Ultrasound examination (ultrasound) of the pelvic organs in women

In the pelvic area in women, the reproductive and urinary organs are located. Any manifestations of discomfort, for example, pain during urination or sexual intercourse, a burning sensation, cramps, the appearance of blood in the urine, indicate that pathological processes are occurring in one of the systems (urinary or reproductive). Due to the fact that all these organs are located side by side, in the limited space of the female small pelvis, often disorders or diseases affect both systems, so their comprehensive examination is necessary. One of the methods for diagnosing women’s health in gynecology is ultrasound of the pelvic organs in women.

What is the small pelvis in women, what organs are located in it

The small pelvis is an anatomical space delineated by the pelvic bones. The anterior border of the small pelvis is the pubic articulation, the posterior border is represented by the bones of the coccyx and sacrum. From the sides, the space is limited by the wings of the ilium. The female pelvis has a smaller depth, but greater width than the male one, and has a wider angle of the pubic articulation – this factor is due to the ability of the female body to bear children, and plays an important role in the process of childbirth.

The anatomical structure of the female pelvis is different from the male. Common organs in both men and women in this area are the bladder and part of the large intestine, namely the rectum.

The bladder acts as a kind of reservoir for urine. This is a hollow organ in which urine is collected from the kidneys, and after the accumulation of a certain volume, it is excreted through the urethra. Its location is behind the pubic joint behind the pubis. This muscular sac can stretch and contract, depending on how much urine has collected in it.

The rectum belongs to the human digestive tract, and is its final part. The name of this gut fully describes its structure – it really has no twists and turns. This part of the large intestine lies between the sigmoid colon and the anus. It is the process of absorption of water, as well as the accumulation of feces.

In addition to the excretory organs, the woman’s pelvis contains the genital organs – the uterus, vagina, ovaries and fallopian tubes.

The uterus is an unpaired organ that looks like a sac. It is hollow inside, and its walls are formed by muscle tissue. During the life of a woman, the size of the uterus changes, for example, in nulliparous women, its weight is about 60 grams, and in those who have given birth – 80 grams. The size of an organ in an adult woman can reach 6-9 centimeters in length and 3-4 centimeters in width. In front of the uterus is the bladder, behind it is the rectum. At the bottom of the sac is a rounded tubular formation called the cervix.

The woman’s vagina is a muscular-elastic formation of a tubular oblong shape, with a slit lumen. Its length can vary from 5 to 14 centimeters, but the vagina has the ability to stretch. The upper border of the organ is the cervix, from below it passes into the vestibule of the vagina.

The ovaries are a paired organ in a woman’s body. In them, the process of maturation of eggs – female germ cells involved in conception. In addition, the ovaries produce some sex hormones (endocrine function):

• progestins;
• estrogens;
• androgens.

Their structure is represented by a connective tissue stroma and parenchyma, consisting of the medulla and cortex. The mass of the ovary is about 6-8 grams, the length is from 25 to 55 millimeters, the width is 15-30 millimeters.

The fallopian tubes look like two paired hollow tubes connecting the abdominal and uterine cavities. The main function of the uterine (fallopian) tubes is the transportation of the fetal egg to the uterine cavity.

All these organs together form a complex system. They are located very close to each other, are small in size, and can overlap each other. Therefore, a full-fledged diagnosis should give the physician the opportunity to examine each of them, fix its condition, features of the structure and location, and also determine the presence of pathologies.

Why is an ultrasound of the pelvic organs prescribed for women, which shows

The female reproductive and genitourinary system is subject to both specific diseases that affect only these organs, and manifestations of complications, for example, from general inflammatory processes in the body, blood diseases, and infectious diseases. In addition to infertility and menstrual irregularities, all these pathologies can significantly affect a woman’s well-being, and some of them even threaten death.

Therefore, an ultrasound examination of these organs is often prescribed to women not only as part of an examination to establish a diagnosis. A consultation with a gynecologist and a general gynecological examination, including ultrasound of the small pelvis, for patients who are sexually active, must be done at least once a year, regardless of the presence or absence of alarming symptoms.

The operation of an ultrasound machine is based on the properties of ultrasonic waves to contact differently with tissues of different densities. Ultrasound waves are reflected from some tissues, absorbed by others, and freely transmitted by others. Thanks to the ultrasonic sensor, the doctor has the opportunity to monitor the condition of the pelvic organs in a woman in real time on the monitor.

In the process, the physician has the opportunity to see:

• uterus and cervix;
• ovaries (follicles, corpus luteum);
• bladder;
• retrouterine space for the presence of free fluid;
• rectum (with some types of examination);
• the fallopian tubes.

Types of ultrasound diagnostics of the small pelvis in women

Depending on how exactly the research will be carried out, there are such types of it:

• transvaginal;
• transrectal;
• transabdominal.

In the first case, the probe of the ultrasound machine is inserted through the vagina. Before that, a condom is put on it to prevent contamination of the sensor itself and the ingress of pathogens into the woman’s genitals.

Transrectal ultrasound is performed quite rarely, mainly for girls who have not yet had sexual intercourse. In this case, the sensor, with a condom previously put on, is inserted through the anus.

The transabdominal method implies that the examination takes place through the anterior wall of the abdominal cavity, that is, the doctor drives the sensor along the abdomen, having previously applied a special gel to it.

The most informative is the transvaginal method. The other two are used only in cases where the ultrasound room does not have the required type of transducer for insertion into the vagina, or if, for physiological reasons, transvaginal ultrasound is not possible.

