Postpartum Bleeding and Abdominal Pain: Your Symptoms

Postpartum menstruation has started, but there is intermittent bleeding along with left lower abdominal pain?

On December 28, I had a natural delivery, and the lochia lasted about five weeks.
My menstruation started on February 10 and ended on February 17.
I had intercourse on February 20, after which I experienced heavy bleeding.
I visited a nearby obstetrician-gynecologist, who said there was nothing to worry about and prescribed me a three-day course of hemostatic medication.
On February 26, after using the restroom, I inexplicably bled again (approximately the amount typical for the third day of menstruation), which was neither too much nor too little.
However, the bleeding stopped by March 2, but I have been experiencing continuous cramping pain in my lower left abdomen.

What could be causing my symptoms? I am considering seeing another doctor, but I am unsure whom to consult.
I definitely do not want to return to the doctor who delivered my baby.
During the delivery, I overheard the doctor and other medical staff discussing how my uterus was not contracting and that my pelvic cavity was not adequately opened, which made the delivery difficult.
They also mentioned severe tearing, which left me shocked.
My situation clearly indicated a need for a cesarean section, and I had repeatedly asked if a cesarean could be considered, but the doctor ignored me.
The baby's head was two weeks larger than the body, and I have a hereditary history of asthma, which flared up twice during my pregnancy.
I was dilated one centimeter for four days and one and a half centimeters for another four days, yet they were reluctant to let me go into labor.
After my water broke, the hospital allowed me to labor for 12 hours before the doctor finally moved me to the delivery room, continuously stating that I did not have enough energy and that I should wait until I was stronger to deliver.
The doctor was aware of my asthma condition! Ultimately, I delivered using vacuum extraction.
The anesthesiologist also administered the pain relief incorrectly, and I had to endure two injections.

Eva, 20~29 year old female. Ask Date: 2017/03/05

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, I'm sorry that I cannot provide a diagnosis based on what you've described.
It is possible that your postpartum menstruation has not yet regulated.
If you continue to experience discomfort, I recommend consulting another obstetrician-gynecologist.
Wishing you good health.

Reply Date: 2017/03/05

More Info

Postpartum bleeding and abdominal pain can be concerning symptoms for new mothers, and understanding the potential causes and appropriate management strategies is crucial for recovery and overall health. Based on your description, it appears that you experienced a complex delivery with significant challenges, including a prolonged labor, a vacuum-assisted delivery, and severe tearing. These factors can contribute to various postpartum complications, including bleeding and pain.

Possible Causes of Your Symptoms
1. Uterine Atony: After childbirth, the uterus should contract to reduce bleeding. If the uterus fails to contract effectively (uterine atony), it can lead to excessive bleeding. This condition is often managed with medications that promote uterine contraction, such as oxytocin.

2. Retained Placental Tissue: If any placental tissue remains in the uterus after delivery, it can cause continued bleeding and abdominal pain. This condition may require further medical intervention, such as a dilation and curettage (D&C) to remove the retained tissue.

3. Infection: Postpartum infections, such as endometritis, can occur and may present with symptoms like fever, foul-smelling discharge, and abdominal pain. If an infection is suspected, antibiotics may be necessary.

4. Pelvic Floor Dysfunction: Given the history of significant tearing and the challenges during delivery, pelvic floor dysfunction could be a contributing factor to your ongoing pain. This can include issues with the muscles and ligaments that support the pelvic organs.

5. Adhesions or Scar Tissue: Surgical interventions and significant tearing can lead to the formation of adhesions or scar tissue, which may cause chronic pain or discomfort in the pelvic area.

6. Hormonal Changes: Postpartum hormonal fluctuations can also affect menstrual cycles and may lead to irregular bleeding or discomfort.

Recommendations for Management
1. Follow-Up with a Healthcare Provider: Since you have concerns about your current symptoms, it is essential to seek a follow-up appointment with a healthcare provider. If you are uncomfortable with your previous doctor, consider seeking a second opinion from another obstetrician or a gynecologist who specializes in postpartum care.

2. Diagnostic Imaging: Your healthcare provider may recommend an ultrasound or other imaging studies to assess the uterus and surrounding structures for any abnormalities, such as retained tissue or signs of infection.

3. Pain Management: Discuss pain management options with your doctor. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may help alleviate discomfort. If pain persists, your doctor may prescribe stronger medications.

4. Monitoring Symptoms: Keep track of your symptoms, including the amount and nature of any bleeding, pain intensity, and any other associated symptoms (e.g., fever, foul-smelling discharge). This information can be helpful for your healthcare provider in determining the next steps.

5. Pelvic Floor Physical Therapy: If pelvic floor dysfunction is suspected, a referral to a physical therapist specializing in pelvic health may be beneficial. They can provide exercises and techniques to strengthen the pelvic floor and alleviate pain.

6. Emotional Support: The postpartum period can be emotionally challenging, especially after a difficult delivery. Consider seeking support from a counselor or joining a support group for new mothers.

Conclusion
Your symptoms of postpartum bleeding and abdominal pain warrant thorough evaluation and management. It is essential to communicate openly with your healthcare provider about your concerns and experiences during delivery. By seeking appropriate care and support, you can work towards recovery and improve your overall well-being. Remember, your health and comfort are paramount, and you deserve to have your concerns addressed comprehensively.

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