Internal Bleeding

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What is internal bleeding?

Internal bleeding is blood loss occurring within your body. Because it occurs inside your body, internal bleeding may go unnoticed initially. If the bleeding is rapid, enough blood may build up to press on internal structures or to form a bulge or discoloration under your skin. Severe internal bleeding can cause shock and loss of consciousness.

Symptoms vary based on the location and rate of blood loss. Slow internal bleeding can cause the gradual onset of anemia, resulting in energy loss, tiredness, shortness of breath, and paleness. Gastrointestinal bleeding may cause blood in the stool or vomit. Similarly, urinary tract bleeding can make the urine bloody.

Hemophilia (rare hereditary disorder in which blood does not clot normally) or other bleeding disorders, anticlotting medications, and trauma are some of the risk factors for internal bleeding. Medical conditions, such as liver disease, and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and indomethacin (Indocin), can also increase the risk of internal bleeding.

Although internal bleeding may occasionally resolve on its own, it can have very serious consequences. Generally, treatment involves stabilization of vital functions, such as circulation and respiration, identification of the bleeding site, control of blood loss, and repairing any damage related to the bleeding. Blood transfusions may be needed if a significant amount of blood has been lost.

Internal bleeding can have serious, even life-threatening consequences. Seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms, such as:

  • Bleeding while pregnant

  • Bloody or pink-colored urine (hematuria) or not producing any urine

  • Chest pain or pressure or rapid heart rate (tachycardia)

  • Cold and clammy skin, pale skin or pallor, bluish coloration of the lips or fingernailsConfusion or loss of consciousness for even a brief moment

  • Difficulty breathing

  • Head injury

  • Obvious deformity or broken bones

  • Profuse sweating

  • Rapid swelling

  • Rectal bleeding or bloody stool

  • Severe pain

  • Vomiting blood

  • Weakness (loss of strength)

What other symptoms might occur with internal bleeding?

Symptoms accompanying internal bleeding vary based on the location and speed of blood loss. Pain may or may not be present. Rapid bleeding can quickly cause weakness, dizziness, shock and unconsciousness. Slower bleeding may ultimately cause anemia, with the gradual onset of tiredness, weakness, shortness of breath, and pallor. Bleeding into the gastrointestinal or urinary tract can cause blood in the stool, vomit or urine.

Common symptoms that may occur with internal bleeding in the head

Internal bleeding in the head may accompany other symptoms including:

Common symptoms that may occur along with internal bleeding in the chest or abdomen

Internal bleeding in the chest or abdomen may accompany other symptoms including:

Common symptoms that may occur along with bleeding into the muscles or joints

Internal bleeding into the muscles or joints may accompany other symptoms including:

  • Bone or joint deformity

  • Loss of sensation

  • Pain

  • Reduced mobility (range of motion)

  • Swelling, redness or warmth

Other symptoms that may occur along with internal bleeding

Internal bleeding at other sites may accompany other symptoms including:

  • Abdominal pain or cramping

  • Bloody or pink-colored urine (hematuria)

  • Bloody stool (blood may be red, black, or tarry in texture)

  • Hematoma (collection of blood in body tissues)

  • Pain

  • Vomiting blood or black material (resembling coffee grounds)

Serious symptoms that might indicate a life-threatening condition

In some cases, internal bleeding may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medica l care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Bleeding while pregnant

  • Bluish coloration of the lips or fingernails

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

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • Chest pain, chest tightness, chest pressure, palpitations

  • Garbled or slurred speech or inability to speak

  • Not producing any urine, or an infant who does not produce the usual amount of wet diapers

  • Paralysis or inability to move a body part

  • Rapid heart rate (tachycardia)

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

  • Severe pain

  • Vomiting blood, rectal bleeding, or bloody stool

What causes internal bleeding?

Internal bleeding can occur as a result of trauma or with a variety of medical conditions. The risk is increased with clotting abnormalities and anti-clotting medications.

Nontraumatic causes of internal bleeding

Although internal bleeding is often due to trauma, it may also be caused by a variety of conditions including:

  • Anticlotting medications

  • Arteriovenous malformation (abnormal connections between arteries and veins)

  • Gastritis (inflammation of the stomach lining)

  • Gastroenteritis (infection of the digestive tract)

  • Hemophilia (rare hereditary disorder in which blood does not clot normally)

  • Inflammatory bowel disease (includes Crohn’s disease and ulcerative colitis)

  • Liver disease (includes any type of liver problem, such as hepatitis, cirrhosis and liver failure)

  • Medication side effects, especially nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and indomethacin (Indocin)

  • Ruptured aneurysm (rupture of a weakened, bulging area of an artery)

  • Thrombocytopenia (low blood platelet count; platelets help form clots to stop blood loss)

  • Von Willebrand’s disease (hereditary bleeding disorder)

Serious or life-threatening causes of internal bleeding

In some cases, internal bleeding may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Bleeding esophageal varices (life-threatening rupture and hemorrhage of swollen veins in the esophagus)

  • Bowel infarction (severe bowel injury due to decreased blood supply)

  • Ectopic pregnancy (life-threatening pregnancy growing outside the uterus)

  • Head injury

  • Ruptured aortic aneurysm (rupture of a weakened, bulging area of the aorta)

  • Ruptured liver or spleen

  • Trauma, such as bone deformity, eye injuries, and other injuries

Questions for diagnosing the cause of internal bleeding

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your internal bleeding including:

  • When did you first notice your symptoms?

  • Have you been feeling tired or dizzy?

  • Have you noticed any blood in your stool or urine?

  • Have you been having any pain?

  • Do you have any other symptoms?

  • Do you have any preexisting health problems?

  • What medications are you taking?

What are the potential complications of internal bleeding?

Because internal bleeding can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

  • Altered or decreased sensation

  • Anemia (low red blood cell count)

  • Brain damage

  • Organ failure

  • Paralysis or weakness (loss of strength)

  • Shock

  • Unconsciousness and coma

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 7
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.
  1. Bleeding. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000045.htm
  2. What is iron-deficiency anemia? National Heart Lung and Blood Institute Diseases and Conditions Index. http://www.nhlbi.nih.gov/health/dci/Diseases/ida/ida_diagnosis.html