Trans Rectal Ultrasound
Surprisingly, this exam has never been described here so I'll throw my two cents in from the exam that was done on me in my mid 20s. This is a true, unenhanced recollection.
At the time, and the doctor never did figure out what was causing the problem, I was experiencing fairly deep pain in my lower pelvis and one of the things he wanted to rule out was some sort of a prostate problem. The doctor's nurse called the radiology lab where the sonogram was to be done and then handed me an appointment card for the next day at 10 am. There was no prep unlike the lower GI series I had had a few days earlier.
I arrived at the x ray facility at 9:50 am and after notifying the receptionist who I was I sat down in a small reception area and thumbed through a few magazines, somewhat nervous about what was going to happen. At about 5 after 10 a nurse opened the door between the reception area and the exam rooms and called out my name. I got up and followed her down the hall and she took me to a changing closet with a sliding door and told me to remove my clothing, shoes and socks, and put on the short gown, open in the back. She then slid the door closed.
Having just gone through this a few days before with the BE, this was not starting out well. The doctor hadn't explained how the test was done, he was sort of old school that way.
So I complied, stripped completely down and then put on the gown with just a single tie at the neck with nothing to hold the rest of the gown below there together. I slid open the door and then reached around to pull the lower fabric together, but there was little overlay as I sat back down. The gown was also short, only falling to my midthigh so that when I sat down I had to press the front of the gown down to not expose myself. Why even have a gown I wondered?
A few minutes pass by with my nervousness continuing to rise.
Than, a new nurse walked up to the changing closet and asked that I follow her. I stood up and grasped the material around my behind and followed her down the hall into a room about 8 X 10 that had a gurney at one end with a large waterproof pad in the middle. There was an adjoining bathroom next to it. At the end of the gurney was a large hook about six feet up attached to the wall. Please lay down on the gurney with your bottom on the pad she instructed as she shut door into the room and locked it, then walked into the bathroom, returning with what appeared to be a one quart enema with a long hose and nozzle attached, hanging the bag on the hook so that it was about 3 feet above the gurney. I need to get your lower colon cleared before the exam can be done so I need to give you an enema now.
Turn on to your left side please she said. I didn't like, and still don't like enemas, but I complied and rolled onto my side as the gown separated over my back exposing me. I heard her squeeze the lubricant on to the nozzle and then she reached over and separated my cheeks and inserted the tip about 4 inches, then released the clamp and the water began flowing in at a pretty good pace. Fortunately there wasn't enough water to cause any cramps since this was a low bowel cleansing. In 30 seconds the water was in and she slipped the tube out and told me to go empty myself in the toilet which I gladly did.
After about 20 minutes my system had emptied and I came out of the bathroom. The nurse told me to return to my changing closet and the tech would come and get me in a few minutes.
I returned and sat back down, still struggling with the gown to try and maintain some modesty.
About 10 minutes passed and a rather attractive and petite blond technician in white pants and a white blouse came to the closet and asked that I follow her so off we went. Just down the hall and to the right was an open doorway that led into a small room, maybe 8X8 that had a built in platform on one side with a thin mattress and a pillow on one end. Next to it was a machine that looked like a cabinet on wheels that had a large monitor on top, a set of probes with cables attached in a holder, and a keyboard. In front of it sat a girl in her mid 20s. A doctor in his early 30s was also in the room. It was just a little claustrophobic with four of us inside.
Where do you want me i ask? On the platform with your head on the pillow the doctor directed. I complied and realized as I laid down that there was no way I was going to be covered up since the fabric of the gown now reached just to my hip bones. I tried to relax knowing that the two girls in the room where medical professionals but nonetheless i was still uncomfortable. As I laid down the tech unhooked from the stand a wand that was about 9 or so inches long and about two inches in diameter. To me it looked more like a baton. I'd had an ultra sound a few years earlier where the technician had put jelly over my abdomen and then pressed the wand down and around the area to image, so my thinking was that given the relatively small gown I was wearing, they would do the same thing but focus on the lower pelvis area. I figured that like when the did the abdomen exam they would need to have direct contact with my skin so this was starting to make sense and I relaxed, putting my hands behind my head and waited for them to apply the jelly.
