Vaginal Bleeding After Hysterectomy: What Is Normal?

Vaginal Bleeding After Hysterectomy

Vaginal bleeding after hysterectomy often take many women by surprise.

The worry about bleeding or just spotting after hysterectomy is
understandable to some degree. First, it is intuitively assumed that
once the uterus is done away with, then the story of vaginal bleeding
may have come to an end. This however may not always be the case.

Secondly,
the hysterectomy is often performed for specific reasons, some
associated with excessive bleeding while others are not.There might be
some heightened concerns about the failure of the surgery or even
recurrence of the underlying condition. Many of such women often ask “am
I bleeding because the surgery did not work? Has the disease returned?
Is there something new happening to me? etc

In this brief
article, we will consider together the circumstances when spotting after
hysterectomy may be considered “normal” and others which need to be
carefully evaluated to make sure a disease process is not responsible.

What Is Done During Hysterectomy?

Hysterectomy is the second most frequently performed surgical
procedure, after cesarean section, for women of reproductive age in the
United States. Approximately 600,000 hysterectomies are performed
annually in the United States, and approximately 20 million U.S. women
have had a hysterectomy.

Hysterectomy is a major surgical
operation during which the uterus is removed, often as the last remedy
for many gynecological conditions. In a 2002 Centers for Disease Control
and Prevention( CDC) report, the three most frequent reason why women
had a hysterectomy included fibroids, endometriosis and uterine
prolapse. Cancer is also a serious indication for this surgery.

The
main procedure during a hysterectomy is the removal of the uterus.
However, in addition to this, there may be at least two additional
procedures done

  1. Removal of the cervix When this is also done, it is called total hysterectomy. When the cervix is left in place, it is called sub-total hysterectomy.
  2. Removal of the ovariesBoth ovaries are often removed and the the procedure is called hystero-oophorectomy. In premenopausal women, this will lead to premature menopause.

The
procedure can either be done through the abdomen( abdominal
hysterectomy) like may other operations or through the vaginal( vaginal
hysterectomy)

Normal Bleeding After Hysterectomy

Bleeding or spotting is expected to occur in some women after
hysterectomy. However, there are two major characteristics of this
bleeding which you should know

  • The time of occurrence of the bleeding
    When the uterus is removed, the “stump” is sutured and it can bleed
    lightly through the vagina within the first 6 to 8 weeks. This occurs as
    the sutures resolve while natural healing takes place. Depending on the
    amount as noted below, light bleeding that occurs within this time
    frame is likely to be related to the surgery and not a reason for much
    concern. The bleeding should normally reduce in amount with time and
    finally disappears. Whatever the case, it should always be reported to
    your doctor during your follow-up appointment.
  • The amount of bleedingVaginal
    bleeding after hysterectomy is not periods and should therefore not be
    like periods! It is usually mild bleeding that might just be sufficient
    to stain the panties in some cases( spotting). Having a period-like
    bleeding is a cause for concern even within the 6 to 8 weeks period and
    requires prompt evaluation.

Furthermore, the
significance of the bleeding after hysterectomy will also be determined
by your specific clinical condition including associated diseases but
most especially the condition that led to the hysterectomy in the first
place. For example, bleeding in a patient with cancer is more worrisome
than bleeding in a patient who had fibroids.

Causes of Abnormal Bleeding

Besides the “normal” bleeding after hysterectomy as discussed above,
there are other cases where bleeding is the result of a disease
process. These diseases may include

  • Vaginal pathologies.
    Remember that vaginal spotting can result from the vagina itself even
    after the uterus is taken away! Common causes may be trauma, infection
    or atrophic vaginitis in post-menopausal women.
  • Cervix disease.
    In subtotal hysterectomy, bleeding can result from the cervix that is
    left behind. Causes may include cervix infection( cervicitis), polyps
    or cancer which should always be considered especially in
    post-menopausal women.
  • The underlying disease processes.
    After a hysterectomy, it is expected that the underlying disease should
    be treated. However, not all cases get completely treated. Diseases
    like fibroids can easily be treated as such. However for others like
    cancer, doctors are always concerned about complete cancer removal so
    any vaginal bleeding thereafter, especially when it seems abnormal,
    will always raise concern about the possibility of residual cancer. This
    will often lead to labs to make exclude or confirm this.
  • Other causes.
    Other causes like bleeding disease or vascular abnormalities are
    uncommon but may occur without any relationship with the genital system.

What Should I Do?

Normally, your doctor will explain to you the complications that may
follow after a hysterectomy including the possibility of mild vaginal
bleeding.

These are good steps you can take depending on what is happening with you,

  • Do nothing other than watch and wait! If the bleeding is just mild as
    described above within the 6 to 8 weeks period, you may just observe and
    wait for your next appointment but remember to report it to your
    doctor.
  • Follow your post-operation instructions
    including showing up for your appointment, any lifestyle issues and
    medications prescribed.
  • Visit your doctor or call
    his/her office if the bleeding is heavy or goes beyond the normal time.
    In the rare event that the bleeding is “bad”, you should visit the
    emergency.

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