Bruising

Overview

Bruising or hematomas occur when blood leaks out of blood vessels. They are usually caused by a physical trauma such as an injury or surgery.

Bruises and hematomas can look similar, but bruises result from damage to small blood vessels, while hematomas result from damage to large ones. Bruises may be blue and purple, while hematomas can be dark blue and black. Hematomas can occur deep within the body and may not be visible. 

They usually go away on their own but bruising and hematomas that occur often and without an identifiable cause can be a signal of an underlying blood disorder. Set up an appointment with your doctor if your bruising happens often and for no obvious reason or does not go away after two weeks.

Bruising causes

Bruising occurs when blood leaks out of blood vessels. It is usually caused by a physical trauma such as an injury or surgery.

Persistent bruising that is not due to an external injury can be a result of a blood disorder or disease, such as:

• Hemophilia A or B
• Von Willebrand disease
• Thrombocytopenia
• Leukemia

Bruising risk factors

You may be more likely to experience bruising if you:

• Are elderly
• Engage in sports with physical contact
• Have a blood disorder
• Are female
• Take a blood thinning medication

Bruising symptoms

Hematomas and bruises can be large and occur deep inside the body where they are not visible, or can be external and marked by blue, black, or green skin discoloration and sensitivity.

Bruises usually begin with a blue or purple color, then turn green or yellow as they heal. They are often tender and can be painful to the touch, especially in the first few days. 

Bruising diagnosis

Minor bruising should resolve on its own. If your doctor suspects an underlying cause, he or she may order a blood test to determine if there is a bleeding disorder. If there could be a coexistent injury, your doctor may order an X-ray of the area to look for any broken bones. 

Bruises that appear in certain areas or are part of an ongoing pattern may alert the doctor to the presence of physical abuse. 

Bruising treatment

Treating a potential bruise right after the injury has occurred is the most effective way to speed up recovery.  Apply ice wrapped in a towel to the affected area for 20-30 minutes after the initial injury to facilitate healing and reduce swelling. 

You may want to take acetaminophen if your bruising is accompanied by significant pain. Do not take aspirin or ibuprofen for bruising pain, as they can hinder blood clotting and prolong bleeding. 

When to seek care

Consult your doctor if your bruising:

• Happens often and for no obvious reason
• Does not improve after two weeks
• May be accompanied by another injury, such as a broken bone
• Is coupled with swelling and extreme pain, particularly if you are taking a blood-thinning medication

Next Steps

If your bruising is accompanied by an additional serious injury, is a symptom of an underlying medical condition, or is a result of physical abuse, your doctor will provide referrals to other specialists as necessary.