Post hysterectomy bleeding often causes women to panic. Without a uterus how can you have vaginal bleeding? Whatever the type of hysterectomy, women are left with an inner wound at the top of the vagina named the vaginal cuff.
Because we cannot see the healing process of this inner wound, many tend to forget it is there, and blood loss often comes as a surprise.
Hysterectomy is a major surgery and the recovery process will take several weeks not to say months. While your body is recovering, small amounts of bleeding are a sign that internal tissues are healing and repairing themselves.
If the bleeding is heavy it is possible that there are complications after hysterectomy, and a woman requires immediate medical attention. It may be a sign of the wound re-opening, and therefore you need to report it immediately.
However, you can expect some spotting or mild bleeding after hysterectomy. Let us begin to separate normal from abnormal bleeding after hysterectomy.
Post Hysterectomy Bleeding – The difference between normal and abnormal:
It is important to know that bleeding after a hysterectomy is normal. Following a hysterectomy, you may experience vaginal bleeding or spotting for four to six weeks, which is nothing to be concerned about. The key with normal bleeding is that it should slowly become less as the internal tissues heal.
Right after surgery, the bleeding is consistent as less area is healed. As long as the blood is not a bright red color, you may consider this as normal. Bright red colored blood may be a sign you are bleeding, the wound may have re-opened so do not ignore this.
As the new tissues are forming and the old ones getting dissolved, you may expect some bleeding. This type of bleeding is irregular and not heavy like normal menstrual periods.
Post hysterectomy bleeding should gradually grow less and take the form of spotting or light pinkish colored discharge. Though you may notice that the bleeding slightly increases (along with the pain) after sudden strenuous physical activities.
Don’t ignore the advice given by your health care provider. Take plenty of rest after surgery, avoid bending, don’t lift heavy things and do not insert anything into your vagina.
Vaginal bleeding after hysterectomy (during 6 week recovery period)
Vaginal bleeding after hysterectomy may occur for several reasons. Sex during the recovery phase may cause vaginal injury or the inner wound to re-open. Therefore, intercourse during the recovery stage is a big no, as the chance it will lead to bleeding is significant.
Sometimes a badly tied blood vessel can lead to post hysterectomy vaginal bleeding. When the suture of the blood vessel slips off, the wound may re-open, and you may need a second operation as they need to re-suture (close) the wound.
Though very rare, vascular abnormalities and hypersensitivity to certain types of suture materials can also cause post hysterectomy bleeding.
Causes of Post Hysterectomy Bleeding (after recovery period)
There are several reasons why women may experience heavy bleeding after six weeks of surgery. The most common causes include wound infection and vaginal injury. Trauma or infection of the vagina can also cause bleeding. In sub-total hysterectomy (where the entire uterus is not removed), the bleeding can be due to infection or injury to the cervix.
If you have a partial or sub-total hysterectomy there is a 10 – 15% chance you will have mini periods. With this type of surgery, the cervix and a small part of the uterus remains which may cause monthly bleeding and cramping.
Some light bleeding after intercourse after hysterectomy is not uncommon and caused by scar (granulation) tissue at the vaginal cuff. A study shows that vaginal vault granulation may occur in about one-third of women who have a hysterectomy. Small lesions equal or less than 5mm will often heal spontaneously. Larger lesions they may need to seal them off by burning them (cauterize). Another way is to treat them with silver nitrate.
Hysterectomy bleeding years after surgery
If you haven’t had a period for several years following your hysterectomy, sudden vaginal bleeding is obviously a shock. Logically, your first thought is that there is a connection between this bleeding and your hysterectomy. This is not necessary the case. Bleeding years after hysterectomy may be direct, indirectly or not at all related to the surgery.
- Often we see this bleeding after intercourse. After the hysterectomy dropping estrogen levels will cause changes in the vaginal wall, known as atrophic vaginitis. Lack of lubrication during intercourse can result in the trauma of the vaginal epithelium and cause bleeding.
- Cervical polyps can also cause vaginal bleeding and spotting. These polyps are fleshy abnormal growths and nearly always non-cancerous. When they grow on the inside of the cervix they call them endocervical and on the outside, ectocervical polyps.
- If the cervix is left intact during the hysterectomy you can still develop cervical dysplasia and cervical cancer. This can cause in some cases significant vaginal bleeding and most often after having intercourse.
- A rare cause of post hysterectomy hemorrhage is endometriosis of the vagina or of the vaginal cuff. A vagina is an unusual place for endometriosis to occur. Surgical spreading of endometrial tissue is possible when they remove the uterus via the vagina.
Treatment of post hysterectomy bleeding
If discovered early, bleeding after hysterectomy is easier to manage and treat. This depends off course upon the source of vaginal bleeding. Your physician may recommend complete bed rest followed by pain medications.
If the cause of bleeding is internal hemorrhage, they find the source and then tie off the blood vessel to stop blood loss. In the case of wound infection, antibiotics are the line of treatment. If a woman has lost a considerate amount of blood, blood transfusion or surgery is in some cases inevitable.