Bloody Discharge From The Vagina : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 17/08/2022

Bloody discharge from the vagina is the appearance of brown, brownish or sanious discharge from the female genital tract. The symptom is accompanied by pain in the lower abdomen, general weakness, and sometimes fever. Bloody discharge normally occurs in the early postpartum period, a connection with the pathology of pregnancy, inflammatory diseases, neoplasms, genital injuries is possible. To establish the cause that caused spotting, ultrasound, gynecological examination, colposcopy, and tests are performed. To stop the bleeding or bleeding, therapy of the underlying disease is necessary.

Causes of bleeding from the vagina

postpartum period

After separation of the placenta, the uterus is a wound surface, so bloody discharge is normally observed. In the first days after childbirth, abundant brown vaginal discharge is possible, women in childbirth are forced to use special absorbent pads designed for the postpartum period. Gradually, the amount of discharge decreases, they become sanious, and by 2-3 weeks they are replaced by leucorrhoea. About prolonged uterine bleeding, discharge with an unpleasant or fetid odor, streaks of pus should be reported to the attending obstetrician-gynecologist.

Inflammation of the genitals

A common cause of mild brown or "meat slop" discharge is inflammatory diseases of various parts of the female reproductive system. Bleeding is associated with erosion and destructive changes in the epithelial layer, damage to small vessels. These diseases are characterized by a combination of brown discharge with other whites (cloudy, mucous with a specific smell, purulent). Bloody discharge begins against the background of pain in the lower abdomen, fever. The symptom is caused by:

  • Damage to the uterus : endometritis, cervical erosion, endocervicitis.
  • Inflammation of the appendages: salpingitis, oophoritis, adnexitis.
  • Diseases of the vagina : colpitis (vaginitis), vulvitis.

Pathologies of pregnancy

Bloody vaginal discharge is one of the reliable signs of a spontaneous abortion that has begun, a late miscarriage. The appearance of a bloody discharge and blood is preceded by discomfort above the pubis, which is gradually replaced by a pulling, aching pain and radiates to the sacrum. Smearing brownish, and then sanious-bloody discharge usually first disturbs periodically, then, if left untreated, becomes permanent and can turn into massive bleeding. In addition to abortion, the following can provoke bleeding from the genitals:

  • Ectopic pregnancy. At first, women report smearing brown discharge, which occurs against the background of the cessation of menstruation and aching pain in the lower abdomen. Termination of a tubal or cervical pregnancy is accompanied by massive bleeding with clots.
  • Choriocarcinoma. Bloody discharge in 80% of patients begins shortly after childbirth. When the tumor node is infected, the discharge is purulent with blood impurities. Bleeding for 3-5 weeks after a miscarriage or a honeybort is typical for a placental polyp.
  • Birth trauma. The release of bright red blood is observed when the genital tract is torn during the passage of the fetal head. The complication is more common in rapid labor or in the case of a clinically narrow pelvis. Massive blood loss is accompanied by shock.
  • Placental abruption. Given the prescription of detachment, the blood may have a scarlet or dark cherry color. In this case, the woman feels severe pain in the abdomen with irradiation to the perineum. In a severe form of detachment, the condition may be complicated by the development of the Kuveler's uterus.

 

Injuries

The outflow of bright scarlet blood from the vagina after falls or bruises of the perineum is due to damage and ruptures of the genital organs. The symptom is combined with sharp pains in the groin, difficulty urinating, sometimes blood is found in the urine. Bloody discharge occurs with injuries of the genital organs in girls associated with domestic or sports injuries to the groin area. In adolescent girls, profuse bleeding occurs during voluntary or violent sexual acts. Vaginal bleeding can be caused by:

  • Violent sexual intercourse . Minor spotting is observed due to traumatization of the vaginal mucosa. Such bleeding is short-lived, accompanied by pulling pains in the perineum.
  • Vaginal lacerations. There is bleeding from the genital slit, which is combined with swelling and cyanosis of the skin of the labia majora, sharp pelvic pain. Massive blood loss is characteristic of damage to the clitoris.
  • perforation of the uterus. Penetrating organ injury associated with curettage or criminal abortion causes profuse, bloody, bright red vaginal discharge. Bleeding develops against the background of a severe general condition of a woman, severe pain in the abdomen.

Taking oral contraceptives

In 30-40% of women taking hormonal contraceptives, during the first 3 months after the appointment of contraceptives, there is scanty bloody discharge from the vagina, usually without any smell. The reasons for their appearance are associated with the adaptation of the body to the intake of hormones from the outside, a change in the synthesis of its own estrogens. Brownish discharge is also noted when the pill regimen is not followed. Excessive bleeding indicates atrophic processes in the uterus due to hormonal imbalance and requires an immediate visit to the doctor.

endometriosis

Periodic spotting brownish discharge that does not have an odor occurs in 50-60% of patients with endometrioid growths. Bleeding from the vagina occurs with hyperplasia of the endometrial tissue, damage to the uterine cervix. Scanty bloody discharge appears a couple of days before menstruation, accompanied by intense pelvic pain, discomfort during sexual intercourse. With diffuse endometriosis, abundant bright red discharge is possible. Retrocervical endometriosis is characterized by a combination of vaginal and rectal bleeding.

Benign neoplasms

Most often, odorless brown discharge is reported by patients with uterine fibroids. This benign neoplasm is characterized by heavy bleeding in the middle of the cycle, which is combined with common symptoms - pain in the lower abdomen, weakness, dizziness. Bloody discharge that occurs against the background of menstrual irregularities is characteristic of atypical endometrial hyperplasia. Smearing brown discharge, mainly after intercourse, is observed with polyps of the uterus or cervical canal. Scanty bleeding occurs with condylomas of the uterine neck.

