Internal Bleeding After C-section: Signs, Treatment

Question: What are the signs of internal bleeding after c-section?

With millions of women undergoing a c-section yearly, there is a possibility of serious complications happening, especially in parts of the world with poor healthcare facilities. Serious bleeding (postpartum hemorrhage) is one of the most important causes of maternal death worldwide. NCBI+1

First of all, a caesarian section is a common major operation carried out by a doctor in the theatre through an incision made in the lower abdomen to deliver a baby while trying to keep risks as low as possible for both mother and child. NCBI

In some cases, your OB/GYN may tell you during antenatal visits that you will likely need a planned c-section. In many other cases, a c-section is decided during labour because of emergency problems with you or your baby, and your doctor will explain why it is needed. Mayo Clinic+1

Currently, it is estimated that more than 20% of births worldwide are by c-section, and in some countries, the rates are much higher. NCBI But here’s the thing: while serious complications after a c-section are not common, they can still happen even in the best hands.

Common complications that can happen after a c-section include infections, heavy vaginal bleeding, internal bleeding, blood clots in the legs or lungs, and in rare cases, death. Mayo Clinic+1

If you’ve had a c-section and are now worried about the risk of internal bleeding, it is essential to see your doctor or go to the hospital right away.

This article explains the signs and symptoms of internal bleeding after c-section, and the urgent treatment that may be needed. It is for information only and does not replace emergency care. If you are in doubt, treat it as an emergency. Cleveland Clinic+1

---

Symptoms and signs of internal bleeding after c-section

Like already mentioned, if you are suspecting abnormal symptoms or health concerns after your surgery, see your doctor right away.

Internal bleeding after c-section is a serious health issue. Sometimes it is mild and can be controlled with medicines and close monitoring, but in other cases, urgent procedures or another surgery are required to stop the bleeding and save your life. NCBI+1

If you are unsure what the signs and symptoms are, here are some things to watch out for.

Fast heart rate and pulse

Regularly checking your heart rate is surely not a habit, but if you are suspecting internal bleeding, it is vital you pay attention to how you feel in a calm environment.

Another way to help is checking your pulse by placing your fingers on your wrist or side of your neck.

If your heart rate or pulse rate is very high, especially together with dizziness or feeling faint, it means that something is wrong, and possibly, it could be because you’re losing too much blood internally. Your heart then beats faster to keep enough blood, oxygen and nutrients flowing to your brain and other organs. NCBI+1

You are breathing faster than normal

Fast breathing (or having difficulty in breathing) is another possible sign of internal bleeding. This happens because your body is trying to get more oxygen into the blood and deliver it to your organs.

If you are bleeding internally after caesarian section, you may notice you are breathing faster than normal (doctors call this “tachypnea”), especially together with chest discomfort, sudden weakness, or feeling like you may collapse. NCBI+1

Fast breathing plus chest pain, cough with blood, or severe shortness of breath are emergency red flags – call emergency services immediately. Mayo Clinic Health System

Abdominal pain

Another warning sign of internal bleeding is new, severe, or worsening abdominal pain that feels different from the usual c-section wound pain.

Normal post-operative pain is usually around the incision and slowly improves each day. Pain from bleeding inside the abdomen is often more intense, may spread all over your tummy or to your shoulder tip, and can be associated with bloating, a very tender stomach, dizziness, or feeling faint. NCBI+1

If you experience sharp abdominal pain together with dizziness, fast breathing, and a fast heart rate, something is not okay. See your doctor or go to the emergency room quickly.

Vaginal bleeding

Vaginal bleeding after c-section is not uncommon. In fact, it is expected that women who have c-section will have about twice as much blood loss as women who had a vaginal delivery. Children’s Hospital of Philadelphia+1

Also, after your surgery, your womb cleans itself on its own, and you will see dark, bloody fluid that continues for days (sometimes lasting for weeks). This is called vaginal lochia and is normal. Mayo Clinic

However, heavy bleeding is different. You should seek urgent help if:

• You are soaking through a large pad in less than an hour,

• You are passing clots the size of a golf ball or larger,

• The bleeding suddenly becomes much heavier or bright red again after it had started to slow down. Cleveland Clinic+1

There are different reasons this may happen, and it could be due to a retained placenta or membranes, a traumatized cervix, a bleeding vessel, damaged or torn stitches, uterine atony (womb not contracting), or a bleeding disorder. Inform your doctor right away. Medscape+1

You look white, pale and tired

Looking pale, feeling dizzy and tired is a sign of excessive blood loss. Usually, if you lose so much blood, you will feel weak and tired because your organs do not get enough oxygen and nutrients.

In addition to body weakness, change in skin colour, pale lips, gums, tongue and inner eyelids can suggest significant anaemia or internal bleeding. Some women may also have cold, clammy hands and feet. NCBI+1

Decreased urine output

Another sign to watch out for is how frequently you empty your bladder. In cases of internal bleeding after surgery, your body has its own protective mechanism that moves blood away from the kidneys to vital organs like the brain and heart.

Because less blood reaches the kidneys, your urine output drops. You may notice you are hardly passing urine, the urine is very concentrated and dark, or you go several hours without urinating. This is a late and serious warning sign and needs urgent medical attention. NCBI

Ruptured or torn internal stitches with a soaked wound dressing

During a c-section procedure, your doctor will make a curvilinear incision on the body of the uterus (usually the lower segment) to deliver your baby. After delivery of the baby and the placenta, this opening in the uterus and any bleeding blood vessels are closed with absorbable sutures.

If these internal stitches or blood vessels open up, bleeding can collect inside the abdomen or around the wound. You may notice:

• Rapidly increasing abdominal pain or swelling,

• A soaked or rapidly filling abdominal dressing,

• Bruising or a firm, painful swelling under the incision. NCBI+1

Any soaking wound, new gush of blood from the incision, or foul-smelling discharge should be reported urgently to your doctor. Johns Hopkins Medicine

---

Treatment of haemorrhage after c-section

Most times, complications like internal bleeding right after your surgery happen while you are still in the hospital, where doctors and nurses can monitor your vital signs and bleeding closely.

If you are already discharged and observe signs of possible internal bleeding, call your doctor or go to the nearest emergency unit immediately. Do not drive yourself if you feel faint or very weak. Cleveland Clinic+1

Depending on the reason you are bleeding, you may require:

• Medicines to contract the womb (oxytocin and other uterotonics),

• Intravenous fluids and oxygen,

• Tranexamic acid to help reduce bleeding,

• Procedures such as balloon tamponade or uterine artery embolization,

• Or, in severe cases, another surgery to find and stop the bleeding or remove the uterus (hysterectomy) if your life is at risk. ACOG+2Obstetrics & Gynecology+2

If your womb fails to adequately contract after your surgery (uterine atony), it may cause much more bleeding. This can often be controlled with uterine massage and oxytocin infusion, and sometimes other medications added according to hospital protocols. ACOG+1

If you’ve also lost a lot of blood, your doctor may request that you receive one or more units of blood transfusion to prevent hypovolemic shock, organ damage, or death. NCBI+1

Therefore, internal bleeding or any sign of heavy blood loss after surgery is an emergency, and it is not something you can manage on your own at home. See a doctor quickly so that the cause can be found and treated as soon as possible.