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Bruises, known as contusions or ecchymosis in the medical field, are characterized by skin discoloration, pain, and swelling.
They develop when the blood vessels that lie under your skin or deep in your tissues, organs, and bones become damaged and leak blood in the surrounding tissue.
Types of Bruises
- Subcutaneous: a bruise underneath the skin
- Intramuscular: a bruise within the muscle
- Periosteal: a bone bruise
What Does a Bruise Look Like?
A contusion first appears as a pink or red splotch on the skin, which gradually acquires a bluish-purple hue as the injury matures.
The discoloration tends to be more intense when the broken capillaries are close to the surface. As the bruise heals, it fades to a lighter shade of greenish yellow before disappearing completely.
Most bruises heal within 2 weeks, but some can last for months if the injury is severe.
Even the slightest of trauma can lead to a contusion, especially in people who have relatively thin skin, a deficiency of nutrients such as vitamin C and K, or other health conditions including obesity, anemia, leukemia, and bleeding disorders.
Even though a tendency to bruise easily does not always stem from a serious underlying health issue, it is best to seek medical evaluation if you suspect otherwise.
Small contusions that develop once in a while despite any physical trauma are rarely a cause of concern.
What Can Cause a Bruise?
Bruises can be an outcome of a direct injury inflicted on the body either by direct blows or by repeated hitting with a dull object.
The jerk may crush the underlying connective tissue and muscle fibers without causing any tear or cuts on the skin surface.
Bruises on the skin are usually incurred from minor trauma or injury, which includes:
- Tripping or falling
- Spraining your ankles
- Bumping your body, typically the foot, against a hard surface· Getting your skin scraped
- Dropping a heavy weight on your foot
- Getting your toe stubbed
- Walking, running, or jumping on coarse, concrete surfaces
- Some people develop a swollen contusion at the site of an injection shot.
When the needle penetrates the blood vessel, the blood may seep out of from the ruptured wall and pool in the surrounding tissue, which is referred to as a hematoma.
If you develop bruised splotches on your skin without a definite cause or physical injury or if you experience a sudden increase in the frequency of bruising, it can point towards any of the following health concerns:
- Unexplained and frequent bruising can be symptomatic of sepsis, which is a potentially fatal condition that develops when a bacterial infection spills into your bloodstream.
- Some people born with a bleeding disorder called hemophilia tend to bruise more easily as their blood does not clot as properly as it should.
Their blood runs low on a specific protein that plays a central role in the clotting process. This protein, referred to as clotting factor, helps the body to keep bleeding under control.
- Von Willebrand factor (VWF) is yet another blood protein that is required for the clotting process.
When your blood is deficient in VWF or if the protein is not functioning properly, your blood will not clot fast enough or well enough.
This kind of blood disorder is referred to as von Willebrand disease (VWD) and can make one prone to easy bruising even from the slightest trauma.
- People with thrombocytopenia, or an abnormally low blood platelet count, frequently experience mild to serious bleeding, which could be internal, could be under the skin, or could emanate from the skin surface.
Platelets are tiny colorless blood cells that clump together to coagulate the blood. If your blood lacks enough platelets, you will bleed easily and suffer increased bruising.
Thrombocytopenia is typically brought on by an autoimmune disorder in which the body destroys its own healthy cells.
- Vasculitis essentially means an inflammation of the blood vessels, which occurs when the body’s immune system attacks the healthy blood vessels after mistaking them as a foreign threat.
The walls of the targeted blood vessels become increasingly thickened, restricting the amount of blood they can carry.
The reduced blood flow can trigger tissue damage, which becomes apparent in the form of skin bruising.
Other diseases can also compromise your blood clotting process and make you prone to bruising. These include:
- Chronic inflammatory diseases such as lupus
- Long-term liver disease such as cirrhosis
- Specific types of cancer, most notably leukemia and multiple myeloma
- Certain nutritional deficiencies such as a deficiency in vitamins B12, K, or C or low levels of folic acid
Symptoms of a Bruise
A bruised skin region may show the following signs:
- Skin discoloration beginning as a pinkish red to bluish, followed by a tinge of greenish-yellow before returning to the normal skin color.
- Tender to touch
- Difficulty using the muscle that has been deeply bruised. For instance, a deep bruise in the thigh muscle may cause problems in brisk walking or running.
- Leakage of blood from abdominal contusions can adversely affect the internal organs.
- In severe injury or trauma, the blood leaking from the damaged vessel may collect inside a damaged tissue and form a fluid-filled lump over the affected site.
