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Bruising

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Related Terms
  • Bleeding disorders, broken blood vessels, bump, compartment syndrome, contusion, ecchymosis, injured blood vessels, myositis ossificans, pain, petechiae, skin discoloration, swelling.

Background
  • A bruise, medically referred to as a contusion, is caused when tiny blood vessels are damaged or broken as the result of a blow to the skin. The raised area of a bump or bruise results from blood leaking from injured blood vessels into the tissues, such as muscle, as well as from the body's response to the injury. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is called an ecchymosis. Petechiae, another type of bruise, refers to very small, one to three millimeter accumulations of blood beneath the skin.
  • Bruises change colors over time in a predictable pattern, so that it is possible to estimate when an injury occurred by the color of the bruise. Initially, a bruise will be reddish, the color of the blood under the skin. Individuals with darker skin tones may have trouble distinguishing a bruise. After one to two days, the red blood cells begin to break down, and the bruise will darken to a blue or purplish color. This fades to green at about day six. Around the eighth or ninth day, the skin over the bruised area will have a brown or yellowish appearance, and the skin will gradually change back to its normal color.
  • Bruising can occur due to trauma or injury, certain medications that thin the blood (including warfarin or Coumadin® and aspirin), physical abuse, bleeding disorders (such as hemophilia), and other medical conditions, including immune disorders (such as human immunodeficiency virus (HIV)), leukemia (cancer of the blood), drug and alcohol addiction, and aplastic anemia (lack of red blood cell production).
  • The injury required to produce a bruise varies with age. While it may take quite a bit of force to cause a bruise in a young child, even minor bumps and scrapes may cause extensive bruising or ecchymosis in an elderly person. Blood vessels become more fragile as individuals age and bruising may even occur without prior injury in the elderly.

Diagnosis
  • Bruising is usually a minor problem, which does not require a medical diagnosis. However, when extensive bruising, bruising with no apparent cause, or bruising in certain locations (such as around the ears or the navel) is present, a doctor will evaluate the individual's health using blood tests, such as blood clotting and platelet counts. If the area of the bruise becomes hard, an x-ray may be required.

Complications
  • Occasionally, the area of a bruise will become firm and may actually start increasing in size instead of going away. The bruise may also continue to be painful. There are two major causes for a bruise that gets worse. First, if a large collection of blood is formed under the skin or in the muscle, the body may wall the blood off causing what is called a hematoma. A hematoma is nothing more than a small pool of blood. Hematomas may need to be drained by a healthcare professional.
  • Getting prompt medical treatment and following a doctor's advice about rehabilitation can help an individual avoid serious medical complications that occasionally result from deep muscle contusions and bruises. These complications include compartment syndrome and myotosis ossificans.
  • Compartment syndrome: In certain cases, rapid bleeding may cause extremely painful swelling within the muscle group of the arm, leg, foot, or buttock. The build-up of pressure from fluids several hours after a contusion injury can disrupt blood flow and prevent nourishment from reaching the muscle group underneath the bruise. Compartment syndrome may require urgent surgery to drain the excess fluids.
  • Myositis ossificans: Myositis ossificans is a condition in which the bruised muscle grows bone instead of new muscle cells. Young athletes who try to rehabilitate a severe contusion too quickly sometimes develop this condition. Symptoms may include mild to severe pain that does not go away and swelling at the injury site. Abnormal bone formations can also reduce flexibility. Vigorous stretching exercises may make the condition worse. Rest, ice, compression, and elevation to reduce inflammation will usually help. Gentle stretching exercises may be used to improve flexibility. Surgery is rarely required.

