Internal Bleeding: Causes, Treatments, and More

Medically reviewed by Graham Rogers, MD on June 26, 2017Written by Kimberly Holland

Overview

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 likely easy to pinpoint what caused it.

Internal bleeding, however, 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.

When internal bleeding does occur, it needs medical attention. In some cases, the bleeding may be a sign of a life-threatening condition, and you should seek immediate medical attention.

If you or someone you know suddenly develops the following symptoms, seek immediate medical attention:

  • dizziness
  • severe weakness
  • passing out
  • low blood pressure
  • acute visual problems
  • numbness
  • weakness on one side of the body
  • severe headache
  • severe abdominal pain

These could be symptoms of internal bleeding.

You could also have the following symptoms:

  • shortness of breath
  • chest pain
  • nausea
  • vomiting
  • diarrhea

In addition, you may notice bloody or dark vomitus 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 the signs and symptoms.

Signs and symptoms of internal bleeding

Internal bleeding is a symptom of an injury, condition, or disease. You won’t start experiencing internal bleeding without an underlying reason.

Recognizing the signs and 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:

Internal bleeding in your chest or abdomen

This can cause:

Internal bleeding into your muscles or joints

This can cause:

Other symptoms

It’s possible to experience shock in some cases of internal bleeding, especially 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:

The presence of other underlying conditions may help doctors recognize that 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 also experience low blood pressure because of the constant blood loss. This is known as orthostatic hypotension. Common symptoms include feeling dizzy or lightheaded when you stand.

Causes of internal bleeding

Sometimes, identifying what’s causing internal bleeding is easy. If you’ve been involved in an accident or had a recent injury, the bleeding is likely the result of that event.

Likewise, diagnosing the cause may be easy if you were diagnosed with a condition that can lead to internal bleeding, such as gastroenteritis.

However, not every case of internal bleeding is so clear-cut. Finding the source of an internal bleed may take some time and a thorough examination.

Nontraumatic causes

These can include:

  • Damage to a blood vessel: Minor tears can occur with an injury.
  • Not enough 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 medicines, like blood thinners, can prevent clotting and lead to severe bleeding if you’re injured or have an accident. Certain over-the-counter medicines, including aspirin, can damage the lining of your stomach, too.
  • 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, gastroenteritis, esophagitis, peptic ulcers, and more.
  • Lifestyle factors: Alcohol, smoking, and illicit drugs can irritate the lining of your stomach.

Life-threatening causes

These can include:

  • Trauma: Car accidents, falls, physical assaults, and dropping a heavy object on yourself are all examples of ways you can damage your body’s 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 is life-threatening.
  • Broken bones: Most broken bones are nothing to be worried about, but breaking your body’s largest 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 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 a variety of lab tests and imaging tools to both identify the cause of your internal bleeding and measure the severity.

For traumatic injuries, an imaging test may be all that’s necessary. Which tests to order may be obvious too. If you had an accident and hurt your right leg, your doctor will order tests that look at your right leg. An X-ray can show the 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 as evident, your doctor may order several medical tests to help identify what’s bleeding and why. These medical tests may include a stool test and several blood tests. Based on your signs and symptoms, your doctor may request several types of imaging tests too.

Treatment options

The first goal of treatment is to find the source of the bleeding and stop it. Some bleeding is minor and may stop on its own. Other cases are more severe and may require more invasive measures, including surgery.

When your doctor considers a treatment for internal bleeding, they’ll likely take three factors into consideration:

  • 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. Few other 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 caused by the bleeding and stabilizing your body.

Outlook

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.

However, if internal bleeding isn’t caught and treated quickly, you may experience lasting permanent effects. 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. Likewise, these therapies may help you prevent future tears or blood vessel damage.

The outlook is less positive if you don’t address any behaviors or risk factors that led to the bleeding. For example, a gastrointestinal bleed that was caused by alcoholism may return if you don’t remove the alcohol dependency.

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