrasound in men

Normal:

Your prostate gland and seminal vesicles are normal in size and shape. No growths, tumours, or other problems, such as cysts, are present.

Your bladder is normal in size and shape. No stones or abnormal growths are present. If the bladder is checked before and after urination, it empties completely during urination. Urine flows normally from the ureters into the bladder.

Abnormal:

Your prostate gland is enlarged (benign prostatic hypertrophy, or BPH). This is one of the most common abnormal findings. An abscess, kidney stone in the urinary tract, or a tumour in or near the prostate gland or bladder may be present.

The bladder has an abnormal shape or a thick wall. A growth or stone is seen in the bladder. If the bladder is checked before and after urination, it may not empty completely during urination.

An abnormal amount of fluid is present in the pelvis.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

  • Stool (feces), air or other gas, or X-ray contrast material (such as barium) in the intestines or rectum.
  • Inability to remain still during the test.
  • Obesity.
  • Having an open wound on the belly.

A full bladder is needed for a transabdominal ultrasound, so that the pelvic organs can be seen clearly.

What To Think About

  • In some cases, a computed tomography (CT) scan or magnetic resonance imaging (MRI) may also be needed to confirm a problem, such as cancer.
  • Ultrasound does not use X-rays or other types of radiation.
  • With pelvic ultrasound, your doctor can usually tell the difference between a fluid-filled cyst, a solid tumour, or another type of lump. This is one of the main advantages of an ultrasound. An abnormal lump needs more testing. A follow-up ultrasound is often done in 6 to 8 weeks because many problems go away on their own within that time. Pelvic ultrasound cannot determine whether a lump is cancerous (malignant) or non-cancerous (benign). A biopsy may have to be done for this.
  • Transvaginal ultrasound is used during fertility checks to help guide the removal of ovarian follicles for in vitro fertilization.
  • Fetal ultrasound can be done to see your baby (fetus). For more information, see the topic Fetal Ultrasound.
  • If male problems, such as a big prostate, are found on ultrasound, more testing may be done.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.
  • Pagana KD, Pagana TJ (2010). Mosby's Manual of Diagnostic and Laboratory Tests, 4th ed. St. Louis: Mosby Elsevier.

Credits

Current as of:
July 17, 2020

Author: Healthwise Staff
Medical Review:
Adam Husney MD - Family Medicine
Thomas M. Bailey MD - Family Medicine
Kathleen Romito MD - Family Medicine
Martin J. Gabica MD - Family Medicine
Elizabeth T. Russo MD - Internal Medicine
Howard Schaff MD - Diagnostic Radiology
Kevin C. Kiley MD - Obstetrics and Gynecology