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Internal Bleeding

 


  • Internal bleeding is bleeding that occurs within your body. An injury that damages the outside of your body is easy to see. A cut or tear in your skin usually bleeds. You can see what’s hurt, and it’s easy to pinpoint what caused it.
  • Internal bleeding isn’t as easy to see or diagnose. Bleeding internally is often the result of trauma or an injury. Less obvious causes can result in internal bleeding, too. These include gastritis, organ damage, or a bleeding disorder.
  • In some cases, the bleeding may be a sign of a life-threatening condition. If you or someone you know suddenly develops the following symptoms, seek immediate medical attention. These could be symptoms of internal bleeding:
    • dizziness
    • severe weakness
    • passing out
    • low blood pressure
    • acute visual problems
    • numbness
    • weakness on one side of the body
    • severe headache
    • severe abdominal pain
    • shortness of breath
    • chest pain
    • nausea
    • vomiting
    • diarrhea

·         You may notice bloody or dark vomit or stool. Occasionally, if the bleeding is behind the internal organs in the abdomen, you may have bruising around your navel or on the sides of your abdomen.

·         Other cases of internal bleeding can be less severe, but it’s still important you see your doctor as soon as you notice symptoms.

Signs and symptoms of internal bleeding

  • Internal bleeding is a symptom of an injury, condition, or disease. You won’t have internal bleeding without an underlying reason.
  • Recognizing the symptoms of internal bleeding can help you and your doctor understand what’s bleeding, why it’s bleeding, and what conditions could be contributing to the problem.

Internal bleeding in your head

  • This can cause:
    • weakness, usually on one side of your body
    • numbness, usually on one side of your body
    • tingling, especially in hands and feet
    • severe, sudden headache
    • difficulty swallowing or chewing
    • change in vision or hearing
    • loss of balance, coordination, and eye focus
    • difficulty speaking or understanding speech
    • difficulty writing
    • changes in overall alertness, including increases in sleepiness, lethargy, or stupor
    • loss of consciousness

Internal bleeding in your chest or abdomen

  • This can cause:
    • abdominal pain
    • shortness of breath
    • chest pain
    • dizziness, especially when standing
    • bruising around your navel or on the sides of your abdomen
    • nausea
    • vomiting
    • blood in urine
    • black, tarry stool
    • bleeding from another area, including ears, nose, mouth, or anus

Internal bleeding into your muscles or joints

  • This can cause:
    • pain in a joint
    • swelling in a joint
    • decreased range of motion


Other symptoms

  • It’s possible to experience shock in some cases of internal bleeding.
  • This is especially true if internal bleeding occurs in locations where a substantial amount of blood can be lost, such as your chest, abdomen, or thigh. Shock occurs when there’s not enough blood to supply your whole body.
  • Symptoms of shock include:
    • rapid heart rate
    • low blood pressure
    • sweaty skin
    • changes in overall alertness, including increases in sleepiness, lethargy, or stupor
    • overall weakness
  • The presence of other underlying conditions may help doctors identify if you’re losing blood somewhere.
  • For example, anemia is commonly associated with a slow and chronic internal bleeding. It can cause fatigue, weakness, and shortness of breath.
  • Some people with internal bleeding will also have low blood pressure because of the constant blood loss. This is known as orthostatic hypotension. Common symptoms include feeling dizzy or light-headed when you stand.



Causes of internal bleeding

  • Sometimes, identifying what’s causing internal bleeding can be simple. If you’ve been involved in an accident or had a recent injury, the bleeding is likely the result of that event.
  • Also, diagnosing the cause may be easier if you have a condition that can lead to internal bleeding, such as gastritis.
  • However, not every case of internal bleeding is so clear-cut. Finding the source of internal bleeding may take some time and require a thorough physical examination.

