Symptoms of Internal Bleeding
Signs and symptoms of internal bleeding include light-headedness, pain, shortness of breath, a rapid heart rate, and more. These symptoms may manifest no matter where the bleeding occurs, but there are a number of other symptoms that you may experience based on the specific location of bleeding, such as bruising around the umbilicus or flank with abdominal bleeding. Internal bleeding can be particularly challenging in children and pregnant women. Without emergency treatment, complications of internal bleeding may include shock and, ultimately, tissue death.
Internal bleeding can vary tremendously between cases. It may be slow and insidious, or, instead, massive. It may occur with little or no symptoms, or be accompanied by shock and loss of consciousness. There may be no clear cause or source, or, such as with trauma, the cause and likelihood of internal bleeding may be obvious. Unfortunately, even in the case of trauma, internal bleeding may not be immediately evident, and a high level of scrutiny may still be needed.
With internal bleeding, the amount of bleeding does not necessarily reflect the severity of the condition. Large amounts of blood may collect in some regions of the body (such as the retroperitoneum in the case of a kidney injury) before symptoms or complications occur. In contrast, even small amounts of bleeding in regions such as the brain can cause major symptoms or even death.
Having an awareness of some of the conditions that can cause internal bleeding may help you recognize the symptoms, should they occur. Some of the potential causes of internal bleeding include:
There are a number of mechanisms by which trauma can cause internal bleeding, and sometimes more than one of them are present at the same time. Mechanisms include:
- Penetrating trauma: When an object enters the body, it may injure any structures in its path and also cause compression to surrounding structures.
- Blunt trauma: Blunt trauma can be more insidious and may not cause symptoms initially. However, it is a common cause of internal bleeding.
- Deceleration injuries: When rapid deceleration occurs, such as during a car crash, tears may occur in blood vessels or in the “stalks” by which organs are connected to one another. Deceleration can also cause brain injuries, such as subdural hematomas.
- Fractures: Some fractures bleed more than others. Fractures of the long bones of the arm, leg, pelvis are often associated with significant blood loss. Fractured bone fragments can also tear blood vessels and other tissues.
Thinning and enlargement of blood vessels can lead to rupture. Sometimes, the rupture is preceded by intense activity, whereas at other times the rupture may occur at rest or even during sleep. Aneurysms may occur in nearly any blood vessel, with more common aneurysms including those in the brain (cerebral aneurysms), in the aorta in the chest, and in the abdominal aorta.
Bleeding Disorders and Blood Thinners
Bleeding disorders may cause spontaneous bleeding or increase the likelihood of internal bleeding when combined with its other known causes. Some of these disorders, such as hemophilia, are usually apparent from birth, whereas some minor bleeding disorders may not become apparent until adulthood.
Medications such as anticoagulants and platelet inhibitors can also increase the risk of internal bleeding. With the use of these drugs increasing, an awareness of the signs of internal bleeding is more important than ever.
Medications such as aspirin and nonsteroidal anti-inflammatory drugs such as Advil (ibuprofen) also increase the risk. Some vitamins and dietary supplements may increase the risk of bleeding as well.
It’s important to stress that the degree of bleeding may not correlate with its apparent symptoms. In the case of trauma, the absence of signs or symptoms of internal bleeding early on does not mean that a person is in the clear. Sometimes, damage to the liver or spleen, such as from a motor vehicle accident, only becomes apparent hours or even days following the accident. Symptoms that may indicate internal bleeding include:
With rapid blood loss, or the loss of a significant amount of blood, lightheadedness and weakness are common. In the case of more gradual blood loss or the loss of a small amount, lightheadedness may only become obvious when a person tries to stand (orthostatic hypotension).
Pain is a common symptom of internal bleeding, as blood is very irritating to tissues. Symptoms such as severe abdominal pain or a severe headache should always be evaluated by a medical professional. In some areas of the body, pain may be localized to the area of bleeding. With areas such as the abdomen, however, the location of pain may not necessarily reflect the area of bleeding. In fact, when blood in the abdomen irritates the diaphragm, pain may be felt primarily in the shoulder.