Malignant tumors

For oncological diseases, an abundant brown discharge with a fetid odor is characteristic, in which individual clots and tissue fragments are visible. In cancer of the vulva and vagina, a triad of symptoms is observed: spotting, periodic mucous leucorrhea and pain in the perineum. For cervical cancer, moderate bleeding is typical, observed after sexual intercourse, douching, vaginal examination. Brown discharge also appears with adenocarcinoma and uterine sarcoma, germ cell neoplasms.

Rare Causes

  • Complicated course of genital infections : chlamydia, gonorrhea, trichomoniasis.
  • Installation of intrauterine devices .
  • Iatrogenic factors : traumatization of the vaginal epithelium or endometrium during diagnostic procedures, the consequences of curettage (RDV).
  • emergency contraception.
  • Sexual crisis in newborns.
  • Pathology of the blood system : thrombocytopenia, coagulopathy, vasopathy.

Diagnostics

A gynecologist is engaged in identifying the cause of the development of bloody discharge from the vagina. A woman needs a comprehensive examination using physical and instrumental methods. Diagnostic search is aimed at establishing the root cause of the symptom, assessing the general disorders in the body caused by blood loss. The most informative are:

  • Gynecological examination. Examination of the vaginal mucosa and uterine cervix with vaginal mirrors is necessary to detect pathological changes, erosions, signs of inflammation or endometriosis. More valuable methods are colposcopy, cervicoscopy and hysteroscopy, which allow to detect microscopic foci of changes in the epithelium.
  • Ultrasound . With the help of ultrasound of the pelvic organs, the uterus, appendages are visualized, volumetric neoplasms, signs of diffuse growth of the endometrium, and other causes that cause odorless or odorous bleeding are detected. In difficult situations, when the doctor cannot verify the diagnosis, they resort to diagnostic laparoscopy.
  • visualization methods . Tumor growths can be visualized by contrasting the genital tract - hysterosalpingography. To clarify the diagnosis and assess the degree of infiltrative growth of neoplasms, modern research methods are used - CT and MRI of the pelvic organs.
  • Biopsy. Identification of altered tissue areas during instrumental visualization serves as an indication for the collection of material from the endometrium, uterine cervix. Microscopic examination of cells assesses the degree of atypia, the presence of pathological inclusions or signs of malignant growth. An immunochemical analysis of materials obtained during the biopsy is also carried out.
  • Diagnostic curettage . Total scraping of the mucous membrane of the uterus and cervical canal is a more informative method than a conventional biopsy, since it allows you to get more material for histological analysis. Separate diagnostic curettage (RDV) is also prescribed for therapeutic purposes.
  • Laboratory Research . To clarify the cause of sanious vaginal discharge with an unpleasant odor, it is recommended to analyze the vaginal smear for microflora and sow on nutrient media. Be sure to evaluate the female hormonal profile. General and biochemical blood tests can clarify the degree of posthemorrhagic anemia and metabolic changes.

Consultation with a gynecologist for bloody discharge from the vagina

 

Treatment

Help before diagnosis

The appearance of bloody discharge from the vagina, not associated with involution of the uterus in the postpartum period or natural menstrual bleeding, is an indication for immediate medical attention. Attempts to self-treat the disorder using folk methods or medications often lead to severe complications from the genital area and other organs. If brown discharge is accompanied by pain, analgesics from the NSAID group, which increase bleeding, should not be used.

Conservative therapy

Medical tactics, first of all, depend on the degree of blood loss and the cause of the formation of a reddish or brown discharge. With slight brown or sanious discharge, etiotropic therapy of the underlying pathology is indicated, massive blood loss requires the use of specific hemostatics. Physiotherapy methods are not recommended. For the treatment of patients with complaints of vaginal spotting, the following are used:

  • coagulants . Medications are designed to stimulate the formation of blood clots and quickly stop bleeding. They are prescribed only for heavy bleeding under the control of coagulogram parameters.
  • Hormonal preparations . Bloody discharge caused by impaired estrogen secretion by the ovaries requires specific therapy. Estrogen and progesterone agents are used.
  • Anti -inflammatory drugs . Reduce the amount of inflammatory mediators. Effectively reduce pain, promote the healing of defects in the epithelium of the genital tract.
  • Antibacterial agents . Indicated for discharge with a fetid odor and signs of infection. Depending on the causes, etiotropic drugs are used: antibiotics, antiprotozoal, antifungal.

Surgery

The ineffectiveness of conservative therapy for extensive endometriosis is an indication for excision of endometrial growths followed by cauterization. With endometriosis of the ovaries and the formation of "chocolate" cysts, operative laparoscopy, ovariectomy is indicated. With cervical erosion, cauterization is performed by laser coagulation. If polyps of the uterus or uterine cervix are detected, they must be removed. To reduce trauma, endoscopic excision of the polyp is used.

In order to stop uterine bleeding, the main feeding arteries are ligated; if this method is ineffective, the uterus is amputated. Surgical interventions are performed for large benign fibroids to prevent malignancy or profuse bleeding. The method of choice is husking of pathological formations with preservation of the organ and restoration of reproductive function. With a malignant lesion, extirpation of the uterus with appendages may be required, which is combined with antitumor treatment (radiation therapy and chemotherapy).