We are a Pregnancy Ultrasound & Wellness Clinic located in Edmonton, AB
Pelvic Patient Information
Explore our patient information resources to learn more about pelvic ultrasounds, what to expect during your appointment, and the advanced techniques we use to assess endometriosis, pelvic pain, and pelvic floor conditions.
What is Endometriosis?
Endometriosis is a common gynecologic condition where tissue similar to the endometrium, the lining of the uterus that sheds during a period, is implanted outside of the uterus where it should not be.
Endometriosis can cause inflammation, scarring, and symptoms, including:
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Pelvic pain
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Infertility (Endometriosis causes up to half of female infertility.)
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Very painful periods
In Canada, the average patient with endometriosis waits 8 years before receiving their diagnosis. The wait time to receive a diagnosis often prevents patients from accessing appropriate medical treatment, surgery, and expert referrals, even impacting their family planning. A major reason for this delay is due to the fact that endometriosis is difficult to diagnose on routine ultrasound—that’s why Milestones Diagnostics™ approaches it differently with advanced pelvic ultrasounds.
How Milestones’ Team Diagnoses Endometriosis
Milestones Diagnostics™ is one of the only clinics in Edmonton, Alberta, to provide step-by-step expert techniques (IDEA Protocol) to accurately diagnose all types of endometriosis.
Endometriosis can appear in three ways on ultrasound or during surgery:
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Endometriomas (also called ovarian endometriosis or chocolate cysts)
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Deep endometriosis
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Superficial endometriosis
Only endometriomas (the non-cancerous cysts that form inside the ovaries) are visible on routine ultrasound, which is why most patients with endometriosis have had “normal” ultrasounds. Because a routine ultrasound only examines the uterus, ovaries, and fallopian tubes, it may miss endometriosis outside these structures. At Milestones Diagnostics™, we use advanced pelvic ultrasound to diagnose endometriosis. These ultrasounds are longer, more in-depth scans that examine all organs where endometriosis can attach, including the bladder, bowel/rectum, and ligaments.
Advanced Pelvic Ultrasounds for Endometriosis: What to Expect at Milestones Diagnostics™
An advanced pelvic ultrasound for endometriosis is much more detailed than a routine or basic ultrasound. It may be longer and feel different from other vaginal ultrasounds that you have had.
During the appointment, we gently move the ultrasound probe in and out at different parts of the exam in order to see how organs move against each other, called the “sliding sign,” to find scarring or adhesions. When we look at structures like the rectum or ligaments, the ultrasound probe may feel deeper or temporarily uncomfortable. This is because the probe may touch pelvic floor muscles. When these muscles are tight, it can cause pain with sex or when inserting anything inside the vagina. Please tell us if you often have pain so that we can make your ultrasound as comfortable as possible.
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How We Look for Superficial Endometriosis During an Ultrasound
Superficial endometriosis is the most common type of endometriosis. Tiny (sometimes 1–2mm) areas of endometriosis attach to the peritoneum, the thin membrane that covers the pelvic organs. This is sometimes called “early stage” or “stage 1 or 2” endometriosis; however, superficial endometriosis can cause just as much pain or fertility problems as deep endometriosis. Most people think that superficial endometriosis can only be diagnosed with surgery, but our expert techniques can now accurately diagnose superficial endometriosis.
To see superficial endometriosis, it is helpful to have pelvic fluid. Fluid is black on ultrasound, and because superficial endometriosis lesions are so small, they are easier to see with a black background. Pelvic fluid is natural and is more common after ovulation, during the second half of your menstrual cycle. If there is no fluid in your pelvis during your ultrasound appointment, we can still miss superficial endometriosis. Remember, even if you leave your appointment without us seeing endometriosis, it does not mean that you are “normal” or that you do not have endometriosis.
Other Pelvic Procedures Offered at Milestones
SonoPODography
Best For: Women who experience pelvic pain or painful periods and want to check if they could have superficial endometriosis.
SonoPODography is a new technique that allows us to put fluid into your pelvis to see superficial endometriosis, even if you have no natural fluid on the day of your appointment. Sterile saline is instilled into the uterus, where it then spills out of the fallopian tubes into the pelvis. This provides the black background that makes it easier to see superficial endometriosis. Your body naturally absorbs the fluid after the appointment.
A SonoPODography is very similar to a procedure called sonohysterogram (SHG/SIS):
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A speculum is placed in the vagina, like during a pap test, and we place a small tube through the cervix and into the uterus.
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We slowly inject saline through this tube.
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The procedure takes less than 10 minutes, and it is common to experience mild discomfort or cramping during these steps.
If you have chronic pain or previous traumatic experiences, please tell your referring provider and our clinic so that we can help make the procedure as comfortable as possible.
Sonohysterogram
Best For: Women who want to identify abnormalities in the uterus that could be causing abnormal bleeding or unexplained infertility.
Sonohysterogram is a common ultrasound procedure that allows us to better identify abnormalities inside the uterus that could be contributing to abnormal bleeding or infertility. A sonohysterogram can be a follow-up test if we are concerned about polyps, adhesions/scar tissue, some fibroids, or shape differences such as a septum. Normally, the front and back walls of the uterus are touching, which can make these conditions harder to see. To improve the accuracy of the ultrasound, we can inject sterile fluid, saline, inside the uterus so that the cavity of the uterus opens up and expands. This highlights irregularities such as polyps or fibroids so you can make informed medical decisions.