This relatively intense form of bruising usually involves a large blood vessel and is referred to as a hematoma.
Diagnosing a Bruise
Timely diagnosis of your bruises can help to determine the underlying reason.
Your doctor will ask for your family history and will conduct a physical examination of the bruised skin region.
Your doctor may prescribe a preliminary blood test to rule out any bleeding disorder and to measure certain factors such as blood count with platelet count, prothrombin time, and partial thromboplastin time.
A peripheral blood smear may also be requested to determine any abnormalities in your blood cells.
Also, an X-ray or MRI may be recommended if your doctor suspects a bruised bone.
Home Remedies and Self-Care Measures for Bruises
You may get bruised as a part of your daily routine activities, and the discomfort can be relieved by an over-the-counter pain-relieving medication such as acetaminophen.
However, if you get bruises often, consider getting a medical review.
As soon as you get a bruise, make sure to do the following to avoid it from worsening:
- Elevation: Raise the bruised body part if possible, at a height above the heart to restrict the accumulation of blood in the injured tissue region
- Rest: Keep the bruised body part at rest to prevent the muscles from getting exhausted.
- Cold compress: Place an ice pack over the bruised skin surface to prevent further seepage of blood into the skin and tissues. The cold application constricts the blood vessels at the site and numbs the area temporarily.
This kind of topical therapy is a safe way to relieve the pain and swelling associated with a bruise. It may be best to use this technique soon after the injury occurs to reduce the intensity of bruising that results thereafter.
- You can prepare a cold compress by wrapping ice cubes in a small cloth or kitchen towel. Place the ice wrap over the bruised site and hold it there for about 15 minutes.
- You can also use a bag of frozen peas or other vegetables for this purpose.
- Apply the cold compress after every few hours, particularly during the first day of the injury.
- If you or your child is uncomfortable with the use of an ice pack, dip a clean cloth in cold water and use it as a compress instead.
- Applying too much pressure on the bruise or rubbing it can aggravate the injury and should be avoided.
- Apply a warm compress. Once the bruise becomes 2 days old, you can use heat therapy to stimulate lymphatic drainage from and increase blood flow to the affected area.
Placing a warm compress on the contusion may speed up the reabsorption of the pooled blood by the skin and result in faster healing of the bruise.
- Arnica: A number of scientific studies highlight the bruise-healing potential of arnica, but the claims need to be validated by more rigorous research.
Arnica-containing gels, creams, and ointments are commonly used for the treatment of minor bruises at home, but it is best to consult your doctor before trying any such product.
Gently massaging a thin layer of arnica gel or cream into the contusion site soon after it appears may reduce the intensity of bruising and promote faster healing. (1)(2)(3)
- Diet: You can reduce the risk of bruising by eating certain foods that can make your blood thick.
Green leafy vegetables such as cabbage, kale, and spinach are packed with vitamin K, which may help your blood clot well and facilitate fast healing of bruises.
Similarly, pineapple contains an enzyme called bromelain, which may help fade your bruise by breaking down the pigments responsible for the skin discoloration. (4)
- Over the counter medication: If your bruise is accompanied by pain, you can take an over-the-counter analgesic such as ibuprofen, acetaminophen, or naproxen to relieve the discomfort.
How to Prevent Bruising?
You can prevent getting bruised by following specific preventive measures:
- Be aware of the safety rules before beginning a new sport.
- When driving vehicles, wear seat belts.
- Wearing sports equipment can help avoid getting bruises in areas that are likely to get bruised easily.
Using thigh pads, elbow pads, and hip guards can be helpful in football and hockey, whereas knee pads and shin guards can offer protection when playing soccer and basketball.
- Children frequently injure their knees while playing. Making them wear knee pads can reduce their risk of bruising. This kind of protective cover absorbs the shock from the trauma and prevents a contusion from occurring.
- Give your toddlers soft toys to prevent bruises.
- Install padding on the edges of sharp-cornered tables, beds, and furniture.
- Be careful when engaging in activities that can make you fall, such as climbing a ladder or picking objects from a height.
Also, try not to kneel or stand on counters and tabletops. These can make you susceptible to falling and getting bruised.
Certain risk factors can render the capillaries under your skin increasingly fragile and make them prone to hemorrhaging, while other factors can prevent your blood from clotting fast enough. These include:
- Aspirin, ibuprofen, diclofenac, oral blood-thinners, warfarin, and heparin, among others, can adversely affect your platelet function and inhibit blood clotting.
