Post-Cesarean Bleeding and Adhesion Concerns

Postpartum lochia and adhesion issues after cesarean section?

Hello, Dr.
Hsu.
I would like to ask you a few questions:
1.
It has been over three months since I had a cesarean delivery, and I occasionally notice a few days of coffee-colored or dark red discharge, but the amount is not significant.
I am currently breastfeeding.
Is this lochia? Is it normal? Previously, when I visited the hospital, the doctor mentioned that the irregular bleeding might be due to breastfeeding, and prescribed a medication to regulate my menstrual cycle (p-N2 5mg).
However, I noticed that my milk supply has been decreasing after taking it, and I am worried about not having enough breast milk.
Should I continue taking the medication, or is it possible to let my body naturally clear the discharge without medication?
2.
Starting from two and a half months postpartum, I have been experiencing abdominal pain and gastrointestinal discomfort.
Could this indicate adhesions? I have been using hyaluronic acid adhesion prevention patches; will adhesions still be an issue? Which specialty should I consult to check for adhesion problems? Can obstetric ultrasound detect this?

Xiao Wei, 30~39 year old female. Ask Date: 2016/02/16

Dr. Xu Junrui reply Obstetrics and Gynecology

1.
Your irregular menstruation is indeed caused by breastfeeding; medication is not necessarily required.
It is recommended that if the bleeding is not heavy, you can let it take its natural course.
2.
Adhesions typically develop several years after surgery (even more than 10 years later) before symptoms appear, so your condition may not be related to adhesions.
Additionally, the standard method to confirm adhesions is through another surgery, so this is usually not done unless there are significant symptoms.

Reply Date: 2016/02/16

More Info

After a cesarean section, it is common for women to experience various symptoms as their bodies recover from childbirth. Let's address your concerns regarding postpartum bleeding and potential adhesion issues.

1. Postpartum Bleeding (Lochia): The bleeding you are experiencing, described as coffee or dark red in color, could indeed be lochia, which is the vaginal discharge that occurs after childbirth. Lochia typically lasts for several weeks and can vary in color and amount. Initially, it is bright red (lochia rubra) and may transition to a darker color as the days progress. By three months postpartum, it is less common to have significant lochia, but some women may experience intermittent spotting, especially if they are breastfeeding. Breastfeeding can lead to hormonal changes that may affect your menstrual cycle, potentially causing irregular bleeding or spotting.
If your doctor has prescribed medication to help regulate your cycle, it is essential to discuss any concerns about breastfeeding and milk supply with them. Some medications can affect lactation, and if you notice a decrease in milk production, it may be worth considering whether to continue the medication. It is often advisable to allow your body to naturally regulate itself after childbirth, especially if the bleeding is minimal and not accompanied by other concerning symptoms (such as severe pain or fever). However, if the bleeding persists or increases, or if you have any other symptoms that concern you, it is crucial to follow up with your healthcare provider.

2. Abdominal Pain and Adhesion Concerns: Postoperative abdominal pain and gastrointestinal discomfort can be concerning, especially if they arise several weeks after surgery. Adhesions are bands of scar tissue that can form after surgery and may cause pain or gastrointestinal issues. The use of hyaluronic acid adhesion barriers can help reduce the risk of adhesions, but they do not guarantee that adhesions will not form.

To assess for adhesions, you may need to consult a specialist. A gynecologist or a general surgeon can evaluate your symptoms and determine if further investigation is necessary. While ultrasound can provide some information about the pelvic organs, it may not be the most effective method for diagnosing adhesions. In some cases, a laparoscopy (a minimally invasive surgical procedure) may be required to directly visualize the abdominal cavity and assess for adhesions.

In summary, while some postpartum bleeding can be normal, it is essential to monitor the situation and consult your healthcare provider if you have concerns. Regarding abdominal pain, a specialist's evaluation may be necessary to rule out adhesions or other complications. Always prioritize open communication with your healthcare team to ensure you receive the best care tailored to your needs.

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