Internal bleeding is bleeding from blood vessels, where blood pools in the body, rather than bleeding through an open wound. Symptoms of internal bleeding (called hemorrhage) may vary depending on the condition.
Internal bleeding may be sudden and rapid, accompanied by extreme pain, shock, and fainting. Or, it can be slow and "quiet." There are almost no symptoms until complete bleeding occurs. Still, symptoms don't always reflect the amount of blood and its severity.
This article explores the causes, symptoms, and complications of internal bleeding, as well as what signs indicate the need for emergency care.
The causes of internal bleeding are as varied as the signs and symptoms. Some are caused by external forces, such as a blow to the body, while others occur within the body due to disease or structural weakness.
- Penetrating trauma: This is when an object enters the body, such as a knife, broken glass, shrapnel, or a bullet.
- Blunt trauma : This can range from hits and punches (which may not cause noticeable symptoms at first) to high-velocity impacts (which often cause noticeable symptoms).
- Slowdown injuries : This often occurs in car accidents. When a speeding vehicle suddenly stops, it can cause blood vessels and organs to rupture or separate from each other.
- Fractures : Some fractures bleed more than others. Fractures of long bones in the arms, legs, and pelvis can cause significant blood loss. Bone fragments can also tear blood vessels.
An aneurysm is a bulge in a blood vessel caused by a weakening of the blood vessel wall. This can cause blood vessels to rupture. Sometimes, strenuous activity can cause an aneurysm to rupture. Other times, it may occur for no apparent reason during rest or sleep.
Aneurysms can occur in any blood vessel, but are more common in the brain (cerebral aneurysm) or aorta, chest (ascending or descending aorta aneurysm), or abdomen (abdominal aortic aneurysm).
Bleeding disorders such as hemophilia put a person at increased risk of bleeding, including internal bleeding. This is caused by a lack of blood cells called platelets or proteins called clotting factors, which prevents the blood from clotting properly.
Overuse of certain medications can have the same effect. This includes blood thinners like warfarin and antiplatelet drugs like Plavix (clopidogrel). Even nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen can cause internal bleeding if taken in excess, especially if you have peptic ulcers or any other condition that causes stomach bleeding.
A less common cause of internal bleeding is viral hemorrhagic fever. Certain viruses can cause small blood clots to form in blood vessels throughout the body. Doing so reduces the number of platelets available to stop bleeding.
Common symptoms include vomiting, diarrhea, muscle pain, tiny red or purple spots on the skin called petechiae, bleeding, and a drop in blood pressure.
There are many viral diseases that can cause internal bleeding, most of which are restricted to Africa. These include:
- Ebola virus
- Lassa fever
- Rift Valley fever
- yellow fever
Signs and symptoms
Symptoms of internal bleeding do not always correspond to the severity of the bleeding.
For example, after an injury to the abdomen or kidneys, a large amount of blood may be lost before symptoms appear. In contrast, even a small amount of bleeding in part of the brain can cause severe symptoms or even death.
In the case of trauma, the initial lack of signs or symptoms does not mean a person is okay. Only in the later stages do symptoms appear and become severe.
Dizziness and lightheadedness are common with rapid or heavy blood loss. If blood loss occurs gradually, dizziness may occur only when a person tries to stand and blood pressure drops (called orthostatic hypotension).
Pain is a common symptom of internal bleeding because the blood irritates the tissue. In some parts of the body, such as the chest, the pain may be limited to the bleeding area. Pain may also be felt in other parts of the body (called referred pain) in other areas, such as the abdomen. For example, bleeding near the diaphragm is often felt in the shoulder.
People often become alert when internal bleeding occurs. Guarding is an unconscious attempt to prevent a person from touching a vulnerable or injured part of the body.
Shortness of breath
Shortness of breath can be a symptom of internal bleeding anywhere in the body. As blood is lost, fewer red blood cells carry oxygen to the tissues. Lack of oxygen can cause difficulty breathing.
Tingling in hands and feet
As blood is lost, the body often "clamps" blood vessels in the limbs to redirect blood to vital organs. Lack of oxygen to the extremities can cause tingling in the hands or feet. Internal bleeding can also cause hyperventilation (shortness of breath) as the body attempts to increase oxygen levels.
Vision changes are common with internal bleeding. When blood loss is rapid or severe, they may precede "fainting." Other changes may be due to brain hemorrhage, in which blurred vision and double vision are common.
nausea or vomiting
Nausea and vomiting may occur due to blood loss or in response to pain. These symptoms are common when bleeding occurs in the digestive tract or brain.
When blood loss is sudden or severe, heavy sweating (called diaphoresis) for no apparent reason may occur. Blood loss can cause rapid changes in body temperature, which can lead to sudden, profuse sweating. People often describe it as "breaking into a cold sweat."
