Bruising, also known as contusion, occurs when an injury causes blood vessels to leak blood into the surrounding tissues. This results in the discoloration of skin often seen with a bruise. Bruises can range from mild to severe depending on factors like the amount of force involved, the location of the bruise, and the person’s health and medications.
What causes bruising?
Bruising occurs when blunt force trauma causes damage to blood vessels and capillaries under the skin. This allows blood to leak into the surrounding tissues. Common causes of bruising include:
- Bumps, blows, and falls
- Sports injuries
- Car accidents
- Surgery
- Blood thinning medications
When a blood vessel is damaged, bleeding occurs under the skin. As blood cells break down, this causes the reddish-purple discoloration of a bruise. The larger the blood vessel damaged, the more severe the bruising will be.
What factors influence the severity of bruising?
Several factors can influence how severe bruising appears after an injury:
- Force of impact – More force causes more blood vessels and capillaries to rupture, resulting in more severe bruising.
- Location on the body – Areas with little muscle/fat underneath, like the face, bruise more easily. Areas over bones, like the shins, also bruise more severely.
- Age – Older adults bruise more easily because their blood vessels are more fragile.
- Medications – Blood thinners and anti-inflammatory medications increase bleeding and bruising.
- Bleeding disorders – Conditions like hemophilia impair blood clotting and lead to heavy bruising.
- Nutritional deficiencies – Low vitamin C, vitamin K, zinc, or iron can make bruises worse.
What are the colors and stages of a bruise?
The color and appearance of a bruise provides information about its age and severity. There are 5 stages of bruise healing:
- Redness – At first, ruptured capillaries leak red blood cells into tissues causing red discoloration.
- Bluish coloring – After 1-2 days, hemoglobin breaks down turning the bruise bluish-purple.
- Greenish hues – During the healing process, the hemoglobin further breaks down causing green/yellow discoloration around 5-7 days.
- Yellowish bruise – After 10-14 days the green hemoglobin has faded leaving a yellowish bruise.
- Brown/fading – Finally, the bruise resolves, often leaving brownish discoloration that slowly fades.
More severe bruises will appear darker purple/blue in the early stages. Mild bruises may only cause slight redness.
What symptoms occur with severe bruising?
Symptoms that can occur along with severe bruising include:
- Significant pain, tenderness at the site of injury
- Swelling around the bruised area
- Limitation in movement/use of the injured area
- Numbness or tingling around the bruise
Large severe bruises over joints or bony prominences often cause the most impairment. Symptoms tend to improve as the bruise heals over 2-3 weeks.
When is bruising considered severe?
Doctors consider bruising severe if:
- The bruise is >10 cm in diameter
- The injury causes heavy or widespread bruising
- Bruising occurs spontaneously without injury
- Bruising develops from minor bumps/impacts
- Bruises appear in unusual locations like the abdomen or back
- The person bruises easily and frequently
Bruises over 20 cm, or ones that takes weeks to fade are considered particularly severe. Elderly adults should have any heavy bruising evaluated.
What conditions cause severe bruising?
Causes of abnormal severe bruising include:
- Medications – Blood thinners like warfarin or NSAIDs like ibuprofen
- Bleeding disorders – Hemophilia, vasculitis, platelet problems
- Cancers – Leukemia, lymphoma, myeloma
- Scurvy – Severe vitamin C deficiency
- Liver disease – Reduced production of clotting factors
- Kidney disease – Abnormal platelet function
Unexplained bruising in an adult should prompt medical evaluation to identify the cause.
When to seek emergency care for bruising
Seek emergency medical care if severe bruising occurs along with:
- Signs of internal bleeding – dizziness, weakness, chest/abdominal pain
- Head injury with bruising, bleeding or loss of consciousness
- Difficulty breathing – bruising could indicate rib/lung injury
- Severe bruising in patients on blood thinners
- Uncontrolled bleeding from the wound site
These symptoms suggest a more serious underlying injury requiring urgent evaluation.
How is severe bruising diagnosed?
Doctors diagnose severe bruising by:
- Asking about medications, medical conditions, prior bleeding
- Physical exam to locate bruises and check for abnormalities
- Discussing recent trauma that could cause bruising
- Ordering blood tests including complete blood count, PT/PTT
- Imaging tests like CT scan or ultrasound if internal bleeding suspected
Testing helps identify bleeding disorders, leukemia, liver/kidney disease that could cause easy bruising.
How is severe bruising treated?
Treatment focuses on:
- Treating any underlying condition causing abnormal bruising
- Controlling bleeding disorders or adjusting medications if needed
- Pain relief – ice, OTC painkillers
- Resting the bruised area to allow healing
- Protecting skin integrity if bruise is severe
- Using compression wraps for support
- Monitoring for signs of internal bleeding which requires emergency surgery
For unknown bruising causes, doctors monitor symptoms until the bruises resolve on their own. Call 911 for heavy uncontrolled bruising.
Home care tips for severe bruising
To care for severe bruises at home:
- Rest and avoid using the bruised area
- Apply ice packs to reduce swelling
- Use OTC pain medication as needed
- Keep the area elevated above heart level when possible
- Avoid hot baths, heating pads, massages until healing occurs
- Consider using a compression wrap to stabilize the area
- See a doctor if bruises worsen or do not improve
Call the doctor right away if you develop fever, drainage, increased swelling or redness around the bruise. These could indicate an infection requiring antibiotics.
Conclusion
In summary, severe bruising involves bruises that are large in size, occur easily from minor trauma, appear spontaneously or seem out of proportion to the injury. Unexplained heavy bruising may be the first sign of an underlying medical condition and warrants prompt evaluation. While most bruises heal on their own with self-care, significant bruising requires a doctor’s supervision to manage, especially in seniors and those on anticoagulants. Monitoring for complications like bleeding disorders or internal injuries is crucial. With proper treatment, even severe bruising can resolve without long term issues.