Definition and Overview

Also called internal hemorrhage, internal bleeding means blood loss inside the body. Experts and laypersons often define it as bleeding that cannot be seen immediately by the naked eye.

A person bleeds for many reasons. For example, women bleed naturally when they have menstruation. When the skin breaks or there are lacerations, bleeding can also occur. However, the body has its own mechanism to heal itself by creating platelets. Platelets help in the coagulation or the clotting of the blood, which then stops the bleeding. In certain cases, such as in menstruation, it just ends.

However, there are cases wherein bleeding becomes more difficult to control. When this occurs, a variety of dangerous complications can occur in the body. These include decreased blood pressure, blocked airways, extreme pain, and organ failure. When it is left untreated, it can result in the death of the patient.

Internal bleeding requires urgent care, so understanding its causes and symptoms are important to increase the patient’s chances of survival.

Causes of Condition

Internal bleeding can be caused by the following:

  • Blunt force trauma – This refers to a non-penetrating injury, which means the object did not break the skin. An example is when the body is hit by a ball. The ball does not cause any laceration or wound, but the impact and force of an accelerating ball can cause serious damage to the affected organs, which may include the liver and the spleen. The blood vessels of these organs can break, causing profuse internal bleeding.

  • Bleeding disorderBleeding disorders are diseases that develop because of the body’s inability to clot blood properly, a natural process that could prevent massive bleeding. Some of these disorders, like hemophilia, are hereditary while others are acquired. Those that are acquired may develop due to an existing illness like a severe liver disease and long-term use of antibiotics and medications like anticoagulants or blood thinners.

These anticoagulants or blood thinners are normally prescribed to prevent the formation of blood clots. Although these clots are important to stop the bleeding, they can also be life-threatening when they form even when there is no bleeding in the first place. Clots are expected to “go away” as they are absorbed by the body after, but sometimes they can remain and accumulate until they block the blood vessels, affecting the delivery of blood to the body and the performance of the heart.

In the course of using anticoagulants, the blood can become “thin” and may not be able to form clots properly.

  • Fractures – Fractures occur when bones are broken usually due to trauma (injury). The vertebrae contain the bone marrow, which is responsible for producing blood cells. If the bone breaks, the marrow, which contain a huge supply of blood, can also get damaged and leak an excessive amount of blood.

  • Deceleration injury – This is a type of trauma after acceleration and upon impact on another object. An example is a person riding a car that suddenly gets hit by another incoming vehicle. This injury often affects the brain, which is encased in the skull. As the vehicle collides with the vehicle, the brain moves around the skull, causing certain blood vessels to rupture, leading to intracranial hemorrhage.

  • Pregnancy – Bleeding happens in different ways during pregnancy. A number of women can suffer miscarriage while others may have vaginal bleeding due to a medical condition known as placenta previa. This happens when the placenta latches itself to the uterus and places itself near the cervix.

  • Underlying condition – Certain conditions such as peptic ulcer can break a tissue, muscle, or blood vessel leading to internal bleeding.

Key Symptoms

  • Low red blood cell count
  • Anemia
  • Dizziness
  • Fainting spell
  • Nausea
  • Lightheadedness
  • Abdominal pain
  • Headache
  • Swelling of the affected organ
  • Vomiting


Not all types of internal bleeding cause pain and there are times when they are manageable. However, some cases can be severe and cause organ failure.

Also, symptoms of internal bleeding may not be immediately noticeable. For example, in the case of blunt force trauma, it may take a few hours before the patient notices something different in his body.

Who to See and Types of Treatments Available

In cases wherein internal bleeding warrants immediate care, such as in the case of blunt force trauma or a vehicular accident, emergency physician will handle the situation. Otherwise, a surgeon is called to stop the bleeding and repair the site.

Internal bleeding can be diagnosed in many ways. A simple method is determining if there’s lower-than-normal red blood cell count, which can be obtained through a blood test. If the number of red blood cells is low, this indicates possible anemia and internal bleeding. It may also be determined through monitoring vitals such as blood pressure and heart rate.

To assess the overall condition of the suspected bleeding site, imaging tests like ultrasound, CT scan, and MRI scan may be performed.

Treatments may include the following:

  • Monitoring and observation – This may be carried out when the bleeding is only mild. There is a good chance that the body will create a clot soon and stop the bleeding by itself.

  • Blood transfusion – If the blood loss is quite severe, a blood transfusion may be necessary to increase red blood cell count. Some bleeding disorders may require regular transfusion.

  • Surgery – Surgery is conducted to stop the bleeding at the source such as that the surgeon may seal the openings like a broken blood vessel. A craniotomy is also another example. It refers to opening the skull to allow the buildup of blood in the brain to drain.

  • Change of medications – Anticoagulants may be stopped for a while or the prescription details like dosage and number of intake changed.

When it comes to internal bleeding, there are two immediate goals: (1) find the source and (2) stop the bleeding. This is then typically followed by repairing the affected organ. If the damage is irreparable, the doctor may recommend an organ transplant.

References:

  • Cameron, J. Current Surgical Therapy, 10th edition, Churchill Livingstone, 2011.
  • Diercks, D. Annals of Emergency Medicine, 2011.
  • Browner, B. Skeletal Trauma, 4th edition, W.B. Saunders, 2008.
  • American Heart Association.
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