Internal Bleeding

Internal bleeding (hemorrhage) happens when your blood vessels burst or break and blood collects inside your body. This is different from external bleeding — when you bleed due to a wound that breaks your skin.

There are many causes of internal bleeding, and they vary in severity. It can happen almost anywhere inside your body. The bleeding can be sudden and rapid or slowly build up. It can be minor and temporary or severe and require immediate medical treatment.

No type of internal bleeding is normal (except regular menstrual bleeding). And it can very quickly become life-threatening. Get medical help as soon as possible if you think you or someone near you has internal bleeding.

Types of internal bleeding

There are two broad categories of internal bleeding: visible and not visible.

Visible internal bleeding

The most common type of visible internal bleeding is a bruise. A bruise is skin discoloration from damaged, leaking blood vessels underneath your skin. Even though there’s blood pooling underneath your skin, you won’t have any external bleeding unless your skin breaks open.

Some types of internal bleeding can become visible when blood leaks from an orifice (body opening) or is in a waste product. For example:

• Bowel damage can lead to bleeding from your anus (rectal bleeding) or blood in your poop (stool).
• A head/brain injury can lead to bleeding from your ears or nose.
• Damage to your esophagus, stomach or duodenum (the connection between your stomach and small intestine) can lead to bloody vomit.
• Lung damage can lead to coughing up blood.
• Damage to your urinary tract can lead to blood in your pee (hematuria).
• Damage to your uterus, cervix or vagina can lead to abnormal vaginal bleeding.
• Damage to your prostate, testicles or seminal tract can lead to blood in your semen (hematospermia).

Not visible internal bleeding

You can have bleeding inside your body that’s not visible. Even though you can’t see it, you’ll likely experience symptoms, like pain, weakness or lightheadedness. The symptoms vary based on the area of the bleeding, the severity of the damage and the amount of blood loss.

Symptoms of internal bleeding

The way internal bleeding makes you feel varies a lot depending on where it is and how severe it is.

Healthcare providers consider up to 15% of blood volume loss a Class I hemorrhage. People with this amount of blood loss generally don’t have symptoms.

A Class II hemorrhage is a loss of 15% to 30% of your total blood volume. The first signs of this level of internal bleeding may include:

• Dizziness or lightheadedness (due to low blood pressure)
• Fatigue and weakness
• Nausea and vomiting
• Shortness of breath and increased breathing rate
• Increased heart rate

Call 911 (or your local emergency service number) or go to the emergency room if you or someone near you has these symptoms.

Losing more than 30% of your total blood volume can lead to severe symptoms and complications, like:

• Confusion
• Seizures
• Loss of consciousness
• Hypovolemic shock

Specific symptoms of internal bleeding

Specific symptoms of internal bleeding in certain areas of your body include:

• Head: Thunderclap headache, vision issues, confusion and weakness on one side of your body
• Chest: Difficulty breathing, chest pain and coughing up blood
• Abdomen: Swelling or a feeling of fullness, abdominal bruising, as well as bloody vomit, pee or poop
• Bones, joints and muscles: Bruising, swelling and pain (compartment syndrome is a medical emergency)

Call 911 (or your local emergency service number) or go to the emergency room if you or someone near you has these symptoms.

Internal bleeding causes

The most common cause of internal bleeding is trauma, like from a vehicle accident or other blunt force or penetrating trauma. But several other types of injuries and conditions can cause internal bleeding.

Gastrointestinal conditions

Several gastrointestinal (GI) conditions can cause bleeding in your GI tract, including:

• Esophagitis
• Gastritis
• Peptic ulcer disease
• Crohn’s disease
• Colon polyps
• Colitis
• Gastrointestinal cancers

Ruptured aneurysms

An aneurysm is a bulge in the wall of an artery. Aneurysms can occur in any artery. But they’re more common in your brain (brain aneurysm) or aorta, either in your chest (thoracic aortic aneurysm) or abdomen (abdominal aortic aneurysm).

If an aneurysm ruptures (breaks open), it can cause severe internal bleeding.

Internal bleeding causes in females

Causes of internal bleeding that specifically affect females include:

• Ruptured ovarian cyst
• Ectopic pregnancy
• Postpartum hemorrhage (PPH)

Other causes of internal bleeding

Examples of other causes of internal bleeding include:

• Hemorrhoids: Hemorrhoids are swollen, enlarged veins that form inside and outside of your anus (butthole) and rectum. They can cause rectal bleeding.
• Bone fractures: Breaking a bone, especially long or large bones like your thigh bone (femur ) or pelvis, can cause internal bleeding if bone fragments tear blood vessels.
• Internal bleeding after surgery: In rare cases, internal bleeding may continue after your surgeon closes your incision. And in some of these cases, the bleeding can be severe.
• Viral hemorrhagic fevers (VHFs): VHFs are a group of viral infections that can cause uncontrolled bleeding. Some of these infections include Ebola virus disease (EVD), Marburg virus disease (MVD) and dengue fever.

Risk factors

Each potential cause of internal bleeding has its own risk factors. For example, smoking cigarettes and high blood pressure increase your risk of aneurysms. But two major risk factors for internal bleeding in general include:

• Blood disorders: Bleeding disorders like hemophilia make it difficult for bleeding to stop and increase your risk of severe internal bleeding.
• Blood-thinning medications: Taking an anticoagulant, antiplatelet medication and/or high doses of NSAIDs can increase your risk of severe internal bleeding if a blood vessel breaks.

Complications of internal bleeding

Complications of internal bleeding happen due to decreased blood flow to your organs, which can mean they don’t get enough oxygen (tissue hypoxia). This can lead to:

• Organ failure
• Coma
• Death

If you have internal bleeding in your skull, it can lead to long-term neurological and cognitive (thinking) issues. A subarachnoid hemorrhage can lead to vasospasms in your brain blood vessels in the following weeks and result in a stroke.

Other complications include re-bleeding and complications related to hospitalization, including deep vein thrombosis (DVT) and infection.

How doctors diagnose this condition

Diagnosing internal bleeding involves finding its location and what’s causing it.

To do this, a healthcare provider will likely use imaging and laboratory tests. They’ll also do a physical exam and ask about your medical history.

How is internal bleeding treated?

The treatment for internal bleeding depends on its cause and severity. If it’s a known underlying condition, like a gastrointestinal issue, your healthcare provider will adjust your treatment plan.

If there’s an unknown cause and/or the bleeding is severe, you’ll need treatment in a hospital. Your healthcare team will find the cause and treat it appropriately. You may need:

• Surgery
• Vitamin K injections (to help stop bleeding)
• IV fluids
• Blood transfusions

Does internal bleeding heal itself?

Minor internal bleeds may heal on their own if you don’t have a bleeding disorder or take blood-thinning medication. But it’s always a good idea to see your healthcare provider if you have signs of internal bleeding (like bloody poop or pee) and don’t know the reason for it — even if it’s a small amount.

Moderate to severe internal bleeding requires immediate medical treatment in a hospital. It can be fatal if you don’t get treatment in time.

What is the prognosis for someone with internal bleeding?

The prognosis (outlook) depends greatly on the severity of the internal bleeding and how quickly it’s detected and treated. The sooner you get treatment, the better. This is why it’s crucial to get medical help as soon as possible if you have signs of moderate to severe internal bleeding.