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Vaginal Bleeding After Hysterectomy (Surgery)

A hysterectomy is the surgical removal of the uterus, with or without the fallopian tubes and ovaries. Post-operative vaginal bleeding after a hysterectomy can be a potentially serious complication which may require a blood transfusion and further surgery. The vaginal bleeding can occur immediately after or within a few days of surgery, or in some cases it may even occur a few weeks after the operation.

Spotting After Hysterectomy

Slight vaginal bleeding is often experienced by some women and this may take the form of spotting or a faint pink discharge in the first four to six weeks following a hysterectomy. The spotting may be considered to be normal in these circumstances. This small amount of bleeding may occur while the wound is healing and should not be a cause for concern in most cases as long as it seems to be decreasing gradually and there is no significant pain.

Post Hysterectomy Bleeding

However abnormal vaginal bleeding is a cause for concern and this may appear as :

  • spotting continuing for over six weeks.
  • distinct vaginal bleeding (not spotting or discharge) immediately after a hysterectomy operation.
  • sudden bleeding occurring within a few days or weeks after surgery.

Along with vaginal bleeding other symptoms such as abdominal or vaginal pain, vaginal discharge or fainting may be present. This requires medical intervention and you should consult with your doctor immediately

Causes of Vaginal Bleeding after Hysterectomy

The incidence of vaginal bleeding is found to be slightly higher after a vaginal hysterectomy than that after an abdominal hysterectomy. Your doctor may consider other investigative techniques to identify the cause of the bleeding as this is important to initiate proper treatment. Some of the causes of vaginal bleeding after a hysterectomy include :

  • Improperly ligated (tied) blood vessel or a slipped ligature is reported as the most common cause of immediate bleeding after a hysterectomy operation. The cut edge of the vaginal mucosa should be sutured carefully during the operation to prevent this type of bleeding. Care has to also be taken to ensure that no severed blood vessel is left unattended and all blood vessels are ligated properly. The suture may become loose or open up in an improperly tied blood vessel, leading to immediate bleeding or bleeding within a few hours of the operation. Early identification of the cause of bleeding is very important for treatment, which may necessitate a blood transfusion and re-suturing.
  • Granulation tissue sloughing results in delayed bleeding. This occurs when the granulation tissue, which forms during wound healing, ‘falls’ off and exposes a blood vessel.
  • Wound dehiscence is the re-opening of the wound after surgical closure which may occur due to infection, poor healing, injury or ineffective suture material. The wound may open up partially or completely and will need re-suturing after recognition of the problem. In addition, antibiotics and pain relievers may become necessary for treatment.
  • Coagulation or bleeding disorders in patients with clotting defects or those on anticoagulant therapy may result in post-operative vaginal bleeding after a hysterectomy. Although this is a rare cause, the bleeding has the potential of becoming quite serious unless adequate steps are taken as soon as possible. Vitamin K supplementation, stopping anticoagulant therapy, blood transfusion, and ligation of bleeding vessels may be necessary. A generalized ooze is quite common in these patients and a vaginal pack is effective here.
  • Non-effective suture material may cause bleeding by improper ligation of the blood vessels and by not effecting proper closure of the wound. Some patients have a reaction to certain suture materials, resulting in improper wound closure and healing.
  • Vaginal injury may occur either during or after the operation. Vaginal douches, insertion of tampons or sexual activity soon after the operation may also be contributing factors.
  • Other causes of vaginal bleeding that may occur any time after a hysterectomy , even years later, and may or may not be related to the operation. These causes  include :
  1. Subtotal hysterectomy – where only a part of the uterus is removed during operation.
  2. Cancer.
  3. Polyps.
  4. Fibroids.
  5. Bladder infections.
  6. Atrophic vaginitis as a result of low estrogen levels.
  7. Vaginal endometriosis.

