We have all been there before, the patient in the waiting room is glaring at everyone who walks by because she has a full bladder and the ultrasound tech is running 20 minutes behind. I have good news for you and your patients, in most cases, a full bladder is not needed, and as a matter of fact, when the patient drinks too much water and the bladder is too full, it can have negative effects on the transvaginal portion of the exam. The transabdominal portion of the exam is an overview, and an important way to rule out a large mass such as a pedunculated fibroid, or a mass that is located superiorly. These masses may be difficult to see transvaginally, making the transabdominal ultrasound very important. If we are looking at a fibroid uterus, or at a large mass, in most cases, a full bladder is not necessary to properly evaluate these structures because these structures are large and easy to see. When performing a transabdominal ultrasound, a partially filled bladder is usually all that is needed.
In the old days, the transvaginal ultrasound did not exist, therefore, the only way to see the uterus and ovaries was to fill the bladder completely. This is no longer the case. In most cases, the transvaginal ultrasound gives us a beautiful detailed look at the uterus, endometrium, and the ovaries. The detail that is achieved with transvaginal ultrasound is phenomenal. Polyps within the endometrium, septations or small polypoid structures within an ovarian cyst are virtually impossible to visualize transabdominally. The two studies complement one another very well. Not only is a completely full bladder unnecessary for the transabdominal study, if the patient drinks too much water, oftentimes after she empties the bladder, by the time she changes her clothes for the TV portion, her bladder has begun to fill again.
A partially filled bladder can interfere with the quality of the transvaginal images because the full bladder pushes the structures away from the probe. If the bladder is too full during the transvaginal portion of the exam, the patient must be sent back to the bathroom to empty a second or third time. You can imagine how frustrating this entire ordeal can be for the patient. This will also more than likely cause your ultrasound schedule to run behind. Avoid all of this frustration by not requiring your patients to completely fill the bladder, you will have happier patients and better quality pelvic ultrasounds!