A middle-aged woman is seen in nephrology clinic for recurrent nephrolithiasis. She was previously advised to drink plenty of water but thinks she is probably drinking ‘too much’ because she has to ‘go to bathroom all the time’. On further questioning, says she has ‘urgency’ to urinate and in fact, feels she needs to go now. A quick suprapubic scan was performed which revealed a small urinary bladder (normally that volume should not cause urge to urinate) and also a prominent heterogeneous appearing uterus compressing the bladder. There was a more focal rounded area (*) at the uterine fundus. It was thought to be a fibroid or some other uterine pathology, likely contributing to urinary symptoms (analogous to an enlarged prostate in a male patient).

She underwent a radiology-performed pelvic ultrasound examination, which was read as ‘fibroid uterus’ vs ‘focal and diffuse adenomyosis’. Note that to look at the uterus on trans-abdominal scans, patient is asked to have a full bladder while it is opposite for the pelvic scans.

Gynecologist opined it was adenomyosis (she had a history of endometriosis). Uterine adenomyosis is characterized by the presence of endometrial glands and stroma within the myometrium, resulting in hypertrophy of the surrounding myometrium. A simple physical exam (POCUS) can change the management instead of making ‘assumptions’ (blaming water intake for frequent urination in this case).