Persistent Lochial Discharge

Persistent Lochial Discharge is a condition where the lochial discharge continues for longer than normal and remains red in color rather than changing to a yellowish, serous discharge. Lochia refers to the bloody discharge coming from the placental site. The normal time of lochial discharge is about 3 weeks. In Western medicine, if the lochial discharge has an offensive odor and the woman has a fever, this may indicate an infection and requires medical attention.

Causes

There are several potential causes of Persistent Lochial Discharge, including:

  • Excessive strain during delivery and long labor can severely deplete Qi. When Qi is deficient, it fails to hold Blood and bleeding may result.
  • Invasion of cold during or after delivery can affect the blood vessels and uterus. Cold slows down the circulation of Blood and may cause stasis of Blood, which can obstruct the blood vessels and uterus and cause bleeding.
  • Severe loss of blood during childbirth can injure Blood and Yin. In women with a pre-existing condition of Yin deficiency, this can lead to severe Yin deficiency with Empty-Heat. Heat enters the Blood portion and makes the Blood reckless, causing it to spill out of the blood vessels.

Pathology

The pathology of Persistent Lochial Discharge can manifest in three possible conditions: Qi deficiency, Blood stasis, or Blood-Heat.

  • Qi deficiency: When Qi is deficient, it fails to hold Blood and bleeding results. In this case, the blood discharged will be pale.
  • Blood stasis: When Blood stagnates, the blood vessels and uterus are obstructed by stagnant Blood. As newly generated Blood has nowhere to go, it leaks out. In this case, the lochial discharge is dark and with clots.
  • Blood-Heat: When Heat invades the Blood portion, it makes Blood reckless so that it pushes out of the blood vessels, causing bleeding. In this case, the lochial discharge will be bright red or dark red.

Identification of patterns and treatment

To distinguish between the different types of Persistent Lochial Discharge, it is important to carefully analyze the amount, colour, density, and smell of the lochia. The treatment principles are to tonify Qi, invigorate Blood, or cool Blood. When tonifying with herbs, it is important to avoid over-tonification, as this may create stagnation. When invigorating Blood, it is important to avoid using strong herbs that may deplete Blood, and to use herbs that simultaneously gather Blood and stop bleeding, or herbs that cool Blood and stop bleeding.

    Identification of patterns and treatments

    The amount, colour, density, and smell of the lochia should be analysed carefully to distinguish deficiency from excess and Heat from Cold. The treatment principles are therefore to tonify Qi, invigorate Blood, or cool Blood. The patterns discussed are:

    • Qi deficiency
    • Blood stasis
    • Blood-Heat

    Prognosis and prevention

    The prognosis for Persistent Lochial Discharge is generally good when treated promptly and correctly. However, a delay in treatment may lead to chronic conditions such as Anaemia or Uterine prolapse. To prevent Persistent Lochial Discharge, one should avoid excessive strain during delivery and pay attention to the invasion of Cold during or after delivery. A balanced diet rich in nutrients and proper rest are also important in the post-partum period.

    Western viewpoint

    In Western medicine, lochia refers to the vaginal discharge containing blood, mucus, and tissue debris that occurs after childbirth. The normal time of lochial discharge is about 3-6 weeks, with the colour changing from red to yellowish-white. Persistent Lochial Discharge may be caused by factors such as infection, uterine atony, or retained placental fragments. Treatment may include antibiotics, uterotonics, or surgery, depending on the underlying cause. It is important to consult a healthcare provider for proper diagnosis and treatment.