Internal Bleeding: Diagnosis, Symptoms and Treatment

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Internal Bleeding: Diagnosis, Symptoms and Treatment

  • Category

    General

  • Published By

    GetWellGo Team

  • Updated on

    21-May-2025

Internal Bleeding Symptoms

Symptoms of internal bleeding depend on the severity and location of the bleed. Signs of internal bleeding:

  • Pain – severe, sudden, or sharp pain in a particular region (abdomen, chest, head, etc.).
  • Swelling or Distension – visible swelling, particularly of the abdomen or extremities.
  • Bruising – large or unexpected bruises, typically spreading.
  • Weakness or Fatigue – feeling abnormally weak or tired from blood loss.
  • Dizziness or Fainting – dizziness or loss of consciousness, showing low blood pressure.
  • Cold, Clammy Skin – indicative of shock.
  • Rapid Heartbeat or Breathing – body attempting to make up for blood loss.
  • Nausea or Vomiting – occasionally with blood.
  • Coughing or Vomiting Blood – bright red or coffee ground material.
  • Black or Bloody Stools – suggestive of bleeding in the gastrointestinal tract.
  • Changes in Vision or Confusion – can indicate brain bleeding.
  • Difficulty Breathing – if blood loss in lungs or chest.

Causes of Internal Bleeding

Internal bleeding may be due to an array of reasons ranging from trauma and medical conditions to some medications. The following are the usual causes:

Causes of Internal Bleeding:

Trauma or Injury

  • Vehicle accidents, falls, sports injuries, or any penetrating or blunt trauma may injured vessels internally.

Medical Conditions

  • Gastrointestinal ulcers: Stomach or intestine ulcers may eat away at blood vessels.
  • Aneurysms: Blood vessel weak spots that may burst.
  • Blood clotting disorders: Disorders such as hemophilia, or taking blood thinners (anticoagulants), elevate risk of bleeding.
  • Cancer: Tumors can invade blood vessels.
  • Liver disease: Alters clotting factors and leads to bleeding.
  • Diverticulosis: Abnormalities in the colon lining can cause bleeding.

Surgery or Medical Procedures

  • Internal bleeding occasionally occurs as a complication with or after surgeries or invasive procedures.

Medication Side Effects

  • Blood thinners (warfarin, aspirin, etc.) or non-steroidal anti-inflammatory drugs (NSAIDs) elevate risk of bleeding.

Infections

  • Severe infections that destroy blood vessels.

Spontaneous Bleeding

  • Bleeding may sometimes occur spontaneously, particularly in individuals with clotting disorders.

Internal Bleeding Diagnosis

Diagnosing internal bleeding usually requires a combination of imaging tests, clinical evaluation, and lab testing. Here is the overview of the common diagnostic procedures:

How to detect internal bleeding?

Medical History & Physical Exam

  • Doctor will inquire about symptoms, recent trauma, medications (particularly blood thinners), and medical conditions.
  • Physical examination to assess for evidence of swelling, bruising, tenderness, low blood pressure, rapid heart rate, or evidence of shock.

Blood Tests

  • Complete blood count (CBC): To look for low hemoglobin or hematocrit suggesting loss of blood.
  • Coagulation tests: To evaluate the ability of blood to clot.
  • Blood type and crossmatch: If a transfusion may be required.

Imaging Studies

  • Ultrasound (FAST scan): Rapid method to look for internal bleeding in abdomen or chest, particularly following trauma.
  • X-rays: To look for fractures or bleeding in chest or lungs.
  • CT Scan: Extremely detailed imaging to find the sites of bleeding in the brain, abdomen, chest, or pelvis.
  • MRI: Occasionally used to examine brain or soft tissue bleeding.

Endoscopy or Colonoscopy

  • To visually examine and diagnose gastrointestinal tract bleeding.

Diagnostic Laparoscopy or Surgery

  • In limited situations, minimally invasive surgery can be employed to trace and control bleeding.

Monitoring Vital Signs

  • Repeated observation of blood pressure, heart rate, and oxygen saturation to determine severity.

Internal Bleeding Treatment

Treatment of internal bleeding varies with the cause, site, and degree of bleeding. Here's a general rundown of how it is treated:

Internal Bleeding Treatment

Emergency Care

  • Immediately call emergency services if internal bleeding is suspected.
  • Stabilize the patient through airway, breathing, and circulation (ABC).

Control and Stop the Bleeding

  • Surgery: In many cases, it's necessary to find and repair injured blood vessels or organs.
  • Endoscopic treatments: In cases of gastrointestinal bleeding, physicians can use endoscopy to clip or cauterize bleeding sites.
  • Interventional radiology: Methods such as embolization (occluding bleeding vessels with coils and catheters) may be employed.

Blood Transfusions

  • To restore lost blood and enhance oxygen delivery.

Medications

  • Blood clotting agents: To prevent further bleeding.
  • Reversal agents: In the case of bleeding caused by blood thinners, medications that reverse their action will be administered.
  • Pain relief: To alleviate symptoms.