Corticosteroids are known to weaken the structural integrity of your blood vessels. Both types of medications can lead to easy bruising. (1)
- Some people inherit the tendency to bruise easily, as it runs in their family.
- Women tend to get bruised more often than men, particularly from minor jerks on the buttocks, upper arms, or thighs.
- Older individuals are more prone to injuries on the hands, feet, upper extremities, and lower extremities.
- With a progression in age, the fat underlying the skin tissues may decrease, reducing the ability of the skin to absorb any jerks or shocks.
This exposes the blood vessels to easy breakage. A slight injury may also cause a bruise in older adults.
- Alcohol may work as an anticoagulant, which can severely hamper your blood clotting process if consumed in excess.
Due to the deficient or inadequate blood clotting, the ruptured blood vessels will bleed easily after an injury, resulting in a bruise.
- People who are extremely overweight or obese are more susceptible to bruising than those who figure within the healthy weight range.
At times, the leaked blood may not form a bruise but instead accumulates underneath the skin or inside the surrounding muscle region.
This may then get trapped and aggregate in the form of a solid mass known as a hematoma.
The blood residing in the hematoma is in the liquid state and must be aspirated and drained before it gets completely solidified.
If a contusion is not cared for properly, it may give rise to the following complications:
1. Compartment Syndrome
Compartment syndrome occurs when a muscle in your arm, leg, foot, or buttock suffers an intense blow or trauma and bleed profusely and rapidly, which may continue for several hours.
The blood that collects in the muscular tissue can make the site extremely painful and swollen.
Due to the fluid accumulation, the blood vessels at the affected site are compressed, which can reduce the amount of blood that reaches the muscle group.
Poor blood flow corresponds to poor nourishment for the damaged tissue, which can delay recovery.
2. Myositis Ossificans
Myositis ossificans refers to the growth of bone tissue within extra-skeletal muscle tissue in the aftermath of an injury.
When a site undergoes intensive or repeated muscular trauma, a calcified lesion forms inside the injured muscle.
This complication usually affects the larger muscles in your limbs and can render the affected site persistently painful and swollen.
Sportspeople, gym enthusiasts, gymnasts, and athletes encounter frequent muscle injuries that can result in severe bruising.
In a rush to rehabilitate the affected site, they fail to give it enough rest. Subjecting the injured muscles to the usual level of activity before it has healed properly can lead to myositis ossificans.
When to See a Doctor
Seek immediate medical attention if:
- The affected skin gets swollen or numb or gives you a tingling sensation. This is due to the leaked blood putting a strain on the surrounding nerves and blood vessels.
- If this compression of nerves and blood vessels is not treated on time, permanent damage on the nerves within the bruised region may occur.
- You still experience pain after three days.
- You feel the affected site as a hard lump.
- You experience difficulty moving due to the associated pain and injury.
- The bruise formed is an outcome of a jerk or blow on your stomach or head.
- Skin breakdown occurs.
- You get frequent bruises.
What your doctor may ask you?
- What caused the bruising and when did it occur?
- Is the bruised site warm or tender to touch?
- Did you observe any swelling in the affected area after bruising?
- What medications, including herbal supplements, are you already taking?
- Is the bruised area spreading or causing skin breakdown?
What you may want to ask your doctor?
- How much time will the bruise take to heal?
- Why do I bruise easily?
- What are my treatment options?
- What are the side effects of these medications?
- Are there any possible complications, if the bruise is left untreated?
Expert Answers (Q&A)
Answered by Dr. Firas Al-Niaimi, MRCP
Healing of a bruise generally varies, but it usually takes around a week and in some cases up to 2 weeks.
Swelling around a bruise can be normal particularly if trauma was involved in the process of bruise formation.
Apply pressure and ice packs to the area.
The signs of an infected bruise include ongoing pain, warmth, and tenderness around the area. A fluctuating abscess is also a sign of an infection.
Certain types of anemia characterized by a low platelet count can lead to bruising.
This does not happen usually. But again, if the high stress level influences platelet function, then it can cause bruising.
In leukemia, the platelet action and clot formation are abnormal and dysfunctional, making the affected individual prone to bruising.
Try to contain the bruise with ice packs and look for a cause. Avoid blood-thinning medications.
About Dr. Firas Al-Niaimi, MRCP: Dr. Al-Niaimi is a consultant dermatologist in the United Kingdom and has over 160 scientific publications.