Scanty bloody discharge from the vagina or anus is commonly called bleeding. Doctors rarely use this term. Experts call even minor discharge vaginal, uterine or anal bleeding. Due to the fact that during bleeding the discharge is not profuse, it usually does not cause pain or discomfort to the patient. This often leads to late consultation with a doctor.
Medical specialists will help determine the cause of bleeding and get rid of this unpleasant symptom. Gynecologists treat intermenstrual vaginal discharge in women in our clinic. An experienced proctologist will tell you how to stop bleeding from anal fissure.
Hemorrhage in ICD-10
The content of the article
To systematize all human pathologies, the International Classification of Diseases, 10th edition (ICD-10) was developed. The code for bleeding in ICD-10 depends on the type of discharge:
- Code 93.0 - Postcoital or contact bleeding .
Bloody discharge that appears after sexual intercourse or medical interventions. - Code 93.8 - Other specified abnormal bleeding from the uterus and vagina.
Bloody discharge that occurs against the background of a gynecological disease - fibroids, polyps, endometriosis, oncology, etc. - Code 93.9 - Abnormal uterine and vaginal bleeding, unspecified.
The cause of blood discharge from the vagina or uterus has not been established. - Code 62.5 - Bleeding from the anus and rectum.
Anal bleeding that develops as a result of injury or inflammation of the rectum. Pathology can also occur with hemorrhoids, tumors and other proctological problems.
By establishing the pathology code according to the ICD, it is easier for the doctor to develop effective treatment and avoid dangerous health consequences.
Causes of polymenorrhea
There are many factors that can lead to abnormal uterine bleeding such as polymenorrhea, and you will need to undergo a thorough medical examination to determine the underlying cause.
Abnormal uterine bleeding has the following causes:
1. Structural problems: Examples of anatomical abnormalities in the organ structure that may cause abnormal menstrual bleeding include fibroids, polyps, endometriosis, endometrial hyperplasia, or certain types of cancer.
2.. Hormonal imbalance: Various endocrine disorders can lead to polymenorrhea, such as dysfunction of the thyroid gland, adrenal glands or pituitary gland. Polycystic ovary syndrome is a disorder characterized by hyperandrogenism, ovulatory dysfunction, and cystic changes in the ovaries.
3. Bleeding disorders: Hemostatic disorders such as von Willebrand disease or bone marrow conditions (such as leukemia) can easily cause bleeding and bruising on the body, as well as lead to excessive uterine bleeding during periods.
4. Medications: Drugs such as steroids, chemotherapy, blood thinners, or some herbal products can affect menstrual bleeding.
5. Contraceptives: Some birth control methods, including intrauterine devices or birth control pills, may cause abnormal bleeding from the uterus, especially in women over 45.
6. Infections: Some sexually transmitted infections (such as chlamydia or gonorrhea) can lead to inflammation of the uterus and abnormal bleeding during reproductive years.
7. Systemic diseases: Chronic liver or kidney disease, anorexia, obesity or rapid weight changes can lead to abnormal menstrual bleeding.
Clinical manifestations
Abnormal uterine bleeding includes NMCs of reproductive age of the following types:
- Oligomenorrhea: cycle duration more than 37 days;
- Amenorrhea: absence of menstruation for six months;
- Menorrhagia: heavy bleeding during menstruation;
- Metrorrhagia: bleeding or spotting between periods;
- Menometrorrhagia: longer menstrual bleeding that occurs at unpredictable intervals;
- Postmenopausal bleeding: more than 12 months after the last menstrual cycle in women over 45-50 years of age;
- Postcoital bleeding: bleeding after sexual intercourse.
These are some of the once popular terms (now obsolete) that experts recommend using for research purposes only. Now they use terminology from ICD-10 according to AMK/NMC/ codes.
Abnormal uterine bleeding that is heavy and/or frequent can lead to anemia. Anemia caused by chronic blood loss makes you tired and weak. If you have significant blood loss, you may experience shortness of breath and/or rapid heartbeat, fainting, or chest pain as your body tries to compensate for the lack of oxygen. This puts significant strain on the heart and can be very dangerous if you have an underlying cardiovascular condition.
Diagnostics
Based on your complaints, your medical history, and physical examination, your doctor will decide what diagnostic tests you will need. These may include a pregnancy test, blood tests for hormones, transvaginal ultrasound, hysteroscopy, or an endometrial biopsy (a small piece of tissue taken from the uterus to be examined under a microscope).
Tests for abnormal uterine bleeding:
- Blood tests
- Ultrasound of the pelvic organs.
