Internal Bleeding: Signs, Symptoms, Causes & Treatment

Sometimes bleeding happens inside the body. This can be dangerous because you might not notice anything is wrong at first. If this happens it is an emergency and you need help right away. Unlike a cut or scrape there is no blood on the outside. The bleeding can start after an accident, a health problem or even for reasons you do not expect. It can happen in any part of the body (organs or tissues). Sometimes the signs are small (but other times it can be very serious). Knowing what to look for and getting help quickly can make a big difference.

Signs and Symptoms of Internal Bleeding

Recognising the signs and symptoms of internal bleeding is vital for prompt diagnosis and treatment. Some manifestations may be subtle or develop gradually, while others can be more pronounced. Specific indicators may vary depending on the location and extent of the bleed. They are:

• Abdominal pain: Internal bleeding in the abdomen can cause severe pain, often described as a dull ache or cramping sensation. You may have tenderness or rigidity in the affected area. If you get internal bleeding in the gastrointestinal system you may experience nausea, vomiting, or bloody vomit.
• Generalised weakness and fatigue: Internal blood loss can lead to decreased oxygen-carrying capacity and blood pressure, resulting in weakness, fatigue, and lightheadedness.
• Bruising and swelling: Unexplained bruising or swelling on the body's surface may indicate internal bleeding.
• Changes in mental state: Internal bleeding in the brain can cause cognitive changes (confusion, dizziness, or loss of consciousness). You should always pay attention to these symptoms and seek immediate medical attention.
• Difficulty breathing: If internal bleeding involves the chest cavity or lungs you may get dyspnoea (or rapid breathing).
• Increased heart rate: Rapid heart rate or tachycardia will be there to compensate for decreased blood volume caused by bleeding.
• Blood in stool or urine: Internal bleeding in the digestive or urinary tract may manifest as blood in the stool or urine.
• Cold, sweaty skin: Your skin may become pale, cold, and clammy due to poor circulation if blood loss is huge.

Causes of Internal Bleeding

Several factors can cause internal bleeding, each requiring specific treatment approaches. Some common causes include:

• Trauma: Accidents, falls, physical injuries or blunt force trauma such as from a car accident or sports injury are some of the common internal bleeding causes
• Gastrointestinal conditions: Certain gastrointestinal conditions, such as peptic ulcers, diverticulosis, or inflammatory bowel disease, can cause internal bleeding in the digestive tract
• Medication and medical procedures: Certain medications, like blood thinners or invasive medical procedures, such as surgeries or biopsies, carry a potential risk of internal bleeding
• Organ rupture: The rupture of organs, such as the spleen or liver (due to trauma or underlying medical conditions) can result in significant internal bleeding 
• Liver Disorder: Liver diseases like cirrhosis can cause increased pressure in the veins (portal hypertension), leading to swollen veins that may rupture and cause internal bleeding
• Bleeding disorder: Conditions such as haemophilia, thrombocytopenia, or Von Willebrand disease can impair the blood's ability to clot properly, increasing the risk of spontaneous internal bleeding
• Vascular conditions: Certain blood vessel conditions, such as aneurysms or aortic dissection, can lead to internal bleeding within the wall of the blood vessels or aorta
• Cancer: Certain cancers, such as colorectal cancer, stomach cancer, or leukaemia, can invade blood vessels or weaken tissues, resulting in internal bleeding.

Diagnosis of Internal Bleeding

Doctors employ various diagnostic tools and techniques to identify and locate internal bleeding, including:

• Medical history and physical examination: Doctors will inquire about the patient's symptoms, medical history, any recent injuries or trauma and perform an indepth physical examination to assess vital signs, check for internal bleeding signs and evaluate the affected area
• Imaging tests: Doctors may conduct several imaging tests, such as X-rays, computed tomography (CT) scans, ultrasound, magnetic resonance imaging (MRI), or angiography, to visualise internal structures and detect abnormalities or signs of internal bleeding
• Laboratory tests: Blood examinations, including complete blood count (CBC) and coagulation studies, help assess blood cell counts, clotting factors, and overall blood health
• Liver function tests: These tests may evaluate liver function, as liver disease can increase the risk of bleeding
• Kidney function tests: Doctors may perform these tests if there's suspicion of bleeding related to kidney injury or disease. 
• Endoscopy or Colonoscopy: If gastrointestinal bleeding is suspected, doctors may perform endoscopic procedures such as upper endoscopy or colonoscopy to visualise the digestive tract and identify the bleeding source.

Treatment

The treatment approach for internal bleeding depends on the location, severity, and underlying cause. Treatment options are:

• Fluid replacement: Intravenous (IV) fluids restore blood volume and stabilise the patient's condition, compensate for blood loss and maintain vital organ function
• Blood transfusion: In cases of significant blood loss, doctors may suggest a blood transfusion to replace the lost red blood cells and improve oxygen carrying capacity
• Surgical intervention: This involves procedures like laparotomy (abdominal surgery), embolisation (blocking blood vessels), or endoscopy (inserting a flexible tube with a camera into the body)
• Medication: Doctors may prescribe medications to manage underlying conditions or control bleeding such as proton pump inhibitors or antibiotics can help treat gastrointestinal bleeding caused by ulcers or infections.

Complications

Internal bleeding can lead to various complications (some of which can be life threatening if not treated urgently). They are:

• Hypovolemic shock (where the body cannot maintain adequate blood pressure and organ perfusion) which may cause organ failure
• Internal bleeding of the brain, heart, lungs or other vital organs 
• Chronic or recurrent internal bleeding can result in anaemia causing fatigue, weakness and shortness of breath.

When to See a Doctor

Go for immediate medical attention if signs of internal bleeding are suspected. They are:

• Intense or persistent pain especially in the abdomen or head
• Sudden onset of weakness, dizziness or fatigue.
• Confusion or loss of (or decreased) consciousness.
• Blood in bodily fluids, such as stool, urine or vomit.

Conclusion

Internal bleeding can be dangerous and it is not something to take lightly. Sometimes the signs are easy to miss. If you notice anything unusual (or just feel like something is not right) do not wait. Get help right away. Acting quickly can really make all the difference.

FAQs

1. Is internal bleeding safe?

No internal bleeding is not safe as it can lead to severe health complications and even be life-threatening (if left untreated).

2. Does internal bleeding heal itself?

In some cases minor internal bleeding may resolve on its own. However significant or recurrent internal bleeding requires appropriate treatment to prevent complications.