Treatment of Vaginal Bleeding after Hysterectomy

Treatment for post-operative vaginal bleeding includes a blood transfusion and control of bleeding by identifying the cause and site of bleeding. This will involve taking the patient to the operation theater and then identifying and  ligating (tying) the bleeding vessels under general anesthesia if the site can be isolated. If the bleeding points cannot be seen, then the stitches on the vault of the vagina may need to be reopened. Vaginal packing is only done in case of clotting defects.

Additional treatment may include antibiotics to control infection, pain relievers, and vitamin K for clotting defects. Discontinuation of anticoagulation therapy may be necessary.

  • Margaret Hall

    Thank you for such a well written article on post-hysterectomy bleeding. I had a (subtotal, I suppose) hysterectomy on Aug 10 and came home the day after. I had minor brown discharge from Day 1 following surgery that has progressed to a light to medium flow of dark blood with bright streaks. My gynecologist insures me this is normal and since I’m not feeling any pain with this bleeding, and you seem to say the same thing, I’m going to assume that I’m alright. My main concern is that the bleeding is gradually getting heavier instead of tapering off. My 6-week follow-up is Sept 9th. I should, I would think, see a remarkable decrease in the bleeding by then. If you think otherwise, I would love to have your opinion off the record. Thanks so much.

  • Margaret Hall

    I failed to mention that my procedure was done laproscopically. I suppose it was a subtotal hysterectomy since my cervix was left in place.

  • Dr. Chris

    From Dr. Alison

    Hi Margaret,

    I understand your concern regarding the vaginal bleeding you are having after your laparoscopic subtotal hysterectomy (LSH). While some amount of bleeding is possible after surgery, as your gynecologist has assured you, this bleeding should gradually become less as the days go by. Since you say that the bleeding is gradually getting heavier instead of tapering off, I would strongly suggest that you see your gynecologist at the earliest.

    While LSH is considered to be a relatively safe surgery, with chances of much less bleeding during the operation, persistent vaginal bleeding can sometimes be a complication, often related to the cervical stump that is left in place. A checkup by your gynecologist should be able to rule out any worrying cause for your bleeding.

    I hope that my answer has been of help to you.

  • Melissa

    My surgery was July 26 when I had a hysterectomy. Started with the Divinci but complications made me have to be opened completely. 2 hours and 45 minutes later I came out of surgery. Apparently when I had a tumor removed 10 years ago and opened completely up the scar tissue attached to my intestines causing issues. I’ve been bleeding since the surgery. It gets really bright read and heavy. Like a normal period. My doctor is going to do surgery again to attempt to find out what’s going on. Part of my cervix had to be left because it was so embedded in scar tissue that I started losing blood during the surgery they stopped as they didn’t want to have to give me a transfusion. I apparently have cyst next to my bladder now. . . is this normal? I’m so tired of this crap.

  • Dr. Chris

    Hi Melissa

    It cannot be called normal or abnormal. Bottom line is that the scar tissue, adhesions should not have been present when your gynecologist went it to do the hysterectomy. But it was, given your previous surgery and he had to do his best to achieve the goals of the operation while minimizing complications in light of the unusual (not abnormal) situation. In most women who undergo a hysterectomy, this does NOT occur but then most may not have had previous abdominal surgery. Just follow through with your doctor, allow him to take it step by step by doing the necessary investigations and so on. It is a more complicated case but if viable, a second operation will achieve all the initial goals.

  • sara

    I am having some spotting every day and sometimes more then that. It has only been two weeks since my hysterectomy and I know I should be patient but the unknown has me a little shaken. How long should this bleeding last. I was told that there would be very little bleeding after my surgery.

  • Dr. Chris

    Hi Sara

    There is no exact time line for when a little spotting etc should stop. It is not always considered abnormal BUT it should always be reported to your gynecologist and more serious causes need to be excluded. It is not uncommon for this to happen in the first 4 to 6 weeks, sometimes on a daily basis, provided that it is very little and some women report the odd slight bleed up to 3 months or so. But like I said, there is no exact time line. 2 weeks is still early and therefore not unexpected but see your doctor to put your mind at ease. A heavy bleed is ABNORMAL and needs immediate medical attention.

