Womens Health

Other causes of bleeding post-hysterectomy

That is the normal course of usual postoperative vaginal bleeding. Sometimes, however, bleeding can occur at other times or even much later (up to years). Causes include:

  • granulation tissue (healing tissue growing on its own)
  • prolapse of a fallopian tube (1)
  • endometriosis of the end of the vagina (2)
  • atrophic vaginitis due to low estrogen levels and traumatic irritation
  • a cancerous growth at end of the vagina (3)

In the situation you describe of bleeding at 4.5 months, you will need to have a vaginal speculum exam to look at the end of the vagina. Most likely you have some granulation tissue at the end of the vagina.

On appearance it would look like a dark red, beefy friable polypoid growth at the end of the vagina. It bleeds easily with touching. The treatment is to biopsy it away and use vaginal sulfa or other antibiotic cream.

There usually are no pain fibers at all. If it hurts at all during biopsy, it may represent a prolapsed tube if only a hysterectomy was performed without removing the tubes and ovaries.

A prolapsed tube more often causes pain rather than bleeding and it may need to be removed under anesthesia rather than in the office.

This bleeding is not a serious problem but be sure to see your doctor.

What are common symptoms I may notice during the recovery after a hysterectomy?

Several hysterectomy support sites have lists of what to expect after hysterectomy but they may represent a mixture of hysterectomy effects as well as symptoms from having the ovaries removed.

The biggest complaint most women have is fatigue. This persists for 2 or 3 months post op. It seems to last longer when the return to activity is slower. In other words it pays to become more active sooner after surgery.

Other immediate (within two weeks) post op symptoms may include:

  • urinary tract frequency and urgency
    • requires being checked for possible urinary tract infection although there may just be bladder spasms due to catheter irritation or small pelvic collections of blood near the bladder.
  • incisional problems
    • discharge or weeping of the incision in the first week or two
    • itching or burning of the incision at 3-6 weeks
    • pain that is localized to one side of the incision or another
    • swelling underneath or to the side of the incision but different than the rest of the incision
    • abdominal wall laxness, pot belly, bloated appearance
  • gastrointestinal problems
    • increased "gassiness" immediately after surgery (treatable with simethicone tablets or liquid)
    • constipation treatable with stool softeners, flax seed
    • loose stools (especially if antibiotics were given)
  • vaginal problems
    • bloody or odorous discharge for 1st 1-4 weeks
    • odor without much discharge (may require topical vaginal antibiotic cream if persists beyond a week)
    • vulvar burning or itching (usually just due to dryness and not a yeast infection)
  • mood changes
    • reversion to moods previously ignored due to hecticness of every day life
    • fatigue
    • decreased libido
    • increased feelings of stress and anxiety
    • increased depressive symptoms
      (Note - any 6 week period of significantly altered daily activity like postoperative recovery can lead to a change in mood for better or worse. It is not very predictable.)
  • pain
    • pain and swelling or redness at the site of the intravenous needles
    • pelvic cramps and catches somewhat sporadic in occurrence or related to increased physical activity
  • general problems
    • generalized allergic rash or itching to medications such as antibiotics or pain medicines

Remember that most women will say it takes up to 6 months after surgery before they do not think on a daily basis about having had surgery.

Table of Contents
1. Post-Hysterectomy
2. Symptoms after surgery
3. Severe complications
4. Tips for recovery
5. Back to work
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