Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Internal bleeding facts
- Internal bleeding may occur in many areas of the body and may cause significant local inflammation and pain. If enough bleeding occurs, signs of shock may be apparent.
- Bleeding is a recognized complication of anti-coagulation and anti-platelet medications. The benefits of taking these medications need to be balanced against the risk of bleeding.
- Bleeding is never normal in pregnancy.
- If internal bleeding is suspected, it is important to seek medical care.
What is internal bleeding?
While the general public understands that internal bleeding means bleeding that can't be seen on the outside of the body, medical personnel tend to use terms that describe more precisely the location inside the body where the bleeding is found. The internal bleeding may occur within tissues, organs, or in cavities of the body including the head, spinal canal, chest, and abdomen. Examples of other potential sites of bleeding include the eye and within tissues that line the heart, muscles, and joints.
Bleeding outside the body is quite easy to recognize. If the skin is damaged by a laceration, puncture, or abrasion, blood can be witnessed as it streams out of the body. The scalp and face have a very rich blood supply and are notorious for demonstrating massