Signs You May Have Internal Bleeding Explained

Unlike a visible wound on your skin, internal bleeding that occurs inside the body is easily overlooked, reports Medical News Today. Blood loss from damaged blood vessels (hemorrhaging) could cause a wide variety of symptoms, since blood permeates the entire body. 

Internal bleeding is most often caused by traumatic injuries such as falls or auto accidents. At first, an injured person may not have any symptoms from internal hemorrhaging but may experience pain, notes the Merck Manual. In addition to the abdomen, chest, and intestines, bleeding can also occur near fractured bones, e.g., pelvic bones. Ultimately, signs of bleeding such as blood in the stool will be spotted. If a substantial amount of blood is lost, blood pressure may fall and cause the person to become light-headed or faint, or even experience life-threatening shock and slip into unconsciousness. In this emergency scenario, the person should be laid down with legs elevated until medical help arrives. 

Per Healthline, other general causes of internal bleeding include GI conditions (e.g., peptic ulcer, colitis), genetic disorders such as hemophilia (inability of blood to clot), hypertension, and some medications such as blood thinners and aspirin. A ruptured aneurysm (bulge in blood vessel due to weakened blood vessel wall), ectopic pregnancy (outside the uterus), and surgery (persistent bleeding) are more urgent causes. Other locations where internal bleeding can occur include the joints, muscles, brain, eyes, and throat (via the National Hemophilia Foundation).

A brain bleed typically occurs suddenly and causes brain damage that can be fatal, notes the Cleveland Clinic. Hemorrhaging in the brain due to burst blood vessels disrupts the flow of oxygen-rich blood. Lack of oxygen causes brain cells to die, potentially leading to physical and cognitive impairment. Brain bleeds occur either between the skull and brain tissue or inside the brain tissue itself. In the former, the bleeding occurs someplace between three membranes that separate the skull from brain tissue: the dura mater (outermost), arachnoid, and pia mater (innermost). Three types of bleeding occur among these three membranes. In order of proximity to the skull, an epidural bleed occurs closest to the skull, followed by subdural hemorrhage. Subarachnoid hemorrhage occurs closest to the brain tissue. Within the brain matter, two types of bleeds can develop: intracerebral hemorrhage and intraventricular hemorrhage.

While brain hemorrhaging is more common in older adults, it can affect people of all ages, and is second only to blood clots as a leading cause of stroke. Some causes of brain bleeds include head trauma, high blood pressure, brain aneurysms, bleeding disorders, and treatment with blood thinners.

Some people with brain hemorrhaging may experience a severe, sudden headache or vision or hearing changes, per Healthline. Others may have difficulty speaking, writing, swallowing, chewing, or staying alert. Additional signs include loss of balance or coordination, tingling in the hands and feet, numbness and weakness on one side of the body, and loss of consciousness. 

As in cases of head and chest bleeding, abdominal bleeding can result from blunt trauma, most often damaging the spleen and liver (via Science Direct). However, according to the Mayo Clinic, peptic ulcers are the leading cause of bleeding in the upper portion of the GI tract, which includes the esophagus, stomach, and the first part of the small intestine (the duodenum). 

Peptic ulcers occur when stomach acid wears away the lining of the stomach or duodenum, primarily as a result of bacterial infection or use of anti-inflammatory medications. Excessive upper GI bleeding may also emanate from tears in the lining of the esophagus (referred to as Mallory-Weiss tears) often caused by excessive alcohol consumption. Bleeding in the esophagus can occur as a result of abnormally enlarged veins or inflammation related to severe liver disease and GERD (gastroesophageal reflux disease), respectively, as well. 

Per GoodRx Health, people with abdominal bleeding may notice blood in their urine, or may be unable to pass gas or have a bowel movement. They may also experience pain in the stomach, abdomen, pelvis, or flank. Another sign of bleeding is abdominal bruising, particularly near the navel or sides of the abdomen. 

Per WebMD, bleeding in a joint often occurs after an injury. Synovial joints link two bones that move against each other and include the hips, knees, shoulders, elbows, wrists, hands, ankles, and feet. Blood spilling from a ruptured artery mixes with synovial fluid and permeates the joint area. This mixture of blood and joint fluid can damage soft issue, bone, ligaments, or cartilage. Severe damage to the joint can cause swelling and pain, and even arthritis if the injury is recurrent. 

People that take anticoagulant medications (blood thinners) or have a deficiency of vitamin K are also at risk of joint bleeding. Advanced liver or kidney disease, blood vessel damage, nerve conditions, tumors, and bleeding disorders such as hemophilia contribute to joint bleeding as well. In fact, according to the National Hemophilia Foundation (NHF), internal bleeding in people with hemophilia occurs most often in a joint, and particularly in the joints of the ankles, elbows, and knees. In addition to swelling and pain, signs of joint bleeding include a tingling or bubbling feeling in the joint, limited ability to move a joint, and warmer skin near the joint. Moreover, a child with joint bleeding may be observed avoiding the use of the affected arm or leg. 

Per the National Hemophilia Foundation (NHF), bleeding inside the eye is a serious condition that, if prolonged, can lead to permanent loss of vision. It can result from eye trauma or occur without a known cause. 

Some types of eye bleeds develop deep within the eye and are not visible at the eye surface (via Medical News Today). For example, bleeding can occur in the transparent part of the eye known as the vitreous (vitreous hemorrhage). Bleeding can also occur beneath the retina (subretinal hemorrhage) or in the space between the retina and a layer of pigmented cells known as the retinal pigment epithelium (submacular hemorrhage). People with eye hemorrhage may experience blurry vision or see floaters in their field of vision. Other signs include a red tint to the vision and scotomas (blind spots or partial vision loss). 

Alternative causes of eye hemorrhage include conjunctivitis, eye tumors, contact lens use, laser eye treatment, and injury to the eye bones. In some people, an eye may bleed from the force of coughing, sneezing, vomiting, or exercising vigorously. The risk of eye bleeding is also increased by certain medications such as blood thinners (e.g., warfarin) and NSAIDs (e.g., aspirin). A number of medical conditions can cause eye bleeds as well, including hypertension, tumors, leukemia, and aneurysms. Eye hemorrhage can also occur in people with hemochromatosis (iron overload disease), thrombocytopenia (low blood platelets), and eye-related conditions such as posterior vitreous detachment (when the vitreous separates from the retina). 

Identifying the site of internal bleeding is often difficult, reports Medical News Today. A thorough medical history and physical exam are vital to help the doctor pinpoint the source of bleeding. 

Imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI) scans usually play an important role in the diagnostic workup. An electrocardiogram (ECG), X-rays, and blood and urine tests may be helpful as well. Some signs of hemorrhaging, such as the presence of red blood cells or bilirubin in the cerebrospinal fluid, can be detected with a lumbar puncture (per StatPearls). 

In some cases, a noninvasive diagnostic test called a FAST (focused assessment with sonography for trauma) scan is particularly useful in the assessment of abdominal bleeding. The FAST exam is highly reliable, and can be performed at the patient's bedside. Various types of endoscopies are also used to look for bleeding inside the body. These include bronchoscopy (lungs), cystoscopy (bladder), colonoscopy, and esophagogastroduodenoscopy or EGD (upper GI).