Internal Bleeding

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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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While the general public understands that internal bleeding means bleeding that can't be seen on the outside of the body, medical personnel tend to use terms that describe precisely where inside the body the bleeding is found. The internal bleeding may occur within tissues, organs, or in cavities of the body including the head, chest, and abdomen. Examples of other potential sites of bleeding include the eye, lining tissues of the heart, muscles, and joints.

Bleeding outside the body is quite easy to recognize. If the skin is damaged by a laceration, puncture, or abrasion, blood can be witnessed as it streams out of the body. The scalp, with its rich blood supply, is notorious for demonstrating massive blood loss. Internal bleeding can be much more difficult to identify. It may not be evident for many hours after it begins, and symptoms occur when there is significant blood loss or if a blood clot is large enough to compress an organ and prevent it from functioning properly.

Internal bleeding occurs when damage to an artery or vein allows blood to escape the circulatory system and collect inside the body. The amount of bleeding depends upon the amount of damage to an organ and the blood vessels that supply it, as well as the body's ability to repair breaks in the walls of the blood vessels. The repair mechanisms available include both the blood clotting system and the ability of blood vessels to go into spasm to decrease blood flow to an injured area.

Patients who take anti-clotting medication such as warfarin (Coumadin), clopidogrel (Plavix), heparin, or aspirin are more prone to bleeding than people who do not take these medications. These individuals may experience significant bleeding even with relatively minor injury or illness, and the risk of bleeding needs to be balanced against the benefits of taking the medication.

Some people have genetic or inborn errors of the blood clotting system. Minor injuries may cause major bleeding in these cases. Hemophilia and von Willebrand disease are two examples.