Transvaginal US for excessive bleeding

[kitsu.livejournal.com]

Hi everyone, I'm a bit nervous about an upcoming trans-vaginal ultrasound I have scheduled for Monday.

A few weeks ago I started to suffer heavy vaginal and rectal bleeding and cramps while on BCP. It had gone on for 14 days before I had a chance to see a doctor. At first he thought it was just breakthrough bleeding until I mentioned the rectal bleeding. He gave me an exam and didn't see anything but suggested I get an ultrasound and see a gastroenterologist as well.

My first question is, will a trans-vaginal ultrasound show endometriosis? I've had a problem with heavy bleeding, cramps, nausea and rectal bleeding since I was 14 but due to lack of insurance and rude doctors I've never been tested.

My second question is, what should I expect during the ultrasound? All they've told me is to drink lots of water and come with a full bladder. Is it a long procedure?

Thanks in advance for your help!

Comments

[fallconsmate.livejournal.com]

i'm not sure if the trans-vaginal ultrasound will show endometriosis, since i dont have that. but it isnt painful, it may very well be uncomfortable with a full bladder.

my last one took all of 20 minutes, with the external ultrasound and the probe. i had pain because well, that's why i was HAVING the ultrasound, to figure out why i had pain. the proble of the trans-vaginal ultrasound is not exceedingly large, the size of maybe two fingers together. if you arent a virgin, it shouldnt be any big deal at all.

the ky gel is a mess, but the external gel is normally warmed, so that's nice. they put a condom on the probe, so if you have latex sensitivity, you need to speak up about that.

when i had mine, they found the two fairly large cysts on the left ovary, one on the right, and two "oh goodness, how do you have no pain from those!" fibroids on my uterus. as far as medical procedure pain, i'd give it a 3 out of 10, most of the discomfort is having someone rooting around in there when you have a full bladder. (and they let you go to the bathroom right after you're done.)

[starry3yedgrl.livejournal.com]

Not to be nosey, but why did they do the transvag US with a full bladder? I've had several US, both TV and abdominal and they want a full bladder for the latter, but they've always made me pee after the abdominal but before the TV.

[fallconsmate.livejournal.com]

They did both at once with no pee break in between because I was in so much pain that they wanted to get it done as fast as possible to stop making the pain worse. My final report was "there isn't anything here that should be causing you so much pain!"

What ended up happening was me in the hospital with referred pain from pancreatitis, and lots of good pain drugs, and a diagnosis that ended up being cirrhosis of the liver. We're still working out how to treat that.

[nickelshoe.livejournal.com]

I'm trying to remember when I had them both at the same time, which they did first, because they also had me pee in between. I'd been in the ER all night holding it like they asked me to, and the tech said he could see that my bladder was full.

Either way, I think a full bladder moves the uterus up a little bit (I know it does my giant pregnant uterus, at least) and makes a clear backdrop for the imaging. Hopefully someone who works in diagnostic imaging will stop by and help clarify.

[sparks37.livejournal.com]

Ultrasound can't see through air, so all of the gas in your intestines really hinders image quality. We have you come with a full bladder since it sits right on top of uterus, if its full it pushes all of the bowel out of the way and makes a clearer picture.

A transabdominal pelvic ultrasound (done from the outside) you have to have a full bladder for. Unless you weigh 100 lbs and are 15 yrs old, they're usually pretty useless without the full bladder. The transvaginal ultrasound on the other hand, needs an empty bladder. Not only is it uncomfortable for the patient, but the full bladder can shadow over your uterus and make it more difficult to image.

[nickelshoe.livejournal.com]

Thanks!

[io2012.livejournal.com]

Transvaginal ultrasound will most likely NOT show endometriosis, especially the type that would cause rectal bleeding. The ONLY type of endometriosis visible on ultrasound is an endometrioma, an ovarian cyst whose walls are made from endometrial tissue.

The transvaginal ultrasound uses a wand about the size of 2 fingers in width and as long as it needs to be (they don't insert the full length). They may also take some images from the outside of your abdomen while your bladder is full, then have you empty your bladder before they continue the exam. The wand wasn't covered by a condom any of the times I've had it, it was covered by a sterile plastic sleeve. If you ask, they will allow you to insert it yourself (if you are in pain, that makes a big difference!). They will likely look at your uterus and ovaries for size, thickness, number of follicles, and any abnormalities (cysts, uterine fibroids, etc).

Endometriosis is a very common GYN condition, and is incredibly underdiagnosed. The ONLY way to make a definitive diagnosis of endometriosis is to perform a laproscopy - a procedure where the surgeon makes a small incision in your abdomen and inserts a camera to visualize the inside of the pelvic cavity. Here's what I wrote recently on another VP entry: "Endo is FAMOUS for getting missed on any/ALL medical imaging tests. The implants are often small enough that they are below the resolution size of the imaging equipment and/or could be considered normal variations in shape for that area of anatomy.
Many, MANY female patients have been opened up by a surgeon who told them "I really don't think endo is the source of your pain." only to find out that they have severe adhesions from the disease. Endometriosis, by definition, it the growth of slightly abnormal uterine tissue OUTSIDE of the uterine cavity. Therefore, it doesn't ever "start in the uterus."
Also, the uterus and bowel being "grossly normal" on an exam doesn't exclude the possibility of endo - sometimes the structures look like that just because that's how they "settled" on that imaging session, and other times they are only in that configuration because they are held together by endometriosis adhesions."