Shortness of Breath
Shortness of breath, or the sensation of being unable to take a deep breath, may be a symptom of internal bleeding anywhere. With blood loss, there are fewer red blood cells and hemoglobin circulating to carry oxygen to tissues, and the lack of oxygen delivery to tissues may be experienced as shortness of breath. Certainly, shortness of breath is also common with bleeding in the chest cavity, or when the buildup of blood in the abdomen pushes up on the diaphragm, restricting airflow into the lungs.
Chest or Shoulder Pain
Bleeding into the chest may cause chest pain, and bleeding into either the chest or abdomen (by irritating the diaphragm) can cause shoulder pain. Chest pain may also occur with internal bleeding at any location due to inadequate oxygen being delivered to the coronary arteries that feed the heart.
Tingling in Hands and/or Feet
A sensation of tingling in the hands and feet is common with internal bleeding, and has several explanations. With blood loss, the body often “clamps” down circulation to the extremities, redirecting blood flow to vital structures such as the heart and brain. Internal bleeding can also cause hyperventilation both due to pain and to an attempt to increase oxygen delivery to the rest of the body. This may also result in tingling in the hands and feet.
Changes in Vision and Other Neurological Signs
Changes in vision associated with light-headedness may be associated with internal bleeding anywhere (why fainting is referred to as “blacking out”). Specific visual changes such as double vision, weakness or numbness of one side of the body, a severe headache, or loss of coordination may be a sign of bleeding into the brain.
Nausea or Vomiting
Nausea and vomiting is also common with internal bleeding, and may occur due to blood loss and/or pain alone, or specifically when bleeding occurs in the digestive tract or brain.
Sometimes, a person who has internal bleeding will be unable to answer questions or may even be unconscious. While symptoms are what a person feels, signs of a condition are visible indicators that another person can see. External bleeding, such as bleeding from the mouth, nose, ears, vagina, or rectum, suggests that internal bleeding may be present as well. Some signs associated with internal bleeding include:
Signs of Shock
With blood loss, several changes may be seen, such as a rapid heart rate, a rapid respiratory rate, and low blood pressure. Most often, signs of shock occur when a person has lost between 10 percent to 15 percent of their blood volume.
Diaphoresis, or profuse, heavy sweating that isn’t caused by heat or exertion, is common with internal bleeding as well as other medical emergencies.
It’s common for people to display guarding when internal bleeding occurs. Guarding is an unconscious attempt to keep another person or physician from touching a region of the body that is tender or bleeding.
Bruising in some regions of the body is sometimes a specific sign of internal bleeding. Bruising around the umbilicus (belly button) is referred to as Cullen’s sign, and suggests internal bleeding in the abdomen. Bruising on the flanks (between the rib cage and hips on the side of the abdomen) is known as Grey Turner’s sign and also suggest bleeding in the abdomen or retroperitoneal space (cavity towards the back of the abdomen where the kidneys lie). Bruising in other regions (ecchymosis) also suggest internal bleeding, such as when extensive bruising occurs on the extremities associated with an underlying fracture.
Change in Mental Status or Loss of Consciousness
A change in mental status or total loss of consciousness often means that a significant amount of blood has been lost (with the exception of head injuries or bleeding into the brain), and should be considered an emergency.
Symptoms Based on Site
Internal bleeding in specific regions of the body may also lead to other symptoms. These include:
Brain and Spinal Cord
Bleeding into the brain often causes a severe headache, nausea, and vomiting. Weakness on one side of the body or changes in vision may occur. As bleeding progresses, changes in mental status such as confusion and disorientation may occur, followed by loss of consciousness. Seizures may also occur.
Bleeding into the chest may cause a number of different symptoms depending on the specific location. Bleeding into the airways can cause a gasping cough. Coughing up blood (hemoptysis), even just a teaspoon, is a medical emergency, and massive hemoptysis (coughing up a fourth of a cup of blood or more) has a high mortality rate. Shortness of breath may occur with bleeding anywhere in the chest.
Bleeding between the membranes that surround the heart (pericardial effusion) can restrict the motion of the heart, causing cardiac tamponade.
