Why is there still blood after hysterectomy?

Still bleeding after hysterectomy may be related to incomplete healing of the surgical wound, inflammation of the vaginal stump, or fluctuations in hormone levels. It is necessary to be alert to pathological factors such as cervical stump lesions or ovarian disease.

1. Surgical wound healing

Within 1-2 months after hysterectomy, a small amount of light red bleeding may appear at the suture site of the vaginal stump, which is a normal healing process. At this time, strenuous exercise should be avoided, the perineum should be kept clean and dry, and iodophor solution should be used for disinfection to prevent infection. If the amount of bleeding exceeds menstrual flow or lasts for more than two months, suture malabsorption or wound infection needs to be ruled out.

2. Vaginal stump inflammation

Vaginal stump inflammation often presents as contact bleeding with yellow discharge, which may be related to improper postoperative care or decreased immunity. It is recommended to wash the vulva with warm water every day and avoid using alkaline lotions. The doctor may prescribe metronidazole vaginal effervescent tablets or Baofukang suppositories to fight infection. In severe cases, oral cefixime dispersible tablets are required.

3. Changes in hormone levels

Patients who retain their ovaries may experience periodic spotting due to hormone fluctuations, similar to menstrual symptoms. This kind of bleeding is usually small in amount and heals itself in a short period of time. Ovarian function can be evaluated through six sex hormone tests. If necessary, the doctor will recommend taking drospirenone and ethinylestradiol tablets to adjust the cycle.

4. Cervical stump lesions

After subtotal hysterectomy, the residual cervix may develop cervicitis, polyps or intraepithelial neoplasia, manifesting as bleeding or bloody leucorrhea after intercourse. Colposcopy and HPV testing are required. After diagnosis, you can choose cervical polyp removal or cervical conization, and use recombinant human interferon α2b vaginal effervescent tablets for antiviral treatment after surgery.

5. Ovarian tumors

Functional ovarian tumors such as granulosa cell tumors may secrete estrogen and stimulate endometrioid tissue proliferation and bleeding. When accompanied by a pelvic mass or abnormal hair distribution, tumor marker testing and pelvic MRI should be performed. Treatment requires ovarian cyst removal or adnexectomy according to the pathological type, and postoperative injection of leuprolide acetate microspheres to control recurrence.

Within 3 months after surgery, it is recommended to use pure cotton underwear and change it daily, and avoid bathing and sex. Pay attention to supplementing the diet with high-quality protein such as fish and eggs to promote tissue repair, and eat animal liver in moderation to prevent anemia. When symptoms of bright red bleeding, blood clots or fever occur, you should return to the hospital immediately for vaginal ultrasound and routine blood examination. Regular follow-up can help detect abnormalities early, and it is recommended to review every 3 months in the first year after surgery.