Bleeding after childbirth: What’s normal and what’s not

What you need to know:

After giving birth, whether through caesarian-section or vaginal delivery, there is vaginal bleeding/discharge for six to eight weeks. This is called lochia and it changes over time.
In the first three to four days, there is lochia rubra, which is red, and the flow is heavy, sometimes with small clots, and may be accompanied by cramping.
The bleeding may also be due to post-partum hemorrhage, which is abnormal or heavy bleeding within 24 hours to 12 weeks after giving birth.

Dear Healthy Nation,

I delivered through caesarian-section 10 weeks ago. Anytime I try doing some simple recommended exercise, I bleed. What could be the issue?

Anne

Dear Anne,

After giving birth, whether through caesarian-section or vaginal delivery, there is vaginal bleeding/discharge for six to eight weeks. This is called lochia and it changes over time. In the first three to four days, there is lochia rubra, which is red, and the flow is heavy, sometimes with small clots, and may be accompanied by cramping. After that, there is lochia serosa, where the discharge becomes thinner and is pinkish or brownish in colour and lasts for four to 12 days. The last stage, lochia alba, has a yellowish or white discharge with spotting and lasts for two to six weeks. Physical activity can cause heavier discharge or even cause the bleeding to start again. For this reason, it is advisable to rest and be careful with the engagement in physical activity including regular activities like climbing stairs.

The bleeding may also be due to post-partum hemorrhage, which is abnormal or heavy bleeding within 24 hours to 12 weeks after giving birth. This is a serious condition that requires urgent medical intervention. It may be due to retained placenta, infection within the uterus, a bleeding disorder, hormonal disorders or due to a urinary tract infection.

It is advisable for you to be reviewed by a gynaecologist urgently for review. If there is postpartum hemorrhage, then the underlying cause will be addressed. If the bleeding is lochia that is prolonged or reactivated by exercise, then you need to rest and be extra careful with physical activity.

Dear Doc,

I am 22. I was born with one testicle. Recently I started getting worried about by sex life. I’m a devout Muslim and I have never engaged in sexual intercourse. I am worried about my marital life: maybe I won’t satisfy my wife or maybe I won’t sire children. What should I do? How will I get help? Kindly advise

Dear reader,

When there is only one testicle in the scrotal sac, this is called monorchia or monorchidism. It could be because one testicle was not formed at all or it is undescended. When the baby is forming during pregnancy, the testicles develop within the abdomen and then travel down to the scrotal sac during the last three months of pregnancy. If the testicles have not descended by the time of birth, in most boys, they will come down within the first six months. If the testicles are missing, then one or both testicles may be trapped within the path between the abdomen and the scrotum, and if this is the case, surgery can be done to bring the testicle(s) down and attach it/them to the scrotal sac. However, for the undescended testicle to be able to function normally, then it needs to be corrected within the first year of life.

It is advisable for you to be reviewed by a doctor and get an ultrasound scan to determine whether the second testicle is undescended or if it never formed. If it is undescended, it needs to be located and corrected or removed depending on where it is found and the condition it is in.

For those with one healthy testicle, the sexual function and fertility is usually normal, so unless there are other attendant issues, you should be able to have a mutually satisfying relationship with your future spouse and to have children, should you so wish.

What is a cyst and how does it develop?

Please shed light on this.

Dear reader,

A cyst is an abnormal pocket of fluid or semi-solid material that can form anywhere in the body including the skin, brain, bones and internal organs. Most cysts are non-cancerous and may vary from very small in size to very large, and sometimes may be painful. It may also cause a swelling or a lump. Cysts do not usually cause problems unless they are very large, or they are infected, or they are pressing on a nerve or a blood vessel or if they are affecting how an organ works or if they are cancerous.

A cyst may form as a result of an injury, or due to blockage of a duct or passage; or because of a problem with the body tissue in a particular area, or due to infection with a parasite. It may also be as a result of genetic changes or due to inflammation. Rarely, a cyst will be cancerous. All abnormal lumps in the body should be examined, including cysts. Depending on the location, the contents and the symptoms, the cyst may be left untouched, or it may be surgically removed. After removal, the contents are examined for cancer and any identifiable cause such as an infection. Sometimes cysts may develop complications like pain, infection, bleeding and inflammation of surrounding tissues in case they rupture.

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