What is bruising?
Bruising is a very general term for a condition in which blood leaks out of the blood vessels into the tissues of the skin, mucus membranes or other organs, including muscles and bones. Different types of bruises include contusions, hematomas and purpura.
Contusions
Contusions are common types of bruises that are caused by trauma, often blunt-force injury, that damages and breaks open the tiny blood vessels in the tissues of the skin, mucus membranes or other organs. Contusions are often accompanied by pain and swelling due to the body’s inflammatory response to injury. This is why a bruise on your shin caused by bumping a table can become swollen.
When a contusion develops in your skin, it turns red, then black and blue or purple, and finally a greenish-yellow shade as the blood is broken down and absorbed by the body. Bone contusions and deep muscle contusions can be very painful and take longer to heal than contusions that only affect the skin tissues.
The most serious type of contusions are contusions of important organs, such as the brain, kidneys, spleen, liver, lungs and heart. These contusions can be life threatening and are generally caused by severe trauma, such as a fall from a significant height, being hit by a car, serious crush injury, or motor vehicle accident, especially without wearing a seat belt.
Hematomas
Hematomas are a type of bruising in which there is significant bleeding that results in a collection of blood that pools at the site of injury. Hematomas can be caused by the same forces that cause contusions but generally cause more pain, swelling and complications than contusions.
Hematomas can be also be caused by surgical procedures or spontaneous rupture of a blood vessel, such as a ruptured aneurysm. Hematomas can occur in any area or organ of the body, and when they occur in certain organs, such as the brain or spleen, they can be life threatening.
Common hematomas include:
Epidural, subdural and intercerebral hematomas are collections of blood in the brain and/or under the skull, which can cause a critical increase in pressure in the skull and brain.
Nasal septum hematoma is a collection of blood that pools in the septum that divides the nose.
Subcutaneous hematoma is a collection of blood that pools just beneath the skin.
Subungal hematoma is a collection of blood that pools under a fingernail or toenail.
A shearing injury can also cause a hematoma in major organs. For example, shaking a baby can cause dangerous shearing forces inside the brain, a brain hematoma, irreversible brain injury, and death.
Purpura
Purpura is caused by spontaneous leaking of blood from tiny blood vessels (capillaries). It is a type of bruising that causes purple or red flat spots or patches on the skin and mucus membranes.
Purpura that results in tiny spots on the skin is called petechiae. A large area of purpura is called ecchymosis, although any type of bruising of the skin is often referred to as ecchymosis.
Purpura is not caused by trauma, as are contusions, but by a variety of medical diseases, disorders and conditions including:
Autoimmune diseases, such as lupus and rheumatoid arthritis
Certain infectious diseases, such as meningitis, mononucleosis and measles
Certain medications, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, antihistamines, and blood thinners
Insect bites
Leukemia
Thrombocytopenia (low platelet count that causes problems with clotting)
Vasculitis (inflammation of blood vessels)
If you experience easy or frequent bruising, especially if it is associated with nosebleeds or bleeding gums, seek prompt medical care. If you, or someone you know, develops petechiae, which are small, flat, purple-colored spots that can indicate meningitis or other serious conditions, seek immediate medical care (call 911).
What other symptoms might occur with bruising?
Bruising may be accompanied by other symptoms that vary depending on the underlying disease, disorder or condition. Skin bruises are often associated with local pain, swelling and skin discoloration. Easy bruising or unexplained bruising, which may be due to an underlying bleeding or blood disorder, may be accompanied by other bleeding symptoms.
Symptoms that may occur along with bruising
Bruising may occur with other symptoms including:
Bleeding gums
Flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches and pains)
Heavy menstrual flow
Local swelling or inflammation
Nosebleeds
Painful or tender area
Poor wound healing
Serious symptoms that might indicate a life-threatening condition
In some cases, bruising may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms:
Change in level of consciousness or alertness, such as passing out or unresponsiveness
Deformity or loss of function of the bruised area
Dizziness or light-headedness
Extreme pain, swelling or feeling of pressure in the bruised area
High fever (higher than 101 degrees Fahrenheit)
Nausea or vomiting
Petechiae (tiny pinpoint red or purple dots from bleeding under the skin)
Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking
Vomiting blood, bloody stools or rectal bleeding
Yellow eyes and skin (jaundice)
What causes bruising?
Skin bruising is usually caused by a minor contusion or injury. You may find that you bruise more easily on your legs, because your legs are generally more prone to injury and the effect of gravity on blood flow. You may bruise easily from minor bumps or scrapes. This may simply be a familial, or inherited tendency to bruise easily and it is not necessarily a cause for concern. Easy bruising is also referred to as purpura simplex. However, frequent and unexplained bruising can also be a sign of something more serious, such as a blood clotting disorder or a blood disease, so contact your health care provider to discuss your symptoms.
In some cases, bruising is a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting.
Bruising due to injury
Bruising is often caused by everyday injuries or more serious trauma including:
Blunt force, such as a blow to the face
Child or domestic abuse
Falling
Motor vehicle collision
Bruising due to age, gender and lifestyle factors
Easy or unexplained bruising can be caused by age, gender and lifestyle factors such as:
Aging skin
Alcohol abuse (decreases blood clotting)
Female gender (women bruise more easily than men)
Bruising due to serious underlying diseases
A variety of diseases, disorders and conditions can cause bruising symptoms, including easy or unexplained bruising and purpura. Purpura is caused by spontaneous leaking of blood from tiny blood vessels (capillaries), resulting in purple or red flat spots or patches on the skin and mucus membranes. Some underlying causes of unexplained bruising or purpura include:
Aplastic anemia
Autoimmune diseases, such as lupus and rheumatoid arthritis
Certain infectious diseases, such as meningitis, mononucleosis and measles
Cushing’s disease
Hemophilia (inherited bleeding disorder)
Insect bites
Organ failure
Thrombocytopenic purpura diseases (potentially life-threatening platelet disorders that cause problems with blood clotting)
Vasculitis (inflammation of blood vessels)
Von Willebrand's disease (inherited bleeding disorder)
Medications that can cause bruising
Always tell your doctor about any medications or treatments you are using including prescription drugs, over-the-counter medications, supplements, and herbal or alternative treatments. The following medications may be a possible cause of easy bruising or purpura:
Anticoagulants (blood thinners such as warfarin and heparin)
Antidepressants including serotonin reuptake inhibitors and tricyclics
Aspirin
Fish oil
Ginkgo biloba
Interferon
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
Penicillin
Plavix (antiplatelet medication)
Radiation or chemotherapy
Complications associated with bruising can be progressive and vary depending on the underlying cause. Because easy or unexplained bruising can be due to serious diseases, failure to seek treatment can result in complications and permanent damage. It is important to contact your health care provider when you experience any kind of persistent or recurrent bruising or bleeding symptoms, such as lacerations or cuts that take a long time to stop bleeding. Once the underlying cause is diagnosed, following the treatment plan outlined by your doctor can lower your risk of potential complications including:
Coma due to brain contusion or hematoma
Compartment syndrome (complication of severe muscle bruise)
Hematoma
Hypovolemic shock and coma due to contusions or hematomas of organs such as the liver or spleen
Risk of fracture, especially in the elderly