Treatment
  • Once a bruise has formed, not much can be done to treat it. Most eventually disappear as the body reabsorbs the blood.
  • It is often recommended that ice packs be applied on and off during the first 24 hours of injury to reduce the bruising. After that, heat, especially moist heat, is recommended to increase the circulation and the healing of the injured tissues. Rest, elevation of the effected part, and compression with a bandage will also retard the accumulation of blood. Long periods of standing may cause the blood that collects in a bruise to seep through the tissues. Rarely, if a bruise is so large that the body cannot completely absorb it or if the site becomes infected, it may have to be surgically removed.
  • If the bruise is being caused by medication interactions or dietary supplement/medication interactions, the individual and their doctor will stop the substance causing the increase in bleeding. If there are any questions about whether or not a medication can contribute to bruising, asking a doctor or pharmacist is important. Stopping medications should only be done under the supervision of a doctor.
  • Minor bruises are easily treated, but it is recommended by healthcare professionals to contact a doctor if: a bruise doesn't go away after two weeks; bruising occurs often without bumping into things and bruises seem to develop for no known reasons; a bruise is getting more painful; the bruise is swelling; the individual cannot move a joint; or the bruise is near the eye.
  • Bruises accompanied by persistent pain or headache also may indicate a more serious underlying illness and require medical attention. It is recommended by healthcare professionals that individuals: do not attempt to drain the bruise with a needle; do not continue running, playing, or otherwise using the painful, bruised part of the body; and do not ignore the pain or swelling.
  • If the bruise is caused by domestic violence, appropriate counseling is needed. Doctors will help the individual find a social worker or other healthcare counselor to help with domestic violence issues. Battered women's shelters are available for those in need. The National Domestic Abuse Hotline can be reached at 1-800-799-SAFE (7233) or 1-800-787-3224. For children, the National Child Abuse Hotline can be reached at 1-800-4-A-CHILD.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Academy of Family Physicians. . Accessed May 17, 2009.
  2. Centers for Disease Control and Prevention. . Accessed May 17, 2009.
  3. Davey AL, Foxton SJ, Bala P, et al. Bruising: when it is spontaneous and not idiopathic thrombocytopenia purpura. J Paediatr Child Health. 2007;43(4):310-1.
  4. Khair K, Liesner R. Bruising and bleeding in infants and children--a practical approach. Br J Haematol. 2006;133(3):221-31.
  5. National Institute on Aging. . Accessed May 17, 2009.
  6. Natural Standard: The Authority on Integrative Medicine. . Copyright © 2009. Accessed May 17, 2009.
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  8. Punwar S, Hall-Craggs M, Haddad FS. Bone bruises: definition, classification and significance. Br J Hosp Med (Lond). 2007;68(3):148-51.
  9. Valente MJ, Abramson N. Easy bruisability. South Med J. 2006;99(4):366-70.

Causes and risk factors
  • Anyone can get a bruise. Some individuals, including women, are more prone to bruising than are others. Easy bruising in women is thought to be due to hormonal changes. As an individual gets older, several factors may contribute to increased bruising, including aging capillaries and thinning skin. Over time, the tissues supporting these vessels weaken, and capillary walls become more fragile and prone to rupture. During the aging process, the skin becomes thinner and loses some of the protective fatty layer that helps cushion blood vessels against injury. Excessive exposure to the sun can thin the skin much like aging, as does smoking and lack of hydration (water).
  • Medications: The amount of bruising may also be affected by medications that interfere with blood clotting. Thus, medications may cause more bleeding into the skin or tissues. Certain drugs, medications, substances, and toxins may cause bruising. It is recommended by healthcare professionals to always advise a doctor and/or pharmacist of any medications or treatments being used, including prescription, over-the-counter (OTC), and integrative therapies (including herbs and vitamins). Medications that may cause an increase in bleeding include: blood thinning medications, such as warfarin (Coumadin®), clopedigrel (Plavix®), and aspirin; birth control pills, such as estrogen and progesterone combinations; non-steroidal anti-inflammatory drugs, such as ibuprofen (Advil®), naproxen (Naprosyn®, Aleve®), celecoxib (Celebrex®), and indomethacin (Indocin®); some diuretics (drugs that increase fluid loss), such as furosemide (Lasix®); and corticosteroids or steroids, such as prednisone (Deltasone®).
  • Certain dietary supplements such as vitamin E, fish oil, ginkgo (Ginkgo biloba), ginger (Zingiber officinalis), and garlic (Allium sativum) also may increase the risk of bruising. These and many other supplements may have a blood-thinning effect. It is highly recommended by healthcare professionals to tell a pharmacist or doctor when taking dietary supplements along with prescription medications, such as those that may thin the blood.
  • Other causes: The following are some of the possible causes of bruising as a symptom: sports-related injuries; accidents; falls; physical abuse; bleeding disorders, such as hemophilia and Von Willebrand's disease; Ehlers-Danlos syndrome, which is a genetic defect in collagen and connective-tissue synthesis and structure; immune disorders, such as human immunodeficiency virus (HIV); leukemia (cancer of the blood); liver diseases, such as cirrhosis; drug and alcohol addiction; aplastic anemia (lack of red blood cell production); disseminated intravascular coagulation (DIC, or blood coagulation throughout the body); and scurvy (a condition caused by a lack of vitamin C).

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.