Patient Information Endometriosis Assessment



As endometriosis mainly occurs behind the uterus, a part of the anatomy that is not well visualised on transabdominal ultrasound, a transvaginal ultrasound will allow much better views. A narrow, covered and gel lubricated probe is gently inserted into the vagina. Most patients will not experience pain. Some patients will experience very mild discomfort. You will be asked to empty your bladder before the scan, for your comfort. This has an additional benefit of obtaining better images. The examination takes approximately 20 minutes. Sometimes patients believe the ultrasound will be done via the rectum but this is not the case. 

For more information on endometriosis and the ultrasound procedure click here.

If your doctor refers you specifically for an endometriosis ultrasound scan and you feel uncomfortable about having a transvaginal ultrasound, or if you have never had sexual intercourse, in which case a vaginal scan is not advisable, please advise our receptionist. She will discuss your request with the doctor as an MRI may be a better way to look for deep infiltrating endometriosis in your situation. 

Because endometriosis can involve the bowel, the doctor who does the ultrasound will carefully look at the bowel during the transvaginal ultrasound. When the rectum is empty, the views of the bowel are generally better as bowel content can cause shadows on ultrasound. Your doctor may have asked you to do bowel preparation.It is outlined below. If your doctor did not mention it, we leave it up to you whether yoo do the prep or not. A mild bowel preparation prior to the ultrasound may optimise the views when you have had a past history of severe endometriosis or when you have significant bowel pain during your periods. If you don't have a proven history of significant endometriosis, or no significant bowel symptoms, it is probably not necessary to take bowel preparation. 

Bowel Preparation

The bowel preparation is always mild and usually well tolerated. The most common one, outlined below, requires you to take a mild laxative the night before the ultrasound and an enema within an hour before the ultrasound. All the medication is over the counter medication. It is cheap and does not require a script.  . Make sure the chemist gives the fleet enema rather than the oral fleet.  

The night before the scan take 

  • Dulcolax tablet, one tablet of 5mg or Dulcolax SP 10 drop

This is mild laxative that will make it easy to go to the toilet the next morning. Some people experience some cramping.

Just before the scan (either at home or in our rooms if you live far away)

  • Fleet enema


A fleet enema is a bottle with 133ml of liquid in it.  It has a nozzle that is precovered with gel. Apply it while lying on your side, inserting the nozzle into the anus and squirting the full content of the bottle into the rectum.  An urge to go to the toilet will follow application.  Try to wait 3 to 5 minutes before going to the toilet. After this your rectum should be completely empty optimising ultrasound images.

When should the test be done? 

In general a gynaecological ultrasound is best done immediately after a period but can be organised at any time during the menstrual cycle, even when you are bleeding. It is not necessary to change your appointment if this happens, unless you feel uncomfortable having a vaginal scan then or if you get a lot of pain during your period.


Because at Women's Ultrasound Malvern the doctor personally performs the ultrasound examination, the results can be discussed with you during and after the examination. Don't hesitate to ask questions. Abnormal results requiring more urgent attention will promptly be discussed with your referring gynaecologist. Some doctors receive the report electronically in which your doctor will have the result the same day. Otherwise a written copy of the result is sent in the mail and should reach your doctor 2 days after your ultrasound. Please advise us if you see your doctor earlier than that so we can fax the results.