  • Diana

    I had a vaginal hysterectomy 6 days ago with minimal bleeding, but I started bleeding heavier today and also had a blood clot is this normal or should I be concerned ?

  • Dr. Chris

    Hi Diana

    It does happen and can persist for weeks after the surgery but it is usually minor. You should see your gynecologist though to ensure that there is no rupture that could be causing this bleed, which may have been previously “plugged” by the blood clot that was expelled.

  • Candy

    I had a full Hhysterectomy two weeks ago, I started spoting a week after my sugery, it was done through an incesion in my lower abdomin. It is getting heavier in the last few days more like a period, should I be concerned, I can feel the flow of blood regularly and I am having pain along with the flow.

  • Dr. Chris

    Hi Candy

    Light spotting or bleeding is not uncommon after a hysterectomy. The fact that its increasing, plus the pain, means that you should see a doctor as soon as possible.

  • tracy

    I had a total vaginal hysterectomy 3 weeks ago. I have had discharge (clear to pink)every day since. Last night I began to see frank blood, enough that it nearly soaks a pantyliner. It is still present this morning. How much a cause for concern is this?

  • Dr. Chris

    Hi Tracy

    It is difficult to say just how serious it could be. Ideally you should see your gynecologist as so soon as you can. Any sign of pain requires IMMEDIATE medical attention.

  • lonnia

    I had a lsh 8 months ago I had internal bleeding. Now I’m starting to bleeding again with minor cramps is this normal?

  • Matt

    My significant other is currently going through some problems regarding abnormal bleeding post emergency hysterectomy surgery. She has been going through chemotherapy to rid her body of lymphoma Cancer and has recently went into remission for a second time. She also has a glioblastoma tumor located on the back side of her brain which she received as much treatment as possible for (chemo/radiation). Doctors were unable to remove this tumor given the location and the high risk involved. On a side note, she has also been fainting more now than ever. It used to be once every 2-3 months, now she’s bound to faint at least once a day, usually in the morning or at night when in bed. I feel that this is an important fact to include as it’ll broaden the scope of possibilities if fainting could be a symptom of a potential ailment. 2 months ago, she was rushed into the ER and it was soon found out that she needed an emergency hysterectomy. The surgery left her with only her Cervix intact. THe bleeding slowed down after the first week of surgery, but has continued to get worse since. She’s seen a Gynecologist regarding this issue and was only given some “maybe this or that” scenarios. Her Gynecologist put her on birth control and advised her to take one every 8 hours for 3 days than after 3 days take one pill a day. When taking the pill every 8 hours, her bleeding stopped but soon continued after taking the once a day dosage. Her gynecologist advised her to go to the ER if the bleednig persists past a week. She went to the ER, and had an Ultrasound to only find out once again that there was nothing visibly wrong. There’s obviously something wrong as this is not normal. Her blood tests come up with numbers in the normal range including her hemoglobin. SHe’s been bleeding non stop with golf ball sized clots for about 2 months. It is difficult because she does not have medical insurance. I’ve researched online for situations that are similar, but given her variables it’s difficult to find someone with similar ailments. We’re both lost with nowhere to go. ANY help or direction would be most appreciated. She’s been through so much and this is the proverbial “icing on the cake”. She is 23 years old. Could this be due to a complication after surgery regarding the stitches? Did the cuts not heal properly? Is this a hormone imbalance? Everytime she goes to the doctor they release her and tell her there’s nothing wrong. 4 times of this happening, once after being instructed to go to the ER to get help, soon becomes extremely discouraging. Any form of direction would be most appreciated

  • Matt

    I’d also like to include that her vagina hurts immensely. She advised me that just the ultrasound alone today hurt her, while the person administering the ultrasound didn’t see anything unusual.

  • Dr. Chris

    Hi Lonnia

    Light spotting may occur but its not common where it occurs so long after the surgery. Pain or cramping should not be present. You should see your gynecologist immediately.

