Bruising

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What is bruising?

Bruising is a very general term for a condition in which blood leaks out of the blood vessels into the tissues of the skin, mucus membranes or other organs, including muscles and bones. Different types of bruises include contusions, hematomas and purpura.

Contusions

Contusions are common types of bruises that are caused by trauma, often blunt-force injury, that damages and breaks open the tiny blood vessels in the tissues of the skin, mucus membranes or other organs. Contusions are often accompanied by pain and swelling due to the body’s inflammatory response to injury. This is why a bruise on your shin caused by bumping a table can become swollen.

When a contusion develops in your skin, it turns red, then black and blue or purple, and finally a greenish-yellow shade as the blood is broken down and absorbed by the body. Bone contusions and deep muscle contusions can be very painful and take longer to heal than contusions that only affect the skin tissues.

The most serious type of contusions are contusions of important organs, such as the brain, kidneys, spleen, liver, lungs and heart. These contusions can be life threatening and are generally caused by severe trauma, such as a fall from a significant height, being hit by a car, serious crush injury, or motor vehicle accident, especially without wearing a seat belt.

Hematomas

Hematomas are a type of bruising in which there is significant bleeding that results in a collection of blood that pools at the site of injury. Hematomas can be caused by the same forces that cause contusions but generally cause more pain, swelling and complications than contusions.

Hematomas can be also be caused by surgical procedures or spontaneous rupture of a blood vessel, such as a ruptured aneurysm. Hematomas can occur in any area or organ of the body, and when they occur in certain organs, such as the brain or spleen, they can be life threatening.

Common hematomas include:

  • Epidural, subdural and intercerebral hematomas are collections of blood in the brain and/or under the skull, which can cause a critical increase in pressure in the skull and brain.  

  • Nasal septum hematoma is a collection of blood that pools in the septum that divides the nose.

  • Subcutaneous hematoma is a collection of blood that pools just beneath the skin.

  • Subungal hematoma is a collection of blood that pools under a fingernail or toenail.

A shearing injury can also cause a hematoma in major organs. For example, shaking a baby can cause dangerous shearing forces inside the brain, a brain hematoma, irreversible brain injury, and death.

Purpura

Purpura is caused by spontaneous leaking of blood from tiny blood vessels (capillaries). It is a type of bruising that causes purple or red flat spots or patches on the skin and mucus membranes.

Purpura that results in tiny spots on the skin is called petechiae. A large area of purpura is called ecchymosis, although any type of bruising of the skin is often referred to as ecchymosis.

Purpura is not caused by trauma, as are contusions, but by a variety of medical diseases, disorders and conditions including:

If you experience easy or frequent bruising, especially if it is associated with nosebleeds or bleeding gums, seek prompt medical care. If you, or someone you know, develops petechiae, which are small, flat, purple-colored spots that can indicate meningitis or other serious conditions, seek immediate medical care (call 911).

What other symptoms might occur with bruising?

Bruising may be accompanied by other symptoms that vary depending on the underlying disease, disorder or condition. Skin bruises are often associated with local pain, swelling and skin discoloration. Easy bruising or unexplained bruising, which may be due to an underlying bleeding or blood disorder, may be accompanied by other bleeding symptoms.

Symptoms that may occur along with bruising

Bruising may occur with other symptoms including:

Serious symptoms that might indicate a life-threatening condition

In some cases, bruising may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Deformity or loss of function of the bruised area

  • Dizziness or light-headedness

  • Extreme pain, swelling or feeling of pressure in the bruised area

  • High fever (higher than 101 degrees Fahrenheit)

  • Nausea or vomiting

  • Petechiae (tiny pinpoint red or purple dots from bleeding under the skin)

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

  • Seizure

  • Stiff neck

  • Vomiting blood, bloody stools or rectal bleeding

  • Yellow eyes and skin (jaundice)

What causes bruising?

Skin bruising is usually caused by a minor contusion or injury. You may find that you bruise more easily on your legs, because your legs are generally more prone to injury and the effect of gravity on blood flow. You may bruise easily from minor bumps or scrapes. This may simply be a familial, or inherited tendency to bruise easily and it is not necessarily a cause for concern. Easy bruising is also referred to as purpura simplex. However, frequent and unexplained bruising can also be a sign of something more serious, such as a blood clotting disorder or a blood disease, so contact your health care provider to discuss your symptoms.

In some cases, bruising is a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting.

Bruising due to injury

Bruising is often caused by everyday injuries or more serious trauma including:

  • Blunt force, such as a blow to the face

  • Child or domestic abuse

  • Falling

  • Motor vehicle collision

  • Sports injury

Bruising due to age, gender and lifestyle factors

Easy or unexplained bruising can be caused by age, gender and lifestyle factors such as:

  • Aging skin

  • Alcohol abuse (decreases blood clotting)

  • Female gender (women bruise more easily than men)

Bruising due to serious underlying diseases

A variety of diseases, disorders and conditions can cause bruising symptoms, including easy or unexplained bruising and purpura. Purpura is caused by spontaneous leaking of blood from tiny blood vessels (capillaries), resulting in purple or red flat spots or patches on the skin and mucus membranes. Some underlying causes of unexplained bruising or purpura include:

  • Aplastic anemia

  • Autoimmune diseases, such as lupus and rheumatoid arthritis

  • Certain infectious diseases, such as meningitis, mononucleosis and measles

  • Cushing’s disease

  • Hemophilia (inherited bleeding disorder)

  • Insect bites

  • Leukemia

  • Organ failure

  • Thrombocytopenic purpura diseases (potentially life-threatening platelet disorders that cause problems with blood clotting)

  • Vasculitis (inflammation of blood vessels)

  • Vitamin C deficiency (scurvy)

  • Von Willebrand's disease (inherited bleeding disorder)

Medications that can cause bruising

Always tell your doctor about any medications or treatments you are using including prescription drugs, over-the-counter medications, supplements, and herbal or alternative treatments. The following medications may be a possible cause of easy bruising or purpura:

  • Anticoagulants (blood thinners such as warfarin and heparin)

  • Antidepressants including serotonin reuptake inhibitors and tricyclics

  • Aspirin

  • Fish oil

  • Ginkgo biloba

  • Interferon

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen

  • Penicillin

  • Plavix (antiplatelet medication)

  • Radiation or chemotherapy

  • Testosterone replacement therapy

What are the potential complications of bruising?

Complications associated with bruising can be progressive and vary depending on the underlying cause. Because easy or unexplained bruising can be due to serious diseases, failure to seek treatment can result in complications and permanent damage. It is important to contact your health care provider when you experience any kind of persistent or recurrent bruising or bleeding symptoms, such as lacerations or cuts that take a long time to stop bleeding. Once the underlying cause is diagnosed, following the treatment plan outlined by your doctor can lower your risk of potential complications including:

  • Coma due to brain contusion or hematoma

  • Compartment syndrome (complication of severe muscle bruise)

  • Hematoma

  • Hypovolemic shock and coma due to contusions or hematomas of organs such as the liver or spleen

  • Risk of fracture, especially in the elderly

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Dec 3
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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