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Hemorrhage - Bleeding


Overview, Causes, & Risk Factors

Bleeding is any loss of blood from the body. Bleeding can occur either internally or externally. It can occur through a natural opening such as the vagina. Most bleeding occurs through a break in the skin.

What are the causes and risks of the condition?

Bleeding is caused by injury to blood vessels, the structures that hold the blood. The injury can be minimal or life threatening. The most common causes of injuries to blood vessels are cuts and puncture wounds. Automobile accidents, gunshot wounds, household tools, machinery, and construction equipment often cause injuries. There are a significant number of visits to emergency rooms for bleeding injuries.


Symptoms & Signs

What are the signs and symptoms of the condition?

Symptoms of a large amount of blood loss are:

  • bluish lips and fingernails
  • bruising
  • clammy skin
  • confusion
  • decreased alertness
  • low blood pressure
  • paleness
  • rapid heart rate
  • shock
  • weakness
  • Examples of external bleeding through a natural opening include:

  • blood in the stool, which can appear to be either black, bright red, or maroon
  • blood in the urine
  • blood in the vomit, which can be red, brown, or black, like coffee grounds
  • vaginal bleeding
  • Internal bleeding can be minimal or serious. It can cause bruising or a hematoma, which is an area of swelling filled with blood. Internal swelling or bruising cannot be seen.

    Signs of internal bleeding may include :

  • abdominal pain, caused by irritation to the coverings of the abdominal structures
  • coughing up blood
  • fainting
  • shock
  • swelling of the abdomen

  • Diagnosis & Tests

    How is the condition diagnosed?

    Diagnosis of bleeding begins with a history and physical exam. Special X-ray tests, such as CAT scans and MRIs, can be used to confirm internal bleeding.


    Prevention & Expectations

    What can be done to prevent the condition?

    Common sense is the most important way to prevent most bleeding. Knives should be kept away from children. Dangerous areas should be avoided. Guards should be kept on saws. People should follow proper procedure and safety instructions when using electrical, mechanical, or construction equipment. It's also important to follow sports safety guidelines for children, adolescents, and adults.


    Treatment & Monitoring

    What are the treatments for the condition?

    First aid is the most common treatment given when a cut or injury occurs at home or in the workplace. First aid is appropriate for external bleeding. If bleeding is severe or if shock or internal bleeding is suspected, immediate emergency medical help should be obtained.

    People are advised to contact the emergency medical system in these cases.

  • The bleeding cannot be controlled.
  • The bleeding is associated with a serious injury.
  • Internal bleeding is suspected.
  • The wound needs sutures or there is a large amount of imbedded foreign materials that cannot be removed easily.
  • The following sequence of events should be followed when giving first aid to someone with bleeding.

  • The person should be calmed and reassured.
  • The person should be laid down on his or her back. This will reduce the chances of the person fainting or falling.
  • The person giving assistance should wear latex gloves to prevent exposure to blood.
  • Any obvious loose debris and dirt in a wound should be removed. It is important not to remove any objects that are stuck inside the person, such as a knife.
  • External bleeding should be controlled using direct pressure. A clean cloth, sterile bandage, or, if nothing else is available, a gloved hand should be used to apply the pressure. Pressure should be applied until the bleeding stops.
  • If it's near the surface, the wound should be washed with soap and warm water and then dried.
  • After bleeding has stopped, even if there is still some oozing, a clean dressing should be firmly applied over the wound. The dressing should be large enough to fully cover the wound and extend beyond the wound by at least one-half inch. The wound should not be dressed so tightly that circulation is reduced.
  • An additional dressing can be placed directly over the first one if the bleeding continues and seeps through the first dressing.
  • Care from a healthcare provider is required if bleeding does not stop after 15 minutes of direct pressure. Pressure can also be applied to the closest artery while waiting for medical care.
  • Immediate medical attention should be sought if the bleeding is severe. The injured part should be kept still or immobilized.
  • If a person has severe bleeding, treatment in a hospital setting may include different treatments based on the location and reason for the bleeding. Sutures, blood transfusions, and surgery to control bleeding may be required.

    What are the side effects of the treatments?

    With any injury, bleeding can continue. Infection can occur with any injury to an organ or the skin. Applying a tourniquet to control bleeding can cause loss of an entire limb and is not recommended.

    Blood transfusions carry a risk of infection and allergic reactions. Surgery carries a risk of further bleeding, infection, and allergic reaction to anesthesia.

    What happens after treatment for the condition?

    If sutures are required, removal may be necessary after healing. Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:James Broomfield, MD
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:09/19/01
    Reviewer:Adam Brochert, MD
    Date Reviewed:09/19/01


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