While I laid there in a relaxed state, the technician took what I can best describe as a very large condom and inserted the wand into so that the tip was firmly stretching it. At the base of the wand where the edge of the condom ended, a series of rubber type bands were tightly pulled from the top of the wand and rolled down to the base so that it was a sealed connection. The condom material around the wand itself was relatively loose. She then handed the wand to the doctor who was seated on a rolling stool proceeded to slather on a huge amount of KY jelly. This made no sense to me because I knew what the KY was normally used for and that all I was expecting was the jelly to be placed on my abdomen.
Now I was getting really nervous.
The doctor then looked at me and told me to roll on to my left side and draw both knees as tightly to my chest as possible. Wait, I said, I thought that you were just going to apply some jelly to my lower pelvic area and then press the wand down on me I said. No, he replied, this doesn't go on top of your abdomen, this goes inside of you through your rectum to your prostate.
I froze. This wand/baton was huge and there was no way he could get that rigid thing in me. Isn't that going to hurt? I asked and he said well yeah a bit because I have to get this all the way inside of you. Now roll on to your left side. I had no choice but to comply since the technician and the computer operator were staring at me waiting on me.
I gave up any sense of modesty and rolled over and pulled the knees as tightly up to my chest as I could, exposing me from my upper back to my feet. Pulling my knees so tightly to my chest also widened by butt cheeks so everything could be clearly seen. The technician also reached over the edge of the gurney and separated my cheeks with both hands so that the doctor could see where he was going. The doctor applied a bit of KY on my rectum and then placed the wand at the opening and then slowly but firmly began pressing it in. The girth of the device was huge and my rectum only slowly complied with this huge thing being shoved inside. It took a good 3-4 minutes of my wincing in pain as he would slowly insert the wand, pull it back, and then push it in still higher until the device was all the way inside. Once it was fully in, the technician flipped a switch and the wand began to be inflated with water that was held between the device and the condom like materials they had wrapped around it. I thought I was going to be split in two! It felt like a huge enema but one that was trapped to the lower 8 inches of my abdomen.
Then, the fun began as the doctor started forcing the wand against the muscle structure around the prostate from all angles. It felt like I was being beaten up from the inside out. The doctor would push the wand to one side at an angle and then shove it forward until the gal at at the computer said the image was clear and she would then snap a pic. This went on for about 45 minutes and by the time I was done I was totally exhausted and in extreme discomfort.
I sure hope the test has been improved since then.
The image of the exam at least for today. http://www.google.com/imgres?imgurl=http://www.sciencephoto.com/images/download_wm_image.html/C0011741-Trans-rectal_ultrasound-SPL.jpg%3Fid%3D670011741&imgrefurl=http://www.sciencephoto.com/images/download_lo_res.html%3Fid%3D670011741&usg=__y08ndeHpoceZpUuQ2-oam3Rcz2Q=&h=352&w=530&sz=50&hl=en&start=0&zoom=1&tbnid=BVgJUPJszXIyFM:&tbnh=146&tbnw=192&ei=AJ-sTavwFszSiALNu9iNDw&prev=/images%3Fq%3Dtransrectal%2Bultrasound%26hl%3Den%26safe%3Doff%26biw%3D1676%26bih%3D908%26gbv%3D2%26tbm%3Disch&itbs=1&iact=hc&vpx=263&vpy=565&dur=2166&hovh=183&hovw=276&tx=168&ty=82&oei=AJ-sTavwFszSiALNu9iNDw&page=1&ndsp=40&ved=1t:429,r:25,s:0
You can see even today why the gowns are pretty much nonexistent...