Bleeding After a Hysterectomy: What to Expect

Recovering completely from a hysterectomy usually takes at least six to eight weeks. It is normal to expect some amount of bleeding during this time. However, if the bleeding doesn't get lighter over time, that is not normal.

This article will explain the difference between normal and abnormal bleeding and how to know when to call a healthcare provider.

Normal Bleeding After a Hysterectomy

Some bleeding and discharge after a hysterectomy are normal for a few weeks following surgery. The key sign that you are healing normally from a hysterectomy is that the bleeding will decrease in the days and weeks following the surgery. Normal bleeding is mainly spotting that gets lighter over time.

Abnormal Bleeding After a Hysterectomy

A sudden and significant increase in bleeding is considered abnormal. In addition, bleeding should never be too heavy at any point in your recovery.

Bright red blood indicates an active bleed. If you pass large clots, this suggests that a large amount of blood has accumulated, often while you sleep. If you are experiencing either of these, seek medical attention immediately.

Some complications that may cause abnormal bleeding include a vaginal cuff tear and hemorrhage.

Vaginal Cuff Tear

The vaginal cuff is the incision where the vagina was cut away from the cervix. A rare complication involves a tear at this site, called vaginal cuff dehiscence.

In addition to vaginal bleeding, people with vaginal cuff tears may experience:

• Sudden and severe abdominal pain
• Pain during and after sex
• Vaginal discharge or bleeding
• Fever
• Nausea

This complication occurs 0-7% of the time. The risk for dehiscence depends on the type of surgery performed for the hysterectomy. It's more common in laparoscopic and robotic surgeries in which the surgeon, using magnification tools to judge the tissue, may not include sufficient tissue in the closure. Traditional vaginal and abdominal surgeries in which surgeons sew the wound by hand seem to have less risk.

Hemorrhage

Hemorrhage is severe bleeding. It is a risk of any surgery, including a hysterectomy. Hemorrhage may be primary (occurring within 24 hours after surgery) or secondary (occurring between 24 hours and six weeks).

Overall, the risk of hemorrhage after a hysterectomy is low (between 0.2% and 2%), but it can be life-threatening when it happens. Signs of hemorrhage include:

• Confusion 
• Pale, clammy skin
• Dizziness 
• Low blood pressure 
• Rapid pulse 
• Shortness of breath
• Weakness
• Abdominal pain and swelling
• Chest pain

Secondary hemorrhage may occur more often after laparoscopic surgeries than other surgical techniques.

When to See a Healthcare Provider

See a healthcare provider if you experience the following:

• Bright red vaginal bleeding
• Vaginal discharge with a foul odor
• Vaginal bleeding is more than light spotting
• A temperature over 100.5 F
• Severe nausea or vomiting
• Difficulty breathing
• Pain that is increasing
• Redness, swelling, or drainage at the incision site
• Difficulty urinating or pain with urination

Heavy bleeding during recovery should be reported to your surgeon immediately. This also goes for any symptoms of infection, such as a fever.

You should also call your healthcare provider if you have any signs of a neurogenic bladder. This is a condition in which there is damage to the nerves that control your bladder, resulting in difficulties with urination. Symptoms may include urinary incontinence (when you lack control of urination, which causes you to leak small traces of urine or release substantial amounts) or urinary retention. This occurs when you're unable to empty your bladder completely, which may cause pain, bloating, and in some instances kidney problems.

Summary

Some bleeding after a hysterectomy is expected. However, the bleeding should lessen over time. Heavy bleeding can be a sign of a complication and can be life-threatening in some cases. If you notice bleeding that is heavier than spotting, contact a healthcare provider.