It is normal to have some bleeding after a hysterectomy. However, in certain circumstances, it is best to contact a doctor for evaluation.
Most people experience light bleeding for several weeks after a hysterectomy. This type of bleeding is normal and is not usually a cause for concern.
However, some types of bleeding after a hysterectomy may indicate an issue that requires treatment.
This article discusses the potential causes of bleeding after a hysterectomy. It also looks at what a person can expect after the procedure, as well as when to see a doctor.
It is normal to have vaginal blood loss and discharge for several weeks after a hysterectomy, according to the American College of Obstetricians and Gynecologists.
The bleeding is likely to be similar to a light period and may be red, pink, or brown. There may also be bright red spotting due to the stitches from the surgery dissolving.
Sometimes, however, a person may experience abnormal bleeding, such as:
- bleeding that is persistent and does not stop
- bleeding that starts suddenly
- bleeding that is heavy or heavier than a menstrual period
A person should contact a doctor right away if they experience abnormal bleeding.
There is a chance that a hysterectomy may cause injury to organs, nerves, or blood vessels, which may also cause bleeding.
Some people experience little or no bleeding immediately after the operation, and then around 10 days later, have a sudden rush of fluid or old blood. This type of bleeding should stop quickly.
During recovery, a person should use sanitary pads instead of tampons for vaginal bleeding and discharge. Using tampons could increase the chances of infection after a hysterectomy, and they may be uncomfortable or painful while the area is healing.
If someone experiences heavy, bright red bleeding, or if they need to change their sanitary pad more than once per hour, they should contact a doctor for advice.
Months or years later
People who have had a hysterectomy can sometimes experience vaginal bleeding years later due to granulation tissue. Granulation tissue is scar tissue that forms at the top of the vagina when a person has a hysterectomy.
Although this is not serious, a person should inform their doctor so that they can confirm and treat the source of the bleeding.
Other reasons for bleeding after a hysterectomy include:
During a total and radical hysterectomy, a surgeon will remove the uterus and the cervix. They will also remove a part of the vagina and nearby tissue.
They will then stitch together the top part of the vagina in the space left by the cervix and the upper vagina. This is known as closing the vaginal cuff.
Though uncommon, there is a small chance that the vaginal cuff may tear after a hysterectomy.
Researchers have mixed opinions about what makes a vaginal cuff tear more likely, but an infection, a hematoma, or the type of surgery may be contributing factors. Resuming sexual activity too soon after surgery may also play a role.
Symptoms of a vaginal cuff tear include:
- vaginal discharge or bleeding
- sudden and severe abdominal pain
- painful sexual intercourse
- a fever
In severe cases of a vaginal cuff tear, the bowel may begin to push out through the open tear and into the vaginal cavity.
A doctor may treat a vaginal cuff tear with antibiotics and surgery.
A pelvic hematoma is a pool of blood that accumulates outside the blood vessels in the pelvic area.
It usually occurs when there is damage to the blood vessels, such as the uterine artery. The uterine artery provides blood supply to the uterus and other female reproductive organs.
Hematomas may develop in the peritoneal cavity, which is the area in the abdomen that contains the stomach, liver, and intestines. Hematomas may also occur in the vagina vault, which is the expanded region at the internal end of the vaginal canal.
Symptoms of a hematoma usually appear within around 24 hours after surgery. These include:
- foul-smelling vaginal discharge
- abdominal pain
- a fever
Having a hematoma may increase the chances of infection.
A doctor may use an ultrasound or CT scan to diagnose a pelvic hematoma. They can treat the hematoma using pain relief, antibiotic medications, and surgical drainage.
Sometimes, a hematoma resolves without intervention.
Rarely, nearby abdominal organs, such as the bowel or bladder, can sustain damage during the procedure.
A doctor may be able to repair any damage to the bowel and bladder during surgery. A person may need to temporarily use a urinary catheter to drain urine and a colostomy to collect stool.
If there is a delay in diagnosing a bowel or bladder injury, a person may notice rectal bleeding or blood in their urine. If this is the case, they should contact a doctor immediately.
A perforated bowel or bladder increases the likelihood of infection and a life threatening complication called sepsis.
A hemorrhage may occur after a hysterectomy. Although hemorrhages are a life threatening complication, they occur in very few people. According to one study, they affect just 1.3% of patients.
Hemorrhaging is more likely to happen after laparoscopic surgery, though researchers are unsure as to why.
Some factors that increase the chances of hemorrhage include:
- having a vaginal vault infection
- having a vaginal vault hematoma
- sustaining a surgical injury
- starting physical activity too soon after surgery
- having a large uterus
Symptoms of hemorrhage after a hysterectomy include sudden or heavy vaginal bleeding. The source of the bleeding is likely the uterine vessels or the cervical and vaginal vessels.
If a person experiences heavy, bright red bleeding after a hysterectomy, they should go to the emergency room immediately. Some people may need a blood transfusion.
After surgery, a healthcare professional will provide medications to help relieve pain and to prevent infection. They will also encourage the person to get up and move around.
In the initial days following surgery, a person can typically walk short distances and do light activity to prevent blood clots in the legs, pelvis, and lungs.
Most people stay in the hospital for around 1–2 days after an abdominal hysterectomy. They may only need to stay overnight for laparoscopic, vaginal, and robotic hysterectomies. Some people have to stay in the hospital longer, however.
Recovery from an abdominal hysterectomy may take around 6 weeks, whereas recovery from other types of hysterectomy may take 3–4 weeks.
Incisions to the abdomen will heal gradually, but there will be a visible scar that may fade over time.
It is important to avoid certain activities for 6 weeks after a hysterectomy, including:
- lifting anything heavy
- having vaginal intercourse
- engaging in strenuous physical activity
Hysterectomy is a major surgery. Recovery will take time and plenty of rest.
Some changes that a person may notice after undergoing a hysterectomy include:
- not having menstrual periods
- relief from the symptoms that the hysterectomy was treating
- menopause symptoms, if the surgeon also removed the ovaries
- less interest in sex
- vaginal dryness
- emotional changes
If the hysterectomy included the removal of the ovaries, a person could have a higher risk of developing conditions such as heart disease, bone loss, or urinary incontinence.
If the person has a partial hysterectomy and the cervix is still in place, they are still at risk of cervical cancer and should undergo regular Pap tests.
It is best to contact a doctor if the incision is inflamed, oozing discharge, or bleeding, or if a person experiences abnormal bleeding after surgery.
Abnormal bleeding includes:
- heavy vaginal bleeding that starts suddenly
- vaginal bleeding that gets heavier with time
- vaginal bleeding that continues after 6 weeks
- vaginal discharge with a foul odor
- rectal bleeding
- blood in the urine
A person should go to the emergency room after surgery if they have:
- heavy bleeding or discharge
- bright red bleeding
- pain that is increasing in intensity
- a high fever
- difficulty breathing
- chest pain
Vaginal bleeding after a hysterectomy is normal and can last for days or weeks following the surgery.
However, bleeding that begins suddenly, gets heavier over time, or does not stop are reasons to see a doctor.
Bleeding after a hysterectomy can sometimes be a symptom of a severe complication that needs prompt treatment.
If a person is worried about bleeding that seems unusual after a hysterectomy, they should ask a doctor for advice.