When to Worry About a Bruise

We've all experienced a bruise or two here and there throughout our lives. Some of us who are a bit clumsier may have seen a few more. Bruising is a very commonly reported symptom at the doctor's office. But it can infrequently be a sign of something more concerning. 

How do you know when a bruise is something you should worry about? And what causes them? 

What is a Bruise?

A “bruise,” or “ecchymosis” (the fancy medical term for a bruise), is a collection of blood and fluid underneath the skin where blood vessels lie to feed the skin and nearby tissues in the body (such as muscle). These blood vessels can leak and release blood into the skin layers and become easily visible.

Causes of Easy Bruising

What exactly causes these blood vessels to leak more easily?

There are three main ways it can all go haywire. There can be a malfunction with the blood vessel lining itself; there can be a problem with the surrounding tissue in which it feeds; or there can be a dysfunction in the body’s protective reaction (by activating a blood clotting process) to an injured or leaky blood vessel that helps “patch up” the boo-boo. In the latter, the clotting cascade, or process, includes some vital components, such as clotting factors, platelets, and vitamin K.

Here are more specific causes of these dysfunctions:

1. Trauma: Trauma is the most common cause of bruising. A contusion at the site of the bruise can injure your superficial blood vessels and they can burst and release some of that blood. Even minor bumps and thumps can do it. You may have bumped into the couch without realizing it after you cleaned that glass of lime margarita, or perhaps another player smashed into your shoulder during football practice a couple of days ago. Or maybe you are just a little clumsy.
2. Blood thinners: Aspirin, anti-inflammatories such as ibuprofen and naproxen which are available easily accessible over-the-counter, and an ingredient in some cough/cold concoctions block the activity of certain clotting processes. Corticosteroids, which are used for treatment of many ailments from asthma exacerbations to autoimmune disorders like lupus, can also cause blood thinning.
3. Liver disease: Heavy alcohol intake (that affects the liver) or cirrhosis of the liver can cause blood thinning. The liver produces many of our vital clotting factors. These are the structures in our blood stream that help stop bleeding. If these clotting factors are lacking because the liver has shut down, then you can bleed.
4. Bleeding Disorders: This is why hemophiliacs bleed—they are genetically missing one of these blood factors mentioned in #3 above. Besides hemophilia, there are a few other hereditary bleeding disorders that can cause easy bruising and bleeding. Von Willibrand’s Disease is another. A family history of one of these disorders or excessive bleeding is a tip off.
5. Platelet dysfunction: Besides clotting factors, platelets are also released and produced by the bone marrow in order to respond to a bleed. If they are dysfunctional, or lacking, then it is a problem.
6. Vitamin C and K Deficiency: Scurvy (vitamin C deficiency) is quite rare in the United States. Vitamin K deficiency is slightly more common. Malnutrition (think elderly), Celiac Disease, antibiotics, and other medications that interfere with Vitamin K (like Coumadin and cholestyramine) can cause easy bruising and bleeding. Vitamin K is an essential element in the clotting process.
7. Hereditory disorders of tissues: Connective tissue disorders and Ehlers-Danlos Syndrome are diseases of the surrounding tissues provide less structural support for the nearby blood vessels and hence they tend to more easily injure. There’s usually a family history.
8. Blood, lymph, and bone marrow cancers: This is a much less common, yet most feared, cause of bruising—which is a highly common medical phenomenon. Also having increased nosebleeds, or bleeding elsewhere, in addition to easy bruising are especially concerning for these cancers. A simple blood test can often rule this one out.

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When Should You Worry About a Bruise?

There’s no need to run to the Emergency Room at the site of your first little boo-boo. Most bruising is benign, and is very common. But here’s when you should perhaps worry about bruising and when you should see your doctor:

• If they persist for prolonged periods of time (not healing)
• If you have more and more bruises through time
• If you experience bruising more frequently than your prior baseline
• If you bruise more easily than your prior baseline
• If you also experience nose bleeds, rectal bleeding, more vaginal bleeding in any way (heavier, more frequent, spotting in between periods, etc.), or bleeding anywhere
• If the bruise is “fluctuant,” meaning there’s a large pocket of fluid under the skin that you can feel, move, and/or compress
• If you also have “petechiae,” which are tiny red dots of blood under the skin
• If you have a family history of hereditary disorders that predispose to bleeding
• If there is significant unexplained weight loss
• If you are taking a medication that causes bleeding

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Please note that all content here is strictly for informational purposes only.  This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider.  Please always seek a licensed physician in your area regarding all health related questions and issues.

Image of a bruise © Shutterstock