Signs and Symptoms of Internal Bleeding (Internal Hemorrhage)

Have you ever heard someone say they had "internal bleeding" and wondered what that means? Maybe you've heard it on a TV show. It can seem more like a vague concept rather than a concrete diagnosis. But this also means it can be easy to worry about it when you experience a new symptom or notice some unusual bleeding - like in your urine or stool.

But before you start to worry that you're bleeding in places you can't see, let's review what internal bleeding really means. We'll go over why it happens and the signs and symptoms to look for if you're potentially at risk for it.

What is internal bleeding?

Internal bleeding, or internal hemorrhage, is any bleeding that occurs in an internal organ. Most organs are full of blood vessels that supply them with oxygen and other nutrients. And just like when you get a cut or bruise on your skin, those little blood vessels can break open and bleed.

Internal bleeding occurs when a blood vessel - or many small blood vessels - leads to a significant amount of bleeding. And this can happen in just about any organ.

Some internal bleeding is relatively common, like bleeding in the intestinal tract. Other types are much less common, like a ruptured spleen after a car accident. And internal bleeding can also range from minor to life-threatening bleeding.

But it's rare to just start bleeding out of nowhere. Typically, there's an obvious cause of the internal bleed.

What causes internal bleeding?

Trauma is the most common reason for internal bleeding. Any major trauma to the body - from a car accident to a bad fall - applies force to internal blood vessels, which can cause them to tear and bleed. This can happen in any part of the body - the chest, abdomen, head, and so on.

But even though trauma is the most common cause, there are many more reasons why someone can have internal bleeding. Some examples include:

• Bleeding after a surgery or procedure

• Gastrointestinal (GI) bleeding

• Ectopic pregnancy, which can rupture and bleed

• Aortic aneurysms and dissections

• Stroke or bleeding into the brain (intracranial hemorrhage)

• Endometriosis

• Broken bones and bleeding into joints

There are also some factors that increase someone's risk of bleeding. These include:

• Blood thinners, like clopidogrel (Plavix), aspirin, and coumadin (Warfarin)

• Inherited bleeding disorders, like hemophilia

• Excessive alcohol consumption

• Some nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can lead to bleeding stomach ulcers.

What are the signs of internal bleeding?

How do you know if you have internal bleeding? Most of the time, internal bleeding is associated with pain. The exception is GI bleeding, but this will still cause other obvious symptoms.

The signs of internal bleeding will vary depending on what kind of bleeding it is.

Bleeding in the brain can cause:

• Severe headache

• Confusion or lethargy

• Repeated vomiting

• Vision or speech changes

• Loss of strength or coordination in the limbs

Bleeding in the chest can cause:

• Chest pain

• Shortness of breath

• Coughing up blood

Bleeding in the abdomen - excluding GI bleeding - can cause:

• Pain in the stomach, abdomen, pelvis, or flank

• Abnormal bruising, especially around the belly button or sides of the abdomen

• Bloody urine

• Severe vomiting

• Inability to pass gas or stool

In addition to these location-specific signs, any significant blood loss can lead to these symptoms:

• A fast heart rate, usually greater than 100 beats per minute

• Dizziness upon standing

• Low blood pressure

• Fast breathing

• Severe weakness or fatigue

• Abnormally pale skin

• Feeling cold, even in a warm environment

• Anxiety, confusion, or sleepiness

Gastrointestinal bleeding

GI bleeding is a little bit different from other types of internal bleeding. It has its own distinct causes and symptoms.

Causes of GI bleeding

Unlike other types of internal bleeding, GI bleeding is rarely caused by any sort of trauma. The most common causes of GI bleeding include:

• Ulcers:Stomach ulcers and irritation of the stomach lining can be due to medications like NSAIDs or infections like the one caused by H. pylori.

• Alcohol: Heavy alcohol use can cause bleeding from blood vessels in the esophagus or stomach.

• Diverticula: These are small outpouchings (bulges) in the intestinal wall that become more common as people age.

• Inflammatory bowel disease: Conditions like Crohn's disease and ulcerative colitis can lead to bleeding, especially during a flare.

• Infection:Gastroenteritis and colitis can sometimes lead to bleeding, especially when they're caused by bacteria like C. diff or E. coli.

• Hemorrhoids: These swollen blood vessels in the anus can get irritated due to constipation or pressure from the pelvis.

• Anal fissures: This is a tear in the anus related to stretching of the skin due to constipation or firm stool.

• Ischemic colitis: This is a more rare condition that can happen when the blood flow to the intestine becomes blocked. This is similar to what happens in a heart attack, just in the intestine instead.

• Cancer: Cancer in the colon or rectum can sometimes cause bleeding.

Signs of GI bleeding

When it comes to symptoms, GI bleeding is typically painless - with a few exceptions listed below. More common symptoms of GI bleeding include:

• Blood in the toilet bowl or when you wipe

• Blood in stool, which can look bright red or black and tarry

• Nausea or loss of appetite

• Bloody vomit

• Any symptoms of blood loss listed above

Some GI bleeding can also cause pain. This is especially true if the GI bleeding is caused by:

• Ulcers (gnawing pain in the stomach area)

• Ischemic colitis (sharp pain throughout the abdomen)

• Hemorrhoids and fissures (pain in the rectal area)

Can you have internal bleeding and not know?

The symptoms of internal bleeding are usually obvious - whether it's pain or visible bleeding. If you can go about your daily activities without difficulty, you likely don't have serious internal bleeding.

GI bleeding is typically the only type of internal bleeding that's subtle, especially if the bleeding is slow and over a long period of time. If you're concerned about internal bleeding, talk with a healthcare professional. Sometimes a simple blood test can rule it out.

How long can you live with internal bleeding?

Internal bleeding can range from minor to very severe. If you have internal bleeding from a bad car crash, for example, it's possible that you might only survive for a few minutes without immediate medical treatment.

On the other hand, some people have internal bleeding that can last for years without causing any symptoms. This usually happens when people have something known as chronic, or occult, GI bleeding. This type of bleeding only causes you to lose a small amount of blood, slowly over time.

So the real answer to how long you can live with internal bleeding is that it depends on how bad the bleeding is.

When should you get medical care for internal bleeding?

If you have any of the symptoms above or reason to believe you may have internal bleeding, see a healthcare professional for evaluation - even if your symptoms feel mild.

And don't wait for a regular appointment if you're having symptoms that need immediate medical evaluation. Go to the nearest ER (emergency room) if you experience any signs of internal bleeding, especially:

• Intense, worsening pain

• Significant new or unexplained bruising on the torso

• Intense headache

• Lethargy, confusion, or extreme weakness

• Large amounts of blood in your stool

Frequently asked questions