Bleeding After Hysterectomy

The surgical removal of uterus is referred as hysterectomy. After the removal of uterus, menstruation is ended and the woman cannot become pregnant afterwards. Hysterectomy can either be total (in which the whole internal organs of reproduction like ovaries, fallopian tubes, uterus and cervix is removed) or partial (only uterus is removed while keeping the cervix intact) performed by gynecologist. Women usually have concerns about bleeding after hysterectomy, which is a common thing that will happen, and want to know about it.

Bleeding After Hysterectomy: Is It Normal?

After having hysterectomy, a woman may experience light bleeding or spotting, which is quite normal. Light bleeding or spotting is indicative of the vaginal discharge of the remnants of hysterectomy. It happens as the organs have been removed, and during the process of healing, the bleeding may occur. The colors of the bleeding discharge can change with time due to changes in the chemical composition of the excretions. As on the start, it may be red and then change out to the brownish tinge. And eventually, it may resemble the woman's normal vaginal discharge of pinkish color. If the bleeding after hysterectomy occurs heavily, then the woman should contact her doctor because this is quite abnormal. If it occurs accompanied by foul smell, fever or pain, it should be reported to the doctor immediately.

In certain circumstances, the amount of bleeding after hysterectomy is not the concerned point, instead, the duration of bleeding should be concerned. Mostly the vaginal bleeding tapers off during recovery period of hysterectomy. But if the bleeding does not stop even after six to eight weeks of recovery period, you must consult your doctor. There are certain circumstances in which the moderate to heavy bleeding with the bright red color after hysterectomy is normal and needs not to be considered an indication of the problem. For example, if only the uterus is removed during hysterectomy and the vagina, cervix and the ovaries are kept intact, the normal menstrual secretion can be confused with the heavy bleeding problem of hysterectomy. But still, if you consult your doctor, you can make sure that all is well or not.

Causes of Bleeding After Hysterectomy

Hysterectomy is a major surgery and needs some time to heal. During the process of healing, old cells die and new ones are formed, causing light or heavy bleeding.

1.     During Recovery Period

There are several reasons of the vaginal bleeding after hysterectomy. A common cause can be sex after hysterectomy during the period of recovery. Sex during recovery period can cause vaginal injury by reopening the inner wound. That's why it is not advised by the doctor to avoid the chances of severe or heavy bleeding.

Another cause of post hysterectomy bleeding can be badly tied blood vessel. The wound may reopen, when the suture of the blood vessel slips off, which requires a second operation to re-suture the wound. Some rare causes of bleeding after hysterectomy are the vascular abnormalities like hypersensitivity to certain types of suture materials, etc.

2.     After Recovery Period

There are many reasons why women experience heavy or severe bleeding after six weeks of surgery (which means beyond the recovery period). The common causes include wound infection and vaginal injury. Any trauma of vagina can also cause bleeding. In sub-total type of hysterectomy, in which the entire uterus is not removed, the bleeding can be due to some infection or injury to the cervix. If the bleeding occurs after the six weeks of recovery, it can be an indication of some internal tissue damage. Therefore, if you experience any bright red discharge or spotting after six weeks of surgery, with associated symptoms like pain, nausea extreme tiredness or severe headache, call your health care provider immediately.

3.     Years After Surgery

If you haven’t had a period for several years after hysterectomy, then sudden vaginal discharge or bleeding can be quite a shock. But hysterectomy may not be the culprit of it. There can actually be related with:

  1. Bleeding occurs mostly after intercourse. The dropped estrogen levels after hysterectomy will cause vascular changes in the vaginal wall. Lack of lubrication during intercourse can cause trauma of the vaginal epithelium, causing bleeding.
  2. Vaginal bleeding and spotting can also be caused by cervical polyps. These polyps are non-cancerous fleshy abnormal outgrowths mainly of two types, endocervical and ectocervical.
  3. Cervical dysplasia and cervical cancer can cause bleeding.
  4. Endometriosis of vagina or vaginal cuff can also be a reason of post hysterectomy hemorrhage.

Treatments for Bleeding After Hysterectomy

If diagnosed early, the bleeding after hysterectomy can be managed and treated easily. The treatment definitely depends upon the source of bleeding. If the internal hemorrhage is the cause of bleeding, then the source of hemorrhage is identified followed by ligation of blood vessel to stop the blood loss. The post hysterectomy bleeding needs blood transfusion. The procedure involves taking the patient to the O.T. and then identifying and tying the blood vessels under anesthesia. If the bleeding points are not obvious, then the stitches on the vaginal vault may be required to be reopened. The vaginal packing is only performed in case of clotting defects. In case of wound infection, the choices of treatment involve antibiotics. Antibiotics are often given along with pain relievers and vitamin K. Anti-coagulation therapy may be required to discontinue for the clotting defects.