Real Time Ultrasound - why we struggle to work with out it

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Ultrasound uses sound waves to produce an image of structures within your body. It is non invasive and pain free. Real time ultrasound is the same type of ultrasound that is used in pregnancy to look at a growing baby but our women’s health Physio’s use it to look at how muscles and tissue behave in real time.

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At The Physiotherapy Clinic we have a real time ultrasound in all three of our clinics in Sydney’s lower north shore (Cammeray), eastern suburbs (Bondi Junction) and Sutherland Shire (Woolooware) because it adds so much value to both our assessment and treatment of pelvic floor and abdominal wall disorders including abdominal separations (rectus diastasis) pelvic floor muscle function, prolapse issues, incontinence, bladder and bowel disorders.

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For the abdominal wall, real time ultrasound allows us to accurately measure the thickness, width and behaviour of the linea alba, which is the ligament that runs from your sternum to the pubic bone that needs to stretch in pregnancy to accommodate a growing baby. When this ligament stretches too much, an abdominal separation or rectus diastasis is diagnosed. We will use the real time ultrasound to track changes in pregnancy. For post partum women, the real time ultrasound allows us to accurately measure the thickness, width and function of the ligament, to track your post natal rehabilitation.

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The abdominal wall muscles are vital in the rehab of the abdominal wall. It is only with real time ultrasound that we can truly assess the behaviour and timing of our four abdominal muscle layers( transversus abdominus, internal and external oblique and rectus abdominus). It is often vital that a woman can visualise the muscles to ensure correct rehabilitation.

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There are multiple ways we use the real time ultrasound in assessment of pelvic floor function. It is especially useful to assess and teach a correct pelvic floor contraction in someone who in unable to have an internal assessment, as we can visualise the pelvic floor muscles through the abdomen. This is especially useful in our kids incontinence population. The trans abdominal approach allows visualisation of the bladder to calculate urine volumes, which can assist in the diagnosis of bladder and pelvic floor conditions.

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More advanced real time ultrasound skills include transperineal ultrasound in our male pelvic health group in the pre and post op period of a prostatectomy procedure. Incontinence is often an issue for these men, so it is a vital tool for pelvic floor strengthening of the correct pelvic floor layer to manage urinary incontinence postoperatively.

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Transperineal real time ultrasound in women has a variety of benefits. We are able to visualise the movement in the vaginal wall tissues that cause prolapse and urinary incontinence and the effectiveness of pessary placement as part of our management. It is very easy to view the rectum and the behaviour of the rectum with bearing down, which is often dysfunctional in men and women who have chronic constipation. Simply, by retraining this with the use of transperineal real time ultrasound is paramount in managing constipation.

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Importantly, we know that pregnant women who have a poorly coordinated push may have longer second stages of labour and therefore more intervention. The biofeedback gained from visualising the pelvic floor lengthening as a pregnant woman pushes is one of the vital tools we use to assist our pregnant women in optimising their pelvic floor for labour and birth.

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From our pregnant and postnatal women to our kids, and mens / women’s pelvic health populations in the shire (Woolooware), Bondi Junction and Cammeray, there are a multitude of benefits to utilising real time ultrasound in clinic. We would struggle to work without it!