Lots and lots of OBGYNs wouldn't know endometriosis if it bit them in the face. Others might recognize it, but would suggest you go back on the birth control merry go round. There is a strong argument that time wasted trying hormonal methods which do NOT cure endometriosis allows the disease to become more severe. The best treatment is early, complete excision via laproscopy. A Reproductive Endocrinologist is more likely to be versed in endometriosis and it's surgical excision. I HIGHLY suggest calling some who are covered by your insurance and asking them how many patients they treat for endo, and how many they perform surgery on.

Always ask for copies of your test results. If you don't understand them and/or the medical provider is a jerk, post them on here and someone will help you know what questions to ask the medical provider!

Heavy bleeding and chronic pain are NOT par for the course if you are female! Don't take "we don't know, take this birth control pill instead" for an answer!

There's lots of good content over at http://cjlevett.proboards.com/index.cgi if you'd like to do some more reading on endometriosis. :-)

Above all (this comment is so long!) (((HUGS!!!)))

[kitsu.livejournal.com]

Thanks for all this helpful information! When I mentioned the menstrual problems I'd been having to my last gyne he said, "It could be fibroids, it could be endometriosis or it could just be your cross to bear". Needless to say I haven't seen him since.

My new gyne listed off a laundry list of things that could be causing the bleeding and at 24 I'm too young for it to be cysts but I think he wants to rule everything out.

Any advice on how to push to get a laproscopy to test for endometriosis? Or should that be the next plan of attack if the ultrasound doesn't show anything?

[io2012.livejournal.com]

First off, I'm 24 and I have 2 types of cysts: Polycystic ovary syndrome "tiny" cysts (immature egg follicles), and large benign cysts that get filled with blood. If you have menstrual bleeds, you are not too young to get ovarian cysts.

The ultrasound will show fibroids, endometrial hyperplasia, ovarian cysts, and the size of your uterus/ovaries. Did you already have it? How did it go?

To get diagnosed for endometriosis I recommend looking at the list of providers your insurance has for both OBGYNs and Reproductive Endocrinologists. Then call each office and ask if they have a doctor who sees patients with endometriosis frequently and performs laproscopy for endometriosis frequently. In my experience, Reproductive Endocrinologists are more experienced with endo than OBGYNs, but a good OBGYN is better than a bad RE! In any case, someone who performs laproscopies for endo diagnosis FREQUENTLY (more than once a month) will be much more likely to appreciate the value of this test. It's also very good continuity of care to have the same provider who asked you the basic questions also performing your surgery.

If the ultrasound doesn't show anything I would STRONGLY suggest finding a doctor who sees a lot of endometriosis patients and getting a laproscopic diagnosis.

[paraxeni.livejournal.com]

You can get functional cysts at any time from puberty to menopause. I had my first burst cyst at 13. The cysts associated with my polycystic ovarian syndrome were first spotted on an ultrasound when I was 18, but I'd had symptoms for 4 years.

[sparks37.livejournal.com]

I'm a sonographer, so I can give you a rundown from the other perspective. Coming with a full bladder part is very important, I know that timing it just right is horribly difficult, but if you show up not very full or go to the bathroom at the last minute, they may make you sit in the waiting room drinking to fill your bladder, this can take at least an hour (some might not though, it depends on department policy). While your bladder is full they will do an ultrasound on top, like the kind you see on TV for babies. During this they'll go through imaging and measuring you uterus and ovaries.

Then, they should let you empty your bladder. I am really surprised by the other commenters who had transvaginal exams with full bladders! I would never do that to a patient unless it was an emergency. After you empty your bladder they'll ask you to undress from the waist down, giving you a gown or a sheet to cover up with. They'll have some sort of pelvic bed like at a gynecologist's office, or will ask you to sit on a foam wedge to help tilt your hips up.

The transducer is not very wide, but it is very long. Don't get nervous about that! 90% of it is handle. It only goes in a couple of inches, similar to a tampon. It will have some sort of cover on it, either condom or specific transducer cover. If they don't offer, you can ask to insert it yourself if that makes you feel better. I usually offer, but most people say no, so some sonographers stop asking altogether.

How long the exam lasts and how uncomfortable it is for you will really depend on your anatomy. If your ovaries are hard to get to it may take longer and the sonographer may have to push out more to the side. Throughout the exam you should feel pressure, but you should not feel pain unless you're already in pain.

The presence of gas and bowel can make a difference in how easy the exam is, so if you kinda feel like you have to go, try to have a bowel movement beforehand. We don't tell people to do that, but its what I would do if I was having one done.

[sparks37.livejournal.com]

I forgot to add that during the transvaginal they will image and measure your uterus and ovaries again. The on top ultrasound is to get a "lay of the land," so to speak, but the resolution on the transvaginal exam is a hundred times better, so its crucial to do it in order to get good diagnostic detail.