Post-Defecation Vaginal Bleeding: Causes and Concerns

Regarding post-defecation vaginal bleeding..?

Hello Doctor: In December 2011, I traveled abroad and purchased menstrual delay medication from a pharmacy.
Since then, I have been experiencing irregular bleeding during my menstrual cycle and in between (sometimes I notice light pink blood, and other times just a drop or two of blood).
In mid-December 2012, I went to the hospital for an abdominal ultrasound and a CA-125 blood test (result was 45).
The doctor diagnosed me with a 4 cm uterine fibroid and advised me to take Dydrogesterone for three months and return for follow-up.
However, I forgot to mention to the doctor that I also experience vaginal bleeding after bowel movements (I am certain it is vaginal).
I would like to ask if fibroids can cause vaginal bleeding after bowel movements? I am really worried that it might be another condition.
Thank you, Doctor.
:)

danxin de ren, 30~39 year old female. Ask Date: 2012/12/31

Dr. Lin Wenbin reply Obstetrics and Gynecology

The body naturally secretes progesterone, and when menstruation is about to occur, progesterone levels drop.
This drop in levels leads to the shedding of the endometrium, which is the onset of menstruation.
Taking medication to delay menstruation essentially supplements progesterone, preventing the natural decline in progesterone levels when menstruation is due, thus achieving the goal of temporarily postponing menstruation.
However, some individuals may experience breakthrough bleeding while on these medications; although the endometrium does not completely shed, small areas may still slough off.
This phenomenon is referred to as breakthrough bleeding in medical terms.
In other words, while the progesterone you are taking may help maintain the endometrium, over time, some shedding can still occur, resulting in what is known as spotting.
Adenomyosis can cause hypertrophy of the uterine muscle and an increase in blood vessels, which naturally leads to heavier bleeding.
Consequently, even outside of the expected menstrual period, there may be occasional bleeding.
During bowel movements, any blood that seeps out can easily be expelled due to increased abdominal pressure.
It is advisable to follow up with a healthcare provider regarding the status of adenomyosis for appropriate treatment.

Reply Date: 2012/12/31

More Info

Post-defecation vaginal bleeding can be concerning and may arise from various underlying causes. Given your history of irregular bleeding and the presence of a uterine fibroid (leiomyoma) measuring 4 cm, it is essential to consider how these factors might be interconnected.

Uterine fibroids are benign tumors that can develop in the uterus and may lead to a range of symptoms, including heavy menstrual bleeding, pelvic pain, and pressure symptoms. While fibroids primarily affect the uterus, their size and location can influence surrounding structures, including the vagina and rectum. In some cases, larger fibroids can exert pressure on the rectum, potentially leading to discomfort during bowel movements. This pressure might also contribute to the sensation of vaginal bleeding after defecation, particularly if there is any associated trauma or irritation to the vaginal walls.

However, it is crucial to note that vaginal bleeding after bowel movements is not a typical symptom directly associated with fibroids. Other potential causes of post-defecation vaginal bleeding could include:
1. Vaginal Trauma or Irritation: Straining during bowel movements can sometimes lead to trauma or irritation of the vaginal walls, especially if there is any associated constipation or hard stools. This could result in minor bleeding.

2. Infections: Conditions such as vaginitis or cervicitis can lead to inflammation and increased sensitivity in the vaginal area, potentially resulting in bleeding, especially after physical exertion like straining during a bowel movement.

3. Cervical Issues: Conditions affecting the cervix, such as cervical polyps or ectropion, can also lead to bleeding. If the cervix is irritated during bowel movements, it may result in spotting.

4. Endometrial Issues: Although less common, conditions such as endometriosis or adenomyosis could potentially lead to bleeding that might be perceived as occurring after defecation.

5. Coagulation Disorders: If there are underlying issues with blood clotting, this could also contribute to unusual bleeding patterns.

Given your elevated CA-125 level (45), which can be associated with various conditions, including endometriosis, pelvic inflammatory disease, or even malignancy, it is essential to follow up with your healthcare provider. While CA-125 is not a definitive marker for cancer, it can indicate the need for further investigation, especially in the context of your symptoms.

In conclusion, while uterine fibroids may contribute to some of your symptoms, post-defecation vaginal bleeding warrants a thorough evaluation to rule out other potential causes. It is advisable to communicate all your symptoms, including the vaginal bleeding after bowel movements, to your healthcare provider. They may recommend further imaging studies, such as a pelvic ultrasound, or additional tests to assess the health of your reproductive organs and ensure that there are no other underlying issues contributing to your symptoms. Regular follow-ups and open communication with your healthcare provider are crucial for managing your health effectively.

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