Preparation: 

Do not take pain medication (analgesics) on the day of your exam.

-During the ultrasound, the specialist gently presses with the probe to check for site-specific tenderness. This pain response is essential: it tells us where disease is likely present and helps confirm which structures are affected. If you take painkillers before the exam, your natural pain signals may be hidden, and we could miss important findings.

For the APU / Advanced Transvaginal / Modified Sonovaginography Ultrasound / Elastography:  The bladder must be slightly filled.

We strongly recommend the following for the examination:

-Purpose: Bowel preparation helps clear the intestines for clearer ultrasound images.

-Medications Needed:

Dulcolax (bisacodyl) tablets: Available over-the-counter at pharmacies. Typically, 5-10 mg tablets.

Fleet Enema (saline laxative enema): A ready-to-use bottle (about 133 mL), also available over-the-counter.

Dietary Advice: On the day before the exam, eat light meals, preferably soup (e.g., avoid heavy or fibrous foods). Stay hydrated but avoid eating after midnight if instructed.

When to Avoid: If you have allergies, kidney issues, bowel disorders (e.g., IBD), or are pregnant, do not proceed without doctor approval. Contact your clinic if you experience severe discomfort.

Timing: Schedule the enema so you're near a bathroom. Effects start within 5-15 minutes.

Exam Day: Wear comfortable clothing. The procedure usually takes around 60 minutes, in some cases more. You may need a full bladder for part of the scan—drink 32 oz (1 liter) of water 1-2 hours before if advised.

Step-by-Step Preparation:

1. The Day Before the Exam (Evening):

Take 2 tablets of Dulcolax (10 mg total, or as prescribed) with a full glass of water around 6-8 PM.

This mild laxative stimulates bowel movements overnight to partially clear the intestines.

Expect loose stools or diarrhea starting a few hours later. Stay near a bathroom.

Avoid eating solid food after taking the tablets if possible; stick to clear liquids.

2. The Morning of the Exam:

Administer the Fleet Enema 1-3 hours before your appointment time.

How to Use the Enema:

Lie on your left side with knees bent (or follow package instructions).

Remove the cap from the enema bottle and gently insert the tip into the rectum.

Squeeze the bottle to release most of the liquid (you don't need to empty it completely).

Hold the liquid in for 1-5 minutes if possible, then expel on the toilet.

This will clear the lower bowel/rectum. Expect a strong urge to defecate within 2-10 minutes.

If traveling far to the clinic, you may do the enema upon arrival (arrive 15-20 minutes early and inform staff).

Do not eat a heavy breakfast; opt for light liquids if needed.

After Preparation:

Proceed to your appointment as scheduled.

If you feel unwell (e.g., nausea, cramping), contact your healthcare provider immediately.

Post-exam: Resume normal diet unless advised otherwise.

Potential Side Effects:

Mild cramping, bloating, or diarrhea from the laxative/enema—these are temporary.

Dehydration: Drink plenty of fluids (water, electrolyte drinks) throughout.

For questions or adjustments, contact your clinic. These instructions align with common practices for deep endometriosis ultrasound mapping.

Note: A fleet enema is a bottle with 133 ml of liquid in it.  It has a nozzle that is covered 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 the application.  Try to wait for 3 to 5 minutes before going to the toilet. After this, your rectum should be completely empty optimizing ultrasound images.