Post-Operative Cough and Heavy Bleeding After Uterine Fibroid Surgery - Obstetrics and Gynecology

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Post-operative complications such as persistent cough and heavy bleeding after uterine fibroid surgery can be concerning and warrant careful evaluation. Based on your description, it seems you underwent a significant surgical procedure to remove two fibroids, with the largest measuring 10 cm. While some post-operative symptoms are expected, the severity and nature of your symptoms suggest that further investigation may be necessary.


Coughing After Surgery
Coughing after surgery, especially after general anesthesia, can be attributed to several factors. It is not uncommon for patients to experience a cough post-operatively due to irritation of the airways from intubation during anesthesia. This irritation can lead to a reflexive cough, which may persist for several days. However, the timing of your cough, which began on the fourth day post-surgery, raises some questions.
1. Post-operative Respiratory Complications: After major surgery, especially abdominal surgery, patients are at risk for respiratory complications, including atelectasis (collapse of part of the lung) or pneumonia. Deep breathing exercises and coughing are encouraged post-surgery to prevent these complications. If you did not practice these exercises immediately after surgery, it could contribute to respiratory issues.

2. Infection: A persistent cough that worsens could also indicate an infection, particularly if accompanied by other symptoms such as fever or increased sputum production.
3. Medication Effects: Some medications used during and after surgery can also lead to respiratory side effects. If you were prescribed narcotics for pain management, they can cause respiratory depression, which may complicate your breathing patterns.


Heavy Bleeding
Regarding the heavy bleeding you are experiencing, it is crucial to differentiate between normal post-operative bleeding and abnormal bleeding that requires medical attention.

1. Normal Post-operative Bleeding: After a significant surgical procedure like fibroid removal, some bleeding is expected as the body heals. However, the amount of bleeding you describe—comparable to the days leading up to your menstrual period, along with the passage of large blood clots—raises concern.

2. Potential Causes of Heavy Bleeding:
- Uterine Atony: This is a condition where the uterus does not contract effectively after surgery, leading to excessive bleeding.

- Retained Products of Conception: If any fibroid tissue or other material was left behind, it could lead to continued bleeding.

- Infection: An infection in the uterus can also lead to abnormal bleeding and should be ruled out.


Recommendations
Given your symptoms, it is advisable to take the following steps:
1. Return to Your Surgeon: You should contact your surgeon or healthcare provider as soon as possible to discuss your symptoms. They may recommend an early follow-up appointment to assess your bleeding and cough.

2. Monitoring Symptoms: Keep track of any additional symptoms, such as fever, increased pain, or changes in the nature of your cough (e.g., producing sputum, worsening severity). This information will be helpful for your healthcare provider.

3. Avoid Strain: While coughing is necessary, try to avoid straining yourself, as this can exacerbate bleeding and discomfort. Use pillows to support your abdomen when coughing.

4. Hydration and Rest: Ensure you are well-hydrated and getting plenty of rest to support your recovery.

In conclusion, while some post-operative symptoms are expected, the severity of your cough and the amount of bleeding you are experiencing should be evaluated by a healthcare professional. Early intervention can help prevent complications and ensure a smoother recovery process.