Indications and contraindications for the appointment of ultrasound

Before referring the patient to a diagnostic session, the attending physician conducts an examination and a survey, finds out what conditions and diseases the woman has suffered, what symptoms bother her. Ultrasound of the pelvic organs is recommended for a woman if:

• there is a suspicion of pregnancy;
• intrauterine fetal pathologies are likely;
• inflammatory processes develop in the pelvis;
• had an abortion;
• childbirth took place with complications;
• oncology is suspected;
• there are congenital or acquired abnormalities in the development of the pelvic organs;
• disturbed menstrual cycle;
• diagnosed or suspected chronic diseases of the uterus, ovaries, fallopian tubes;
• the woman developed suspicious symptoms: sharp pains in the lower abdomen, bleeding from the vagina, not associated with menstruation, pulling and aching sensations.

In what cases is it forbidden to conduct an ultrasound of the pelvic organs? In fact, there are practically no strict contraindications for this method of examination. It is prescribed to pregnant women, can be carried out at any age, including before the onset of sexual activity. In this case, rather, there are limitations associated with the choice of the method of conducting. For example, pregnant women in the later stages and patients who have not yet begun to have sex, transvaginal ultrasound is not prescribed – diagnosis is carried out transabdominally, less often transrectally. If the condition of the anus does not allow the insertion of an ultrasound probe there, the simplest method remains – examination through the anterior abdominal wall.

It is inappropriate to conduct ultrasound diagnostics immediately after X-ray procedures with barium contrast agents. The contrast agent remaining in the body can significantly distort the image on the monitor of the ultrasound machine.

How to prepare for an ultrasound procedure

To obtain the most objective results, an ultrasound examination of the pelvic organs is recommended for women on the 7-10th day of the menstrual cycle, if examination of the uterus and fallopian tubes is expected, and ovarian pathology is also suspected. To detect uterine fibroids, the procedure is prescribed immediately after menstrual flow stops. Endometriosis is most accurately determined before the onset of menstruation. To study the process of folliculogenesis, the procedure is prescribed for 5, 9, and once in the period from 14 to 17 days of the menstrual cycle. For pregnant women, this type of diagnosis is carried out once a trimester. A planned three-time examination is mandatory during pregnancy and is included in the screening of pregnant women.

The requirements for preparing the patient when prescribing different types of pelvic ultrasound differ from each other. A common requirement for all three types of ultrasound is to follow a diet in order to reduce the level of gas formation in the intestines. Dietary restrictions are recommended to be introduced 2-3 days before the date of the examination.

From your menu you need to exclude:

• carbonated drinks and alcohol;
• fresh bread, especially black, and confectionery;
• fresh fruits and vegetables with a high fiber content;
• milk and dairy products;
• beans.

As for the special preparation rules, they relate to the fullness of the bladder. For example, with a transabdominal diagnostic method, one hour before the procedure, you need to drink 1-1,5 liters of water so that by the time of the study the bladder is noticeably full. Before transvaginal ultrasound, on the contrary, it is required to empty the bladder.

How is a pelvic examination performed with an ultrasound probe

The patient lies on the couch or is located in the gynecological chair. If the procedure is performed transabdominally, the subject releases the abdomen from clothing, and a conductive gel is applied to it. The doctor firmly presses the sensor to the body at various angles, moves it along the stomach, receiving an image of the internal organs on the monitor.

If we are talking about the transvaginal method, a condom is put on the sensor and a hydrogel is applied, after which the doctor inserts it into the vagina. In this case, the sensor has the form of a thin long tube, about 3 centimeters in diameter, with a rounded end. The doctor changes the angle of the transducer in the vagina to get a clear image of all the organs being examined. The transrectal procedure is similar.

The duration of the study is from 15 to 25 minutes. Patients note that ultrasound is almost completely painless. In some cases, when the sensor moves into the vagina, discomfort may occur, and if an inflammatory process occurs there, even pain. They should be reported to the doctor.

What happens after the procedure

The doctor-diagnostician, having completed the process of examining the organs on the monitor of the ultrasound machine, and having recorded all the information seen with the help of a nurse, proceeds to decipher the results and draw up a medical report.

The results of ultrasound make it possible to assess the size of organs and their structure, due to the property of tissue echogenicity. The diagnostician analyzes the position, structure and size of the fallopian tubes, bladder, uterus and cervix, the structure, size and location of the ovaries, and can determine the number of follicles. The ultrasound image shows the presence or absence of masses in the pelvic area, stones or masses in the bladder.

The doctor compares all anatomical parameters with the norm, thus getting the opportunity to determine the presence of deviations. For example, thickening of the walls of the cervix or fallopian tubes may indicate the presence of oncological formations or an inflammatory process. Various inclusions of an oval or round shape in the wall of the uterus in most cases are fibroids. In addition, it is possible to assess the condition of the endometrium (the inner layer of the uterus) and the uterine cavity. All indicators require comparison with the phase of the menstrual cycle. The retrouterine space is also examined to detect free fluid and tumor formations.

The conclusion of the ultrasound diagnostician, along with pictures or a recording of the procedure on a digital medium, is handed over to the patient. All these documents must then be transferred to the attending physician who ordered the ultrasound examination.

Doctors around the world note the high information content and absolute harmlessness of ultrasound of the pelvic organs in women. The accuracy of determining the pathology of the ovaries through ultrasound is about 90%, the detection of diseases of the uterus – 97-98%. The procedure is recommended as an annual preventive examination for women: both to establish a diagnosis and to monitor the effectiveness of treatment. The results of an ultrasound examination of the pelvic organs make it possible to establish the anatomical features of the structure and location of the organs, and the presence of pathological changes in them.