What is a bruise?
A bruise, also known as a contusion, is a traumatic injury to the skin or the tissues underneath the skin. Bruises may occur after an accident, such as a fall, or from bumping into or being struck by a blunt object. Because the outer skin is not cut or broken, there is no external bleeding. However, damage occurs to blood vessels underneath the skin, causing them to rupture and leak blood. This blood collects or pools underneath the skin.
After a blood vessel is injured, platelets in the blood collect at the site of the injury to form a plug. The platelets combine with certain proteins called clotting factors to form a fibrin clot. This clot helps to prevent blood from leaking from the blood vessel and holds the platelets together so that healing can begin.
As the blood coagulates (clots together), the skin above the injured area will look discolored. At first, the skin is often red or purplish in color, but later on, as the bruise heals, it may turn brown, green, or yellow. This discoloration is commonly called a black-and-blue mark. Other symptoms might include swelling, tenderness, or pain in the area.
Types of bruises
The main types of bruises are:
- Ecchymosis (plural: ecchymoses): a flat, purple-colored bruise caused when blood leaks into the top layers of the skin.
- Hematoma: a mass of clotted or coagulated blood. It differs from a simple bruise or contusion because the area becomes swollen, raised, or painful. Hematomas may occur after an injury or impact to the skin, but they can also develop without any apparent cause. If the hematoma develops in a vital organ, the condition may become very serious and will require medical attention.
What causes bruises?
These are some of the things that can cause bruises:
- Minor accidents, such as bumping into a piece of furniture, falling, or dropping a heavy object on your foot or hand may cause a bruise to form at the site of impact.
- Older adults tend to bruise more easily than younger people. This is because their skin is thinner and they have less fat deposited underneath their skin to provide a cushioning effect. The blood vessels tend to break more readily after a minor injury.
- In general, women tend to bruise more easily than men do.
- The use of certain medications, such as anticoagulants (also known as blood thinners), can increase the tendency to bruise. Aspirin may have the same effect.
- Certain bleeding disorders, such as hemophilia and Von Willebrand’s disease, can cause a person to bruise more easily. These conditions are caused by an absence of certain clotting factors (proteins) in the blood. Hemophilia is a relatively rare condition that is usually inherited and mostly affects males. Von Willebrand’s disease is the most common type of bleeding disorder in the United States and affects both males and females.
- A vitamin deficiency can also result in a greater tendency to develop bruises. Vitamins B12, C and K, or folic acid play a role in the blood’s ability to clot.
- Bruises may be a sign of domestic, child or elder abuse, especially if an individual has several bruises, or bruises keep coming back. In cases of suspected abuse, a healthcare provider or social worker may question the individual or caregiver about the cause of the injuries. The victim might need to be placed in a safe environment or the abuser might have to be removed from the home to prevent further harm to the person.
Diagnosis and Tests
How are bruises diagnosed?
Your doctor will be able to tell whether you have a bruise simply by looking for skin discoloration. In some cases, there may be a bone fracture that causes discoloration. If your doctor suspects you have a fracture, he or she will probably order X-rays of the injured area.
Bruises that have no apparent cause may be a sign of a blood or bleeding disorder, a vitamin deficiency, or another underlying condition. In these cases, you will need to have blood tests to determine the cause. If you are taking an anticoagulant medication, your blood should be monitored periodically to ensure that the medication does not exceed the recommended level.
Management and Treatment
How are bruises treated?
Treatment of a bruise depends on what caused it. Bruises due to minor injuries or accidents will often disappear on their own after a few weeks. During the healing process, the bruise may change color, turning from red or dark purple, to yellow, brown, or green, before fading away.
Here are some things you can do to treat a bruise:
- Apply an ice pack during the first 24 to 48 hours after the bruise develops. The ice pack should be removed after 15 minutes. Prevent direct contact between the ice pack and the injured area by placing a towel or cloth between the ice pack and the skin.
- Rest and raise an injured limb to help reduce pain and swelling.
- After 2 days, begin applying a heat pack or cloth soaked in warm water to the injured area several times each day.
- Take acetaminophen, an over-the-counter pain medication, to relieve pain or discomfort.
Bruises that do not go away after a few weeks or come back without any apparent cause may need medical attention.
If you think that you have a broken bone or fracture, see your doctor immediately or visit the emergency room.
How can bruises be prevented?
Bruises are a common problem even among healthy children and adults. Although they cannot totally be prevented, you can reduce your risk of bruises in the following ways:
- Wear helmets or other protective equipment when playing contact sports or riding a motorcycle.
- Keep floors and walkways clear of obstructions (such as throw rugs) that might cause you to slip and fall.
- Keep furniture away from doorways or walkways where you might bump into it.
- Carry a flashlight when walking through poorly lit areas to reduce the risk of accidental falls.
- Keep a night light on in case you need to get up during the night to go to the bathroom.
- Make sure your diet contains adequate amounts of vitamins B12, C, and K, and folic acid.
© Copyright 1995-2020 The Cleveland Clinic Foundation. All rights reserved.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.
This document was last reviewed on: 03/27/2017