When a lung is punctured and collapses (pneumothorax), bruising may be noted diffusely on the chest and neck. The skin over the neck and upper abdomen may also feel crinkly, like bubble wrap, due the presence of air in the subcutaneous tissues. With blood in the chest (hemothorax), pain usually changes significantly when people move into different positions.
Bleeding into the abdomen may result in swelling of the abdomen and diffuse pain. When a doctor places a stethoscope on the abdomen, bowel sounds may be absent. As noted earlier, bruising around the umbilicus or on the flank strongly suggests internal bleeding.
Certainly, bleeding into the oesophagus or stomach may induce vomiting blood, while bleeding in the lower digestive tract may cause rectal bleeding.
Bleeding from the kidneys and other tissues in the retroperitoneal region may cause blood to appear in urine. Symptoms of shock may occur before any specific symptoms are noted, as large amounts of blood may be lost in this region before any specific symptoms occur.
Bones, Joints, and Muscles
Bleeding associated with bones, joints, and soft tissues may cause extensive bruising. It may also, however, result in skin that is very pale and tight when compartment syndrome occurs. Pain is very common, as well as decreased mobility of joints as the joint space or surrounding areas fill with blood and swell.
Bleeding can cause different symptoms or raise special concerns in some groups of people. In addition to the underlying cause of bleeding, blood loss itself may result in further complications.
Unlike adults, children may not be able to express some of the symptoms of internal bleeding noted above. Instead of complaining of pain, they may become fussy, cry continually, or become difficult to console. They may have a poor appetite, or refuse to eat completely. Changes in mental status can be very important to note. A child who normally loves to play may become lethargic. Neurological symptoms can also be challenging to discern. Instead of complaining of blurry vision, a child may walk into a wall. Instead of complaining of extremity pain, they may begin to limp.
Bleeding during pregnancy is never normal, and any significant pain in the pelvis should be investigated immediately. Early on in pregnancy, the most common cause is a miscarriage, although ectopic pregnancy is a potentially life-threatening cause. Later on, placenta previa, placental abruptions, or uterine rupture can cause bleeding. Complications such as these are often associated with external bleeding from the vagina, but this is not always the case. For example, significant bleeding may occur with an abruption or with a ruptured uterus without external signs if the baby is positioned in a way that prevents blood from passing through the cervix.
Many people are confused about the precise meaning of shock, or at least the type of shock that is considered a medical emergency. Adequate blood pressure and an adequate volume of blood is needed to deliver oxygen to the tissues of the body. When this fails to occur and when the tissues are deprived of oxygen (hypoxia), the body first compensates by trying to increase blood pressure and blood flow. Heart rate increases. Blood vessels to the arms and legs constrict to keep enough blood perfusing vital organs (causing cool and clammy extremities). If these measures are not sufficient, tissues of the bodies fail to receive oxygen and begin to die.
All of the tissues of the body depend on receiving adequate oxygen and nutrients, but some organs are more sensitive than others to blood loss and shock. When the kidneys are damaged, not only does tissue death begin, but the kidneys then fail to play their role in managing the complex actions needed to maintain homeostasis in the body. When oxygenated blood fails to adequately nourish the coronary arteries, the heart muscle begins to die. The heart, in turn, is then less able to play its role in maintaining blood flow to the rest of the body. Fortunately, emergent measures to restore blood pressure and blood volume can often protect vital organs before this issue.
When to Seek Professional Help
Internal bleeding can be life-threatening, and often times emergent treatment can be lifesaving. It’s important to call you Country’s emergency line (not take the time to call a doctor) if you are having severe abdominal or chest pain, if you are experiencing severe shortness of breath, if you feel lightheaded (as if you may faint), or if you experience any neurological symptoms such as vision changes. If you are with someone who shows any of the signs of internal bleeding, call 911 as well.
Keep in mind that delayed bleeding after trauma is not uncommon, whether that may be due to a partially ruptured spleen or due to a slowly leaking subdural hematoma. It’s always better to be safe and make an appointment if you have any concerns at all.