During a sonohysterogram:
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A speculum is placed in the vagina, like during a pap test, and we place a small tube through the cervix and into the uterus.
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We slowly inject saline through this tube to inflate the uterus.
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It is common to experience mild discomfort or cramping during these steps, and it usually takes less than 10 minutes.
If you have chronic pain or previous traumatic experiences, please tell your referring provider and our clinic so that we can help make the procedure as comfortable as possible.
Tubal Patency
Best For: Women who struggle to get pregnant or are experiencing infertility.
If you are having difficulty getting pregnant or struggling with infertility, it may be important to check whether your fallopian tubes are open. Sometimes this is checked in the hospital using X-ray, called an HSG (Hysterosalpingogram), but we can also check it using ultrasound. A sonohysterogram is performed (see above). After confirming that the inside of the uterus is normal, we can use tiny air bubbles or other visible fluids on ultrasound to check whether the fallopian tubes are open. This takes only a few minutes longer than a sonohysterogram alone and involves no X-ray radiation.
Discomfort and Pain Control
At Milestones Diagnostics™, we try our best to make your ultrasound experience as comfortable as possible. We practice trauma-informed care, and Dr. Sullivan is an expert in chronic pelvic pain. However, vaginal ultrasounds and ultrasound procedures may not be very comfortable for some patients, so we want you to feel informed about options to increase your comfort.
Oral Medications
Anti-inflammatory drugs like Advil (ibuprofen) or Aleve (naproxen) can be helpful, especially before procedures. If you cannot take anti-inflammatory drugs, Tylenol (acetaminophen) can also be helpful. Do not take opioids like codeine or anxiety medications like Ativan (lorazepam) before your procedure, since these make the procedure more risky.
Penthrox
Trying an inhaled anesthetic that you administer yourself by breathing in through a green whistle can help with pain and anxiety. It can make you feel dizzy, but it leaves your body shortly after you stop inhaling. However, you cannot drive for 30 minutes after using it. Penthrox requires a prescription, so ask your doctor if you are interested in trying it during your visit at Milestones. If you use Penthrox during your ultrasound or procedure, you can take acetaminophen but not anti-inflammatory drugs.
Local Anesthetic/Freezing
This can reduce pain from the cervix, but does not help with pain from the uterus or tight pelvic floor muscles. Local anesthetics typically require a needle, so we typically recommend them only if your procedure is difficult.
Muscular Pain
Many patients have pain with penetrative sex or putting things inside the vagina. This is even more common in patients with endometriosis or other types of pelvic pain. This type of pain is often due to tight pelvic floor muscles that spasm when they are touched. Although it may be impossible to avoid all discomfort, we try our best to avoid irritating tight muscles and warn you when this might happen. We may recommend that you see a pelvic floor physiotherapist to learn strategies to relax these muscles. If you have symptoms of tight muscles, like pain with sex, lower back pain, constipation, or difficulty emptying your bladder, we encourage you to see a physiotherapist before your ultrasound appointment, though this should not delay your appointment.
Miniprobe
Vaginal ultrasounds may be painful or impossible for adolescent or virgin patients. For these patients, or anyone else who has pain from the width of the ultrasound probe, we can use a miniprobe that is much narrower. If using the miniprobe inside the vagina is not possible, we can use the miniprobe inside the rectum to look at your pelvic organs.
Additional Pelvic Floor Ultrasound Services
Ultrasound Assessment for Tight or Injured Pelvic Floors During Birth & Postpartum
Dynamic Pelvic Floor Assessment
The pelvic floor muscles act like a hammock in your pelvis, supporting your bladder, uterus, and bowel, and helping control your bladder and bowel. During childbirth, they also need to stretch to let your baby pass through.
At Milestones Diagnostics™, we offer dynamic pelvic floor assessment, which uses an ultrasound probe, either on the outside between your labia or just inside the vagina, to look at the pelvic floor muscles. We look at the muscles at rest (relaxed), during a squeeze or Kegel, and when you push down. This tells us how the muscles open and close, and the size of the opening that a baby would pass through.
Why Take a Pelvic Floor Assessment? This information helps us learn who may benefit from pelvic floor physiotherapy before having a baby. Some patterns, like muscles that have difficulty relaxing, are linked to a longer, harder pushing stage with a higher chance of needing a cesarean section or assisted vaginal delivery (vacuum or forceps). Knowing ahead of time gives you the chance to work with a pelvic floor physiotherapist during pregnancy to learn how to relax, strengthen, and use these muscles.
Detailed Pelvic Floor Ultrasound
During a vaginal birth, the pelvic floor muscles need to stretch to about three times their normal length so that a baby can pass through. Sometimes this stretching tears the muscle away from the bone, called a “levator ani avulsion”. This happens in 15—20% of normal vaginal deliveries, but is more common after a forceps delivery (up to 60%). Most patients with this injury have no idea that it happened, since it cannot be seen from the outside during childbirth.
Milestones Diagnostics™ provides a detailed pelvic floor ultrasound using specialized 3D imaging to closely examine these muscles and determine whether they remain attached where they should be. These injuries can contribute to symptoms that may occur months or years later, such as prolapse or incontinence.
Why is a Pelvic Floor Ultrasound Important? Knowing whether you have this injury helps you and your care team plan ahead, such as recommending pelvic floor physiotherapy, monitoring symptoms, or referring you to a specialist.