Bruises Bruises can sometimes show where bleeding has occurred. Bruising around the belly button (called Karen's sign) indicates abdominal bleeding. When bleeding occurs in the abdomen or retroperitoneal space (where the kidneys are located), bruising on the flanks, called Gretner's sign, may occur. Extensive bruising may occur when a bone is broken.
changes in mental state
Changes in mental status, including confusion and disorientation, are signs of significant blood loss. This may include complete loss of consciousness. Changes in mental status are signs of a medical emergency.
Internal bleeding in specific parts of the body can cause different symptoms. These include:
Brain hemorrhage often causes severe headache, nausea, and vomiting. Weakness on one side of the body or changes in vision are also common. As the bleeding progresses, confusion and disorientation may occur, followed by loss of consciousness or seizures.
Chest bleeding can cause shortness of breath, wheezing, and coughing up blood (coughing up blood). Coughing up even a teaspoon of blood is a medical emergency. Coughing up 1/4 cup or more of blood is associated with a higher risk of death.
Bleeding around the heart (called pericardial effusion) can restrict the heart's movement. This can lead to life-threatening cardiac tamponade.
Bruising often occurs around the chest and neck when a lung is punctured and collapses (pneumothorax). The skin on your neck and upper abdomen may also feel wrinkled, like bubble wrap, when air gets into the skin's layers. Because of blood in the chest (hemothorax), the pain worsens when people move into different positions.
Abdominal bleeding can cause swelling and diffuse pain. Bowel sounds may not be heard when the doctor places the stethoscope over the stomach. Bruising around the belly button or flanks strongly indicates internal bleeding.
Bleeding from the esophagus or stomach may cause bloody vomiting, while bleeding from the lower gastrointestinal tract may cause rectal bleeding or bloody stools. Bleeding from the kidneys or bladder can cause blood in the urine.
bones, joints and muscles
Bleeding from a broken bone or injury to a joint or muscle often results in bruising, sometimes severe. On the other hand, the skin may become pale and tight when bleeding causes compartment syndrome, a painful condition caused by extreme pressure within muscle tissue. It may be difficult to move your joints or walk.
Blood loss can lead to serious complications. This can include death from massive blood loss (called hemorrhage). This most commonly occurs when the body loses half to two-thirds of its blood.
But there are other complications that can lead to death or permanent injury:
Shock is a medical emergency that occurs when the tissues in your body don't get enough blood and oxygen. When the blood volume is too low, for example due to bleeding, it is called hypovolemic shock.
Most commonly, symptoms of shock (including clammy skin, rapid heartbeat, and difficulty breathing) occur when a person loses 10 to 15 percent of their blood volume.
organ failure or damage
Some organs are more sensitive to blood loss and shock than others. For example, in the heart and kidneys, a lack of blood flow can cause the tissue to die quickly, which is called necrosis. This reduces the function of these organs, often permanently, leading to organ failure.
The same happens with brain hemorrhage, where tissue death can lead to paralysis, vision loss, personality changes, memory loss and swallowing problems.
Bleeding causes special concern among different groups, especially children and pregnant women.
Unlike adults, children may not be able to describe their symptoms. Instead of complaining of pain, they may become irritable, cry constantly, or become inconsolable. They may also lose their appetite or refuse to eat.
Changes in mental status are also common clues. For example, a child who normally loves to play may become lethargic. Changes in vision may cause children to hit walls or miss objects they are reaching for.
Early in pregnancy, bleeding can be a sign of miscarriage or a more potentially fatal condition called ectopic pregnancy. Later, placenta previa, premature placental separation, or uterine rupture can cause internal bleeding.
Such complications often result in vaginal bleeding, but this is not always the case. The baby's position in the womb may prevent blood from escaping. This may increase the risk of late diagnosis and death.
When to see a doctor
Internal bleeding can be life-threatening and requires immediate action to prevent death or irreversible organ damage.
If you or someone you know has signs of internal bleeding, it is important to call emergency numbers, including:
- severe abdominal or chest pain
- Shortness of breath or difficulty breathing
- dizziness or fainting
- Coughing up blood
- vision changes
- changes in mental state
People should also get tested after suffering any form of trauma, including serious falls or blunt injuries from car accidents or contact sports. These sometimes cause no outward symptoms until later when bleeding becomes severe.
Bleeding is often caused by trauma, including stab wounds, fractures, and blunt trauma, as well as from causes such as ruptured aneurysms and bleeding disorders. Overuse of certain medications and viral hemorrhagic fevers, although uncommon, can be serious causes.
Symptoms include pain, dizziness, nausea or vomiting, bruising, cold sweats, tingling in the hands and feet, vision changes, confusion, and fainting. Complications may include shock, organ damage or failure, and death.