Internal bleeding, also known as hemorrhaging, is bleeding that occurs inside the body when a blood vessel is damaged.
Very minor hemorrhages, such as small, ruptured blood vessels near the surface of the skin, are common and usually only produce tiny red specks on the skin or minor bruising.
But large, uncontrolled hemorrhages are life-threatening and are one of the leading causes of death worldwide.
Hemorrhaging is not a condition in itself, meaning it always has an underlying cause. The most common reason for a hemorrhage is a traumatic injury.
One of the reasons internal bleeding is so dangerous is because the bleeding itself is not visible.
It is hard to ignore a bleeding cut or wound on the outside of the body. But it can be easy to overlook bleeding deep inside the body until it begins to cause life-threatening symptoms.
As blood is crucial to the functioning of nearly every organ and type of body tissue, blood loss causes a wide range of symptoms that can seem unrelated.
Symptoms of moderate to severe internal bleeding include:
- light-headedness or dizziness
- a headache, often severe
- diarrhea, often a dark, brown or black color
- general weakness
- unexplained exhaustion
- muscle and joint pain, aching, and weakness
- lower blood pressure than normal
- confusion, memory loss, or disorientation
- vision problems, often blurred, patchy, or double vision
- abdominal pain, often severe enough to cause nausea and vomiting
- chest pain
- shortness of breath or shallow breathing
- blood in the urine
- bruising, usually around the site of the hemorrhage
Very severe hemorrhaging can cause dangerous symptoms that set in within minutes, generally after a traumatic injury.
Signs of very severe hemorrhaging include:
- very low blood pressure
- rapid heart rate
- sweaty, wet skin that often feels cool to the touch
- little or no urine
- vomiting blood
- loss of consciousness
- leakage of blood from the eyes, ears, or nose
- organ failure
Anything that damages blood vessel walls can lead to hemorrhaging. For minor ruptures, the body can create a clot or plug made of proteins and red blood cells to seal off the broken tissue and stop bleeding.
Significant injuries, however, cannot be stopped by a clot, which means the blood vessel continues to pump blood into the surrounding space or organs.
Because many cases of internal bleeding occur as the result of a specific injury or trauma, the cause may be easy to identify.
But hemorrhaging can also be caused by factors that weaken blood vessel walls over time or interfere with the clotting process. These factors include certain medical conditions, medications, and lifestyle habits.
Potential causes and risk factors for minor to moderate internal bleeding include:
- minor injury
- chronic or long-term high blood pressure
- blood-thinning medications
- genetic clotting conditions
- diabetes or uncontrolled blood sugar levels
- long-term dehydration
- excessive or chronic alcohol use
- use of illegal drugs
- stimulant medications, such as diet pills
- anti-clotting medications
- stroke or heart attack
- liver, kidney, or spleen conditions
- deep vein thrombosis (DVT)
- gastrointestinal conditions
Gastrointestinal conditions that may cause internal bleeding include gastroenteritis, ulcerative colitis, Crohn’s disease, celiac disease, inflammatory bowel disease, and irritable bowel syndrome.
Potential causes of severe or sudden hemorrhaging include:
- traumatic injury from events such as car accidents, bullet wounds, impalement, falls, explosions, and crush injuries
- embolism (objects that become trapped in blood vessels and reduce blood flow)
- broken bones
- an aneurysm (bulges that form in blood vessels)
- ectopic pregnancy, where the fetus develops outside the uterus
Diagnosing a hemorrhage can be very difficult. In many cases, even locating the source of the bleeding can be challenging.
To diagnose internal bleeding, a doctor will typically begin with a thorough physical examination, ask questions about symptoms if possible, and review the individual’s medical history.
If a doctor suspects that an individual is hemorrhaging, they will place the person on the high priority list for diagnostic imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI) scans, to locate and evaluate the extent of the hemorrhage.
Blood and urine tests may also help diagnose and confirm hemorrhages.
Once a doctor has identified the source of the bleeding, they may use angiography to look inside individual blood vessels.
Depending on the severity or cause of the hemorrhage, a doctor may also order an electrocardiogram (ECG) or an X-ray to assess damage or blood flow to the heart.
Treating minor or mild hemorrhages typically involves rest and hydration. Typically, a clot will develop that temporarily limits bleeding while the blood vessel repairs itself. Over time, the surrounding bodily tissues will reabsorb the excess blood.
Treating moderate to severe internal bleeding involves the administration of intravenous vitamin K, fresh frozen plasma, blood, and platelets.
More recently, doctors have begun to administer very high doses of complexes and compounds that stimulate clotting.
Sometimes, doctors may give intravenous fluids rich in electrolytes to people with internal bleeding.
Once an individual is stabilized, or no longer at risk of death, treatment involves locating and stopping the source of the bleed.
Depending on the severity of the hemorrhage, surgery may be necessary to repair the blood vessel and remove excess blood.
Doctors may prescribe preventative medications after the bleeding has stopped.
Physical therapy and lifestyle changes, such as quitting smoking or drinking alcohol, may also be recommended to reduce the chances of further injury and bleeding.
Internal bleeding is considered a leading cause of trauma-associated mortality globally.
If untreated, severe or chronic hemorrhaging might lead to organ failure, seizures, coma, external bleeding, and eventually death. Even with treatment, severe internal bleeding is often fatal.
Early identification and treatment of internal bleeding can reduce the risk of complications and help a person make a full recovery.
Except for minor cases, such as those involving small blood vessels close to the surface of the skin, internal bleeding requires immediate medical attention.
Even a small hemorrhage can quickly become life-threatening. In severe cases, internal bleeding can cause death within 6 hours of hospital admission.
It is critical to go to a hospital or call emergency service as soon as internal bleeding is suspected.
A person should be sure to notify the 911 telephone operator or hospital reception that an individual is experiencing internal bleeding and needs urgent care.