General causes

These can include:

  • Damage to a blood vessel. Minor tears can occur with an injury.
  • Clotting factors. Your body makes proteins to stop any bleeding if you’re cut or injured. If your body doesn’t make enough clotting factors, you may bleed freely.
  • Certain medications. Certain medications, like blood thinners, can prevent clotting and lead to severe bleeding if you’re injured or have an accident. Some over-the-counter medications, including aspirin, can damage the lining of your stomach.
  • Chronic high blood pressure. High blood pressure weakens blood vessel walls. Weak walls can form aneurysms that can rupture and bleed.
  • Inherited bleeding disorders. Hemophilia is a genetic condition that prevents your blood from properly clotting. A minor injury may bleed heavily if it’s not properly treated.
  • Gastrointestinal (GI) causes. Bleeding in your abdomen, or stomach, may be caused by one of several GI conditions. These include colon polyps, colitis, Crohn’s disease, gastritis, esophagitis, and peptic ulcers.
  • Endometriosis. Endometriosis is a condition where endometrium-like tissue grows outside the uterus in areas like the ovaries, abdomen, and bowel. The uterus will shed its lining and cause bleeding in a separate place, such as the pelvis. Diagnosis is made with the help of biopsies, a CT scan, an MRI, and an ultrasound.
  • Lifestyle factors. Alcohol, smoking, and illicit drugs can irritate the lining of your stomach.

More serious causes

  • These can include:
    • Trauma: Experiences including car accidents, falls, and dropping a heavy object on yourself can damage your organs, blood vessels, and bones. You may experience internal bleeding without cutting your skin.
    • Aneurysms: Weak blood vessel walls can bulge and form pockets of blood. Many aneurysms don’t cause any symptoms, but a burst aneurysm can be life-threatening.
    • Broken bones: Most broken bones are nothing to be worried about, but breaking your body’s larger bones, such as the femur, can cause significant internal bleeding.
    • Ectopic pregnancy: A pregnancy outside the uterus can cause internal bleeding as the fetus grows. The condition can be life-threatening.
    • Surgery: Before a surgeon completes an operation, they make sure all the bleeding has stopped. If they miss something, bleeding may continue even after the incision is closed. In some cases, this bleeding can be severe.
  • No matter the cause, it’s important that you get medical attention. Minor internal bleeding can quickly become more serious if the cause isn’t identified and treated quickly.
Diagnosing internal bleeding

  • Diagnosing an internal bleed usually requires medical tests, a physical exam, and a thorough review of your medical history. Your doctor may use lab tests and imaging tools to both identify the cause of your internal bleeding and measure the severity.
  • For injuries, an imaging test may be all that’s necessary. An X-ray shows an image of your bones. A CT scan is an advanced X-ray that can see bones, tissues, and blood vessels. Angiography is an imaging test that can carefully examine individual blood vessels.
  • If the cause of the bleeding isn’t easily determined, your doctor may order several medical tests to help identify what’s bleeding and why.

Treatment options

  • The first goal of treatment is to find the source of the bleeding and stop it. Some bleeding can be minor and may stop on its own. Other cases are more severe and may require more in-depth measures, including surgery.
  • When your doctor prescribes a treatment for internal bleeding, they’ll likely consider:

    • the severity of the cause
    • the organ or blood vessel that is injured
    • your overall health
  • In mild cases of internal bleeding, treatment typically involves rest and symptom control.
  • Rest gives your body time to heal while it reabsorbs the blood and the inflammation decreases. A few additional treatment techniques may be necessary for slow bleeds once the cause is identified and treated.
  • However, some causes of internal bleeding need greater treatment. Surgery may be necessary to stop the bleeding and clean out any pooled blood. The type of surgery you need depends on how severe the bleeding is, where the bleeding is, and your overall health.
  • After the bleeding stops, treatment will focus on repairing any damage and stabilizing your body.

Complications

  • Depending on the severity, untreated internal bleeding can lead to organ failure, coma, and in some cases death. Even with treatment, severe internal bleeding can result in death.
  • It’s very important to identify and treat internal bleeding early in order to avoid any complications.

Outlook

  • It’s important to find and treat the cause and risk factors that may lead to internal bleeding. Without quick treatment, you may experience lasting effects.
  • For example, bleeding in the brain may cause a stroke or long-term brain damage. You may need physical, occupational, and speech therapy to relearn certain behaviors and activities. These therapies may also help prevent future tears or blood vessel damage.
  • If internal bleeding is caught, diagnosed, and treated appropriately, the outlook is positive. Many people can make a full recovery. Additional treatments may be necessary to prevent a future bleed, but few lasting effects will remain.

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