Internal Bleeding

  • Medical Author:
    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.

  • Medical Editor: Melissa Conrad Stöppler, MD
    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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What are the signs and symptoms of internal bleeding?

The symptoms of internal bleeding depend upon where the bleeding is located, how much bleeding has occurred, and what structures and functions in the body are affected. Blood outside the circulatory system (the heart and blood vessels) is very irritating to tissues, causing inflammation and pain. Examples of some internal bleeding situations are listed below.

Intracranial bleeding from trauma or from a leaking aneurysm often causes pain, but may also result in symptoms of altered mental function. Subarachnoid bleeding often causes headache and a stiff neck (meningismus). Neurological examination can range from a near-normal exam to confusion to coma. Symptoms of stroke, including weakness, slurred speech, and loss of vision, may also be associated with intracranial bleeding. The signs and symptoms depend upon where and how much blood there is in the brain. If the bleeding continues, symptoms become progressive and easier to recognize. Bleeding may also occur within the spinal canal and affect spinal cord function.

Intra-abdominal bleeding may be hidden and present only with pain, but if there is enough blood loss, the patient may complain of weakness, lightheadedness, shortness of breath, and other symptoms of shock and decreased blood pressure. Once again, the symptoms depend upon where in the abdomen the bleeding occurs.

  • If there is bleeding in the stomach, the patient may vomit bright red blood, or if it has been in the stomach for a period of time, the vomit may look like coffee grounds. Blood in the stool may be due to bleeding anywhere in the gastrointestinal tract, from the esophagus and stomach to the colon, rectum and anus. Hemorrhoids are a common cause of blood in the toilet bowel. Black, tarry stools usually signal bleeding from the stomach or duodenum. Black stool may also be due to iron pills, bismuth (PeptoBismol) and some foods. If internal bleeding causes blood to spill into the peritoneum, there can be a significant amount of pain with any movement, and the abdomen can become tense and feel rigid to touch.
  • Sometimes intra-abdominal blood will track toward the skin and can be appreciated on physical examination. Cullen's sign is the term used to refer to the appearance of bruising surrounding the umbilicus. Grey-Turner sign is bruising in the flanks.

Blood seen in the urine may be due to internal bleeding at any site within the urinary tract, from the kidney to the bladder. Often bladder infections are associated with blood in the urine, but other causes, inclduing kidney and bladder cancer, need to be considered based upon the particular symptoms, patient's age, and medical history. Males who may have had prostate surgery may have blood in the urine. Men and women who have had radiation therapy may develop inflammation of the bladder wall that can cause a significant amount of bleeding. Some patients with kidney stones may experience blood in their urine.

Bleeding may occur deep within muscles after injury, and rarely, compartment syndrome may occur. Muscles are often sheathed in tight linings. Should enough bleeding and swelling cause the pressure within the muscle compartment to be greater than the patient's blood pressure, blood cannot be pumped to the muscle cells and beyond. Symptoms include intense pain, difficulty moving the joints below the injury, and loss of sensation. Most commonly this is seen in the shin and forearm injuries and may or may not be associated with a broken bone.

Bleeding may also occur into joints, causing significant pain and loss of range of motion. This most frequently is seen in patients who are on anti-coagulation medications. An injury may or may not be needed to cause the bleeding.

Medically Reviewed by a Doctor on 1/26/2016

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