  • Karen

    I am 42 years old. I had a partial hysterectomy 1 year ago. I had uterine fibroids and endometriosis. The endometriosis had attached my uterus and one ovary to my back wall, which the Dr. had to scrape out to remove. About two weeks after surgery I had very heavy bleeding due to a hematoma that lasted 2 weeks. Before surgery I had very bad lower back pain that kept me awake at nights, because of the attachments, after surgery my back pain went away. Now for about the past 6 months my lower back pain is returning to where I am having problems sleeping again and I am also having some spotting of blood (bright red) several times a month. Could my endometriosis have returned??

  • crystalyn

    hi, I had a subtotal hysto. on Dec. 6th (removed uterus and one ovary), had a hematoma but that resolved and no other complications. Had hardly any vaginal bleeding afterwards, hardly even spotting. Then today I started experiencing vaginal bleeding, not spotting, that is dark and I have eveloped lower right side abdominal pain and pulling. Especially when I sit up. Any ideas? I have 4+ week post op. later this week. Thanks in advance for your response and time.

  • Dr. Chris

    Hi Matt

    This could very well be a hormonal problem and possibly there are other complications following the surgery like a mild, chronic infection. Autoimmune conditions, clotting disorders and so on are also a possibility. It is a fairly complicated case when you look at it in isolation without considering previous findings (prior to the hysterectomy, other possibly features since teens and so on). Therefore it is essential that you stay with a single doctor and request a referral to another practitioner when necessary. This will ensure that the medical records are carried over so that there is some continuity rather than each practitioner starting again from scratch.

    Since she is still undergoing chemo, these are also factors to consider and communication between her oncologist and gynecologist is important. Rushing to the ER without following up afterwards with a doctor/specialist does not help in the overall assessment of her case. Insurance is obviously an issue but the correct channels have to be followed in order for this condition to be recorded and evaluated accordingly. There is not much that we can say just based on this information that you have provided. Your partner needs to discuss these issues with her doctor(s) and possibly request a referral to other specialists who her doctors may find will be able to shed more light onto the situation. Once again, the funding issue does become a problem.

    Remember without considering the findings of previous clinical investigations, your partner’s medical history and so on, just focusing on the current symptoms may be not provide a true indication on the nature and progression of the causative condition(s).

  • Dr. Chris

    Hi Crystalyn

    You should see a doctor. The presence of pain is more worrying that just he bleeding on its own. It is not uncommon for spotting/light bleeding to be reported a short while after the surgery but pain should not be present. See your doctor immediately just to exclude any other serious causes.

  • Dr. Chris

    Hi Karen

    Yes, it is possible but there could be other causes here that you may be missing and you should see your gynecologist immediately. Pain with bleeding should never be ignored so long after a hysterectomy.

  • sansil

    Hi am a 53 years old and I had a vaginal hysterechtomy 7 years ago…my uterus and cervex were removed but I still have both overies. I suddenly started having light pink vaginal bleeding….I do have vaginal dryness….but never had bleeding. What could this be?

  • Dr. Chris

    Hi Sansil

    This could be due to atrophic vaginitis which occurs with a drop in hormone levels. Here the vagina dries excessively and the lining thins thereby making it very prone to bleeding due to trauma (like during intercourse) or with infections. Another possibility is vaginal cancer, which is quite uncommon but should be kept in mind given your age and history. I would advise that you see your gynecologist IMMEDIATELY.

  • Tramaine

    Hello, I am 25yrs old, and I had an abdominal hysterectomy in Nov of 2010. Well I had my first sexual encounter a few days ago,and awoke this morning feeling really faint, minor pale pink spotting, and pain after urination. Could this be bad?

  • Dr. Chris

    Hi Tramaine

    This may occur given that this is your first time, however, the concern here with the painful urination is that it may be a sexually transmitted infection. Another possibility as well, is pregnancy. I would advise that you see a doctor immediately.