Transrectal Ultrasound

What is a transrectal ultrasound?

Ultrasound is a minimally invasive procedure that uses sound waves to look at organs and tissues. Healthcare providers often use transrectal ultrasound (TRUS) to examine the prostate gland in men or people assigned male at birth (AMAB). They sometimes also use TRUS to look at the pelvic and reproductive organs in women or people assigned female at birth (AFAB).

During a transrectal ultrasound, your healthcare provider inserts a probe into your rectum. This probe gives off high-energy sound waves. These waves (echoes) travel through your rectum and bounce off other organs and tissues. The echoes create computerized images that your provider can see on a video screen.

Other names for a transrectal ultrasound include:

• Endorectal ultrasound (ERUS).
• Prostate sonogram.
• Prostate ultrasound.

Who needs to have a transrectal ultrasound?

Healthcare providers may use a transrectal ultrasound if you have:

• Abnormal findings on a digital rectal exam (DRE).
• Bloodwork that shows an elevated PSA (prostate-specific antigen) level.
• Cancerous or noncancerous prostate conditions that need treatment.
• Issues with getting pregnant (infertility).
• Issues with pelvic organs in women or people AFAB when transvaginal ultrasounds aren’t an option.
• Symptoms of prostate cancer, such as trouble urinating (peeing).

Why is a transrectal ultrasound done?

Providers use a transrectal ultrasound to diagnose prostate conditions. They can use it to take tissue from your prostate and examine it more closely to understand the cause of a prostate concern. They can also treat some prostate conditions through TRUS.

A transrectal ultrasound lets healthcare providers look at:

• Abnormal areas of your prostate.
• The shape and size of your prostate.

Providers may also use a transrectal ultrasound to diagnose conditions of the reproductive organs.

What does a transrectal ultrasound diagnose?

Health providers may use a transrectal ultrasound to obtain tissue samples (needle biopsy). These samples can help them diagnose:

• Enlarged prostate (benign prostatic hyperplasia).
• Inflamed prostate (prostatitis).
• Prostate cancer.
• Cysts on your reproductive organs.
• Issues with getting pregnant (infertility) in women or people AFAB.
• Issues with the female reproductive system, such as cancer.
• Rectal cancer.
• Anal cancer.

What conditions are treated with a transrectal ultrasound?

A transrectal ultrasound allows physicians to treat:

• Cancerous and noncancerous conditions of your prostate and surrounding tissues by providing internal radiation (brachytherapy), freezing (cryosurgery) or high-intensity focused ultrasound (HIFU) for prostate cancer.
• Pockets of pus (abscesses) by draining them.

What happens before a transrectal ultrasound?

Before a transrectal ultrasound, your provider will ask about your health history. Let them know if you have any:

• Allergies to medications.
• Heart conditions.
• Lung conditions.

Also, tell your provider if you typically take antibiotics before a surgical procedure.

Your provider will give you specific instructions. For example, they may ask you to:

• Avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.
• Stop taking blood thinners (anticoagulants).

Your provider may also ask you to have an enema one to four hours before TRUS. An enema helps clear out your colon and rectum. They may ask you to urinate (pee) to empty your bladder before the procedure.

What happens during a transrectal ultrasound?

On the day of your transrectal ultrasound, you should wear comfortable clothing. You may need to remove some of your clothing or wear a hospital gown during the procedure.

During the transrectal ultrasound:

• You’ll lie on your side and bend your knees toward your chest.
• Your provider inserts a lubricated probe into your rectum. The probe is about the size of a finger. The pressure may feel similar to having a bowel movement (pooping).
• After your provider positions the probe, they’ll see the images of your organs and tissues sent from the probe to a computer screen.

A transrectal ultrasound usually takes less than 30 minutes.

What happens during a transrectal ultrasound with biopsy?

Your provider may take a sample of tissue during the transrectal ultrasound (needle biopsy). Providers most commonly use needle biopsies on your prostate. Depending on your sex assigned at birth and other health concerns, they may take tissue samples from other organs, such as your cervix.

If physicians take a prostate biopsy, they’ll:

• Inject an anesthetic into your prostate to numb it.
• Put a thin, hollow needle next to the probe.
• Push the needle through your rectum wall into the prostate.
• Collect a variety of samples of prostate tissue.

What happens after a transrectal ultrasound?

After a transrectal ultrasound, you can go home the same day. You may be able to drive yourself home after the procedure but check with your provider to find out if you need a driver.

Your provider will give you follow-up instructions. You may need to:

• Avoid taking any aspirin or NSAIDs for at least three days after a transrectal ultrasound.
• Take antibiotics as prescribed.

If you have a biopsy during TRUS, your provider will send the biopsy to a lab for analysis. When the results are back, your provider will contact you to set up an appointment or talk about them.

What are the advantages of a transrectal ultrasound?

Providers consider transrectal ultrasounds minimally invasive and safe. They:

• Don’t use radiation.
• Give clear images of soft tissues that may not look as clear on X-rays.
• Produce images in real time.

What are the risks or complications of a transrectal ultrasound?

There are no known risks or complications of transrectal ultrasound. If you have a biopsy along with TRUS, your physician will discuss any potential complications. They may include brief periods of:

• Blood in your semen (hematospermia).
• Blood in your urine (hematuria).
• Erectile dysfunction (ED).
• Infections.
• Pain and soreness.
• Pain when urinating (dysuria) or urinary retention.
• Rectal bleeding.

What is the recovery time after a transrectal ultrasound?

Your recovery after a transrectal ultrasound is usually very short. Most people don’t have any side effects after the procedure. If you have rectal pain, you can try soaking in a warm bath.

If you have a biopsy during TRUS, a full recovery may take a few weeks or more.

When can I go back to work or school, drive or eat?

If you have a transrectal ultrasound without a biopsy, you can usually return to your normal activities right away. If you have a biopsy during TRUS, you may need to wait a few days to go back to your normal activities.

After a transrectal ultrasound, you can eat your regular diet. Try to drink six to eight glasses of water a day for at least three days to keep your urinary system clear.

When should I see my healthcare provider?

Talk to your healthcare provider if you have any of these symptoms after your surgery:

• Blood clot in your urine.
• Bloody urine that doesn’t go away.
• Fever.
• Trouble urinating that doesn’t go away.
• Pain that medication doesn’t help.

A note from Cleveland Clinic

Transrectal ultrasound (TRUS) uses sound waves to look at organs and tissues. These sound waves (echoes) travel through your rectum and produce images on a screen. Healthcare providers often use TRUS to diagnose and treat prostate conditions or problems with the female reproductive organs. Providers may do a needle biopsy during transrectal ultrasound. TRUS is quick and very low-risk. Recovery is usually fast but depends on the purpose of the TRUS and whether your provider completes other treatments at the same time.