Monitoring and Supportive Care

  • Monitoring of vital signs, oxygenation, IV fluids to support blood pressure.
  • Intensive care for serious cases.

Treat Underlying Cause

  • Such as, antibiotics for infections, management of ulcers, or control of blood disorders.

Internal Bleeding in Stomach

Internal stomach bleeding normally means gastric bleeding, which is bleeding in the lining of the stomach or from the arteries and veins that supply it. It's gastrointestinal (GI) bleeding and can be mild or life-threatening.

Causes of Internal Bleeding in the Stomach

  • Gastric ulcers (peptic ulcers): Open sores in the stomach lining due to acid in the stomach, infection with H. pylori, or taking NSAIDs.
  • Gastritis: Inflammation of the stomach lining, commonly due to alcohol, infection, or medications.
  • Esophageal or gastric varices: Dilated veins secondary to liver disease that may rupture.
  • Tumors or cancer: May erode vessels.
  • Mallory-Weiss tears: Laceration of the lining near the stomach due to forceful vomiting.
  • Use of blood thinners or NSAIDs: Potentially increasing risk of bleeding.

Symptoms of Stomach/Internal GI Bleeding

  • Vomiting blood (bright red or coffee-ground appearance).
  • Black, tarry stools (melena).
  • Abdominal pain or discomfort.
  • Weakness, dizziness, or fainting caused by blood loss.
  • Blanching skin, fast heart rate.

Internal Bleeding in the Brain

Internal brain bleeding is referred to as a brain hemorrhage or intracranial hemorrhage. It's a severe medical condition in which blood breaks into or around the brain tissue, resulting in pressure and injury.

Types of Brain Internal Bleeding

  • Intracerebral hemorrhage: Internal bleeding directly within the brain tissue.
  • Subarachnoid hemorrhage: Bleeding into the space between the brain and the thin covering tissues.
  • Subdural hematoma: Bleeding between the brain and its outer covering (dura mater).
  • Epidural hematoma: Bleeding between the dura mater and skull.

Causes

  • Trauma or head injury
  • High blood pressure (hypertension)
  • Rupture of aneurysm
  • Abnormalities of the blood vessels (arteriovenous malformations)
  • Blood clotting disease or blood thinners
  • Brain tumors
  • Stroke (hemorrhagic)

Symptoms

  • Acute, severe headache
  • Weakness or numbness on one side of the body
  • Confusion, inability to speak or understand speech
  • Vision disturbances
  • Loss of balance or coordination
  • Seizures
  • Loss of consciousness or coma
  • Nausea and vomiting

Internal Bleeding Complications

Internal bleeding can cause severe complications, particularly when not treated early. Complications range from mild to severe depending on the location, volume of blood lost, and rate of treatment. The following are the most frequent and severe complications:

  • Hypovolemic Shock
  • Organ Failure
  • Anemia
  • Brain Damage
  • Death
  • Infection
  • Compartment Syndrome
  • Blood Clots

Internal Bleeding Management

Management of internal bleeding includes quick assessment, stabilizing the patient, determining the source of the bleeding, halting the bleeding, and preventing complications. The management varies by severity, location, and etiology.

Basic Emergency Management

Stabilization (ABC technique):

  • Airway: Make sure it's clear and secured.
  • Breathing: Administer oxygen if required.

Circulation:

  • Initiate IV fluids (crystalloids such as normal saline).
  • Initiate blood transfusion if there's excessive blood loss.
  • Monitor closely for vital signs.

Hospital Admission:

  • Usually to an intensive care unit (ICU) in severe cases.

Diagnosis and Monitoring

  • Imaging: CT, ultrasound (FAST), endoscopy, angiography based on suspected source.

Labs:

  • CBC (to check hemoglobin/hematocrit)
  • Coagulation profile (PT, aPTT, INR)
  • Type & crossmatch for blood transfusion
  • Renal and liver function tests

Definitive Treatment (Depending on Site & Cause)

A. Medication Management:

  • Discontinue anticoagulants (blood thinners) if safe.
  • Reverse anticoagulants (vitamin K, protamine sulfate, or specific antidotes such as idarucizumab for dabigatran).
  • Proton pump inhibitors (for GI bleeds)
  • Antibiotics, if infection or peritonitis is suspected.

Procedures:

  • Endoscopy or colonoscopy for GI bleeds.
  • Angiographic embolization for occlusion of bleeding vessels.
  • Surgical treatment if there is excessive or uncontrolled bleeding (e.g., laparotomy for intraperitoneal hemorrhage, craniotomy for intracranial hemorrhage).

Ongoing Monitoring

  • Vital signs, urine output, neurological status
  • Repeating labs to check for blood counts and clotting
  • Imaging follow-up as required

Supportive and Long-Term Care

  • Rehabilitation (most notably for brain bleeds or orthopedic trauma)
  • Iron supplementation for chronic blood loss
  • Treatment of underlying causes (ulcers, hypertension, aneurysms, liver disease)

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