Pelvic Pain in Women: Ultrasound in Ajax

Pelvic pain is a symptom, not a diagnosis. It can be a dull ache that comes every month, a sharp twinge on one side, a heaviness that builds through the day, or pain that flares during intercourse or when using the washroom. It can come from the reproductive organs, but also from the bladder, the bowel, the muscles and joints of the pelvis, or nerves. That variety is exactly why it can be frustrating to live with and why it often takes some careful detective work to understand.

Ultrasound is one of the most common tools health-care providers use in that detective work. This article explains where an ultrasound fits when a woman has pelvic pain, what it is good at showing, where it has limits, and how you can help your provider make the most of it. It is written for patients across Ajax, Pickering, Whitby and Durham Region, but the principles apply wherever you are.

One thing comes first, though.

When pelvic pain is an emergency

A community imaging clinic is not the right place for sudden, severe pain. Call 911 or go to the nearest emergency department if you have pelvic or lower abdominal pain along with any of the following:

• Pain that is sudden, severe or rapidly getting worse.
• A positive pregnancy test, or any chance you could be pregnant, together with pain or bleeding.
• Heavy vaginal bleeding, such as soaking through a pad every hour.
• Fainting, dizziness, a racing heart or feeling as though you might pass out.
• Fever with severe pain, or pain with repeated vomiting.
• Pain after a recent procedure, birth or miscarriage that is getting worse.

Some causes of pelvic pain need urgent assessment and treatment that only a hospital can provide. If you are not sure whether your symptoms are an emergency, it is safer to be checked. You can also call Health811 to speak with a registered nurse at any time.

For pain that is ongoing, recurring or not urgent, the usual first step is a visit to your family doctor, nurse practitioner, gynaecologist or walk-in clinic.

Why ultrasound is often the first imaging test

When a provider decides imaging would help, ultrasound is frequently the first choice for the female pelvis. There are a few good reasons.

• It shows the pelvic organs well. The uterus, its lining, and the ovaries can usually be seen in good detail.
• It uses sound waves, not radiation. That makes it a comfortable first option for women of reproductive age, including those who are or might be pregnant.
• It works in real time. The sonographer can watch structures move, check how tissues respond to gentle pressure, and look at blood flow using Doppler.
• It is widely available. Many community clinics, including ours in Ajax, offer pelvic ultrasound by requisition.

If a provider needs more information afterwards, they may order other tests. But ultrasound often provides a useful starting map.

What a pelvic ultrasound may help your provider look for

Your requisition will describe what your provider wants to examine, and the final interpretation belongs in your report and the conversation with your provider. In general terms, a pelvic ultrasound is often used to look at:

The uterus

The size, shape and outline of the uterus, the thickness and appearance of its lining, and whether there are growths in or on its wall. Fibroids are one common example; our article on uterine fibroids and ultrasound looks at those in more detail.

The ovaries

The size and appearance of each ovary, and whether there are cysts. Many ovarian cysts are a normal part of the menstrual cycle and come and go on their own, so finding one does not automatically explain the pain. Your provider will put the finding in context.

The surrounding area

The bladder, and whether there is any fluid in the pelvis that would not normally be expected. Sometimes the scan also helps point toward a cause outside the reproductive organs, which can lead your provider in a new direction.

Pregnancy-related questions

In early pregnancy with pain, ultrasound is used to help confirm where a pregnancy is located. If you are pregnant and have pain or bleeding, contact your provider or go to the emergency department rather than booking an elective scan.

Two ways of scanning, briefly

A pelvic ultrasound may be done through the lower abdomen, through the vagina, or both.

Transabdominal scans are done from the outside with gel on your lower abdomen. They usually need a full bladder, and we have a whole article on why a full bladder matters for pelvic ultrasound, so we will not repeat the details here.

Transvaginal scans use a slim, covered probe placed a short way into the vagina. Because the probe is closer to the organs, the images are often more detailed. It is done with an empty bladder, explained before it begins, and you can ask questions, request a chaperone or decline. Many women find it less uncomfortable than they expected, though if you have pelvic pain it is completely reasonable to say so and ask the sonographer to go slowly.

If you have never had an internal exam, or if past experiences have been distressing, let the clinic know when you book. You do not need to explain why.

What ultrasound cannot always show

This is the part of the story that often gets left out, and it matters a great deal for women with ongoing pain.

A “normal” pelvic ultrasound means that the scan did not show the specific kinds of changes it is able to detect. It does not mean your pain is not real, and it does not mean nothing is wrong.

Some conditions associated with pelvic pain can be difficult or impossible to see on a standard ultrasound. Endometriosis is a well-known example. Some forms of it, such as cysts on the ovaries known as endometriomas, may be visible, but small patches of tissue elsewhere in the pelvis often are not. Pain from pelvic floor muscles, nerves, the bowel or the bladder lining may also leave no trace on imaging.

So if your scan comes back without an explanation, that is a reason to keep talking with your provider, not a reason to stop. They may suggest a different test, a referral to a specialist, or a treatment trial. Bring your questions back to them.

Help the scan help you: tracking your symptoms

The more clearly your provider understands your pain, the more precisely they can request imaging and interpret it. A simple symptom diary, kept for a few weeks or a couple of cycles, can be surprisingly powerful. Jot down:

1. When the pain happens, including the date and where you are in your menstrual cycle.
2. Where it is: one side, both sides, central, low back, or moving around.
3. What it feels like: cramping, stabbing, aching, burning, pressure.
4. How strong it is, on a scale of zero to ten.
5. What makes it better or worse: movement, eating, bowel movements, urination, intercourse, rest, heat.
6. Other symptoms: changes in bleeding, bloating, nausea, urinary symptoms, fatigue.
7. What you have tried, and whether it helped.

Bring this to your appointment with your provider. If your scan is timed around your cycle, they may ask you to book it on particular days, and your notes can help with that as well.

Questions worth asking your provider

When an ultrasound is suggested, a few questions can help you understand the plan:

• What are you hoping the ultrasound will show or rule out?
• Will it be transabdominal, transvaginal, or both?
• Does it matter where I am in my cycle when I have the scan?
• If the scan is normal, what would the next step be?
• Are there other tests, such as blood or urine tests, that should happen at the same time?
• How and when will we go over the results?

Results from your scan are sent to the provider who ordered it, who will go through them with you. Our article on how imaging results reach your doctor explains that process if you are curious.

Having your pelvic ultrasound in Ajax

Rossland Diagnostic Clinic offers general and obstetrical ultrasound, including pelvic scans, at Unit 102, 300 Rossland Road East in Ajax. A few practical points:

• Bring your requisition and your health card.
• Follow the preparation you are given at booking. Pelvic exams often need a full bladder; our patient preparation page lists the standard instructions.
• Wear comfortable, two-piece clothing. It makes changing simpler.
• Mention anything that affects your comfort. That includes pain that makes lying flat difficult, mobility needs, or a preference about the internal portion of the exam.

We are open Monday to Friday from 9:00am to 5:00pm and Saturday from 8:00am to 3:30pm, with free parking and ground-floor access, so getting in and out is straightforward even on a day when you are not feeling your best.

Living with pelvic pain can be wearing, and getting answers sometimes takes more than one step. If your provider has requested a pelvic ultrasound, call us at 905-426-3111 or request an appointment, and our team will confirm your preparation and find a time that works for you.