- Hysteroscopy
- Endometrial biopsy
- Sonohysterography
- Magnetic resonance imaging
- Computed tomography (CT)
Causes of bleeding in women in the middle of the menstrual cycle
Bloody vaginal discharge for 3-7 days a month is considered normal for women of reproductive age. This phenomenon is called menstruation. During this period, the inner layer of the uterus (endometrium) is shed and excreted from the body in the form of menstrual blood.
Bleeding in the middle of the menstrual cycle is considered a pathology. When this symptom appears, a woman should immediately contact a gynecologist to determine the cause. Spotting bloody discharge from the vagina does not always indicate the development of the disease. Sometimes such a reaction occurs during normal physiological processes in the body.
Physiological bleeding in the middle of the cycle
Possible causes of physiological bleeding in the middle of the cycle include the following factors:
- Ovulation.
The release of the egg from the ovaries into the fallopian tube occurs on days 14-16 of the menstrual cycle. Normally, discharge during ovulation is abundant, transparent, and has a mucous consistency. Minor bleeding after ovulation is considered normal. It is associated with rupture of the follicular sac. In addition, slight spotting is possible with a sharp increase in the level of estrogen in a woman’s blood. The volume of blood that can be released during normal ovulatory bleeding does not exceed one teaspoon. If you experience more heavy bleeding, you should consult a gynecologist. - Sexual intercourse.
Blood may leak from the vagina as a result of the hymen breaking, which occurs during the first sexual intercourse. Bleeding after sexual intercourse most often indicates injury to the vaginal walls. This happens during rough and intense sex. - Use of contraceptives.
In some women, bleeding begins while taking COCs (combined oral contraceptives). This symptom manifests itself especially often in the first 2-4 months of taking hormonal medications. Usually, bleeding when taking birth control pills is associated with the stabilization of a woman’s hormonal levels and does not pose a threat to her life and health. The risk of bleeding increases if the patient misses a pill. You should consult a doctor if there is heavy bleeding and it appears for more than 4 menstrual cycles. - Installation of an intrauterine device.
Scanty, brown spotting may persist for several days after IUD insertion. This is a normal reaction of the body to the introduction of a foreign body. If this bleeding persists for several weeks or is accompanied by abdominal pain, you should make an appointment with your gynecologist. - Before and after menstruation.
Bleeding for several days before and after menstruation is considered normal. Some women experience this phenomenon during every menstruation. This is due to the individual characteristics of the reproductive system.
Despite the physiological nature of such bleeding, consultation with a gynecologist is advisable. This will help rule out pathology.
Treatment of polymenorrhea
Your treatment will depend on the cause of the bleeding. If you have an infection in your vagina, you may need to be treated with antibiotics, and if it is a benign uterine tumor, it may need to be removed.
The cause of abnormal uterine bleeding may be secondary to a medical condition outside of your reproductive system. For example, if you have a thyroid disease, you will need to treat it - and this can alleviate polymenorrhea-type NMC.
After your doctor conducts a thorough examination, it may turn out that there is nothing abnormal about your increased menstrual frequency. For some women, a shorter than average individual cycle is normal, and the exact “why this is” may remain unclear.
If you are concerned about frequent menstrual cycles or polymenorrhea-type bleeding has led to anemia, the gynecologist-endocrinologist at our clinic may recommend a combined hormonal contraceptive to increase the “light” intervals. Another option is to use a contraceptive method that temporarily stops your period or makes bleeding very light and infrequent, such as Mirena, Depo-Provera, or Implanon.
Pathological bleeding in the middle of the cycle
Scanty bleeding in the middle of the menstrual cycle can be an alarming sign of the development of pathology. The following diseases can cause this symptom:
- Uterine fibroids.
These are benign nodular formations in the muscular wall of the uterus. Such neoplasms are usually not life-threatening for the patient, but can cause significant discomfort. One of the symptoms is spotting in the middle of the menstrual cycle. - Adenomyosis of the uterus.
The uterus of a healthy woman consists of three layers - the endometrium, the intermediate layer, and the muscular layer. With adenomyosis, endometrial cells begin to grow deep into the intermediate and muscular layers. Inflammation is observed at the site of germination. One of the symptoms of the pathology is bleeding between periods. - Endometrial polyps.
These are benign focal growths of the uterine mucosa. They can be on a wide base or have a thin stem. The vessels feeding the polyps can become twisted and bleed. For a woman, this is manifested by scanty blood discharge from the vagina. After removal of the polyp, prolonged bleeding may also occur. This is due to the characteristics of the uterine endometrium. - Endometriosis.
This is a pathological growth of the inner layer of the uterus beyond its limits. This process can cause tissue inflammation with increased bleeding. - Oncology and precancerous conditions.
The growth of tumors often injures healthy tissue cells located in the area of oncology. Cervical dysplasia and malignant endometrial tumors can also cause scanty vaginal bleeding. - Infections.
An infectious-inflammatory process in the genitals can be caused by opportunistic microorganisms, as well as bacteria and sexually transmitted viruses. These diseases are often asymptomatic, but slight bleeding between periods can be one of the first symptoms. - Blood clotting disorders.
Abnormalities of the coagulation system, in particular the platelet system, can cause minor bleeding even during physiological processes. - Chronic diseases.
Some chronic diseases of the body (hypothyroidism, liver and kidney diseases) can cause bleeding as a concomitant symptom.
Only a gynecologist can determine the exact cause.
Internal bleeding
It is necessary to ensure that the patient is transported to a specialized care unit as quickly as possible. The patient needs to be kept at rest. If hemothorax or pulmonary hemorrhage is suspected, the patient is placed in a semi-sitting position; if there is blood loss in other areas, the patient is placed on a flat surface. Apply cold (such as an ice pack) to the area of suspected bleeding. It is strictly forbidden to heat the painful area, give enemas, give laxatives or introduce drugs into the body that stimulate cardiac activity.
Patients are hospitalized in a hospital. The choice of department is made taking into account the source of internal bleeding. Treatment of traumatic hemothorax is carried out by traumatologists, non-traumatic hemothorax and pulmonary hemorrhage - by thoracic surgeons, intracranial hematomas - by neurosurgeons, uterine bleeding - by gynecologists. In case of blunt abdominal trauma and gastrointestinal bleeding, hospitalization is carried out in the general surgery department.
The main tasks in this case are to urgently stop internal bleeding, compensate for blood loss and improve microcirculation. From the very beginning of treatment, to prevent empty heart syndrome (reflex cardiac arrest due to a decrease in the volume of bcc), restore the volume of circulating fluid and prevent hypovolemic shock, a jet transfusion of a 5% glucose solution, saline solution, blood, plasma and blood substitutes is performed.
Sometimes internal bleeding is stopped by tamponade or cauterization of the bleeding area. However, in most cases, emergency surgery under anesthesia is required. If there are signs of hemorrhagic shock or the threat of its occurrence at all stages (preparation for surgery, surgery, the period after surgery), transfusion measures are carried out.
In case of pulmonary hemorrhage, bronchial tamponade is performed. For medium and small hemothorax, pleural puncture is performed, for large hemothorax - thoracotomy with suturing of the lung wound or ligation of the vessel, for loss of blood into the abdominal cavity - emergency laparotomy with suturing of the wound of the liver, spleen or other damaged organ, for intracranial hematoma - craniotomy.
For a gastric ulcer, gastric resection is performed; for a duodenal ulcer, the vessel is sutured in combination with vagotomy. For Mallory-Weiss syndrome (bleeding from a fissure of the esophagus), endoscopic bleeding control is performed in combination with cold, the prescription of antacids, aminocaproic acid and blood clotting stimulants. If conservative treatment is ineffective, surgery (suturing cracks) is indicated.
Internal bleeding due to ectopic pregnancy is an indication for emergency surgery. In case of dysfunctional uterine bleeding, tamponade of the uterine cavity is performed; in case of massive bleeding due to abortion, birth trauma, and after childbirth, surgical intervention is performed.
Infusion therapy is carried out under the control of blood pressure, cardiac output, central venous pressure and hourly diuresis. The volume of infusion is determined taking into account the severity of blood loss. Blood substitutes with hemodynamic action are used: dextran, rheopolyglucin, solutions of salts and sugars, as well as blood products (albumin, fresh frozen plasma, red blood cells).
If blood pressure cannot be normalized despite infusion therapy, dopamine, norepinephrine or adrenaline is administered after stopping the bleeding. Pentoxifylline, dipyridamole, heparin and steroid drugs are used to treat hemorrhagic shock. After eliminating the threat to life, the acid-base balance is corrected.
Bleeding during pregnancy
Any bleeding during pregnancy is a reason to urgently consult a doctor. However, this is not always a sign of pathology. Bleeding in early pregnancy is often associated with the implantation of a fertilized egg into the lining of the uterus. The discharge is not abundant and passes quickly.
In rare cases, a woman continues to have regular bleeding throughout her pregnancy, simulating the menstrual cycle. Only a doctor can determine the reason for this reaction of the body.
Even slight bleeding in the second and third trimester of pregnancy is an alarming signal. This may be a sign of such dangerous pregnancy pathologies:
- sexually transmitted infectious diseases;
- risk of miscarriage;
- cervical erosion;
- ectopic pregnancy;
- placental abruption;
- fading of fetal development;
- endometrial fibroids and polyps;
- microtrauma of mucous membranes.
If the discharge becomes profuse and turns bright red, a pregnant woman should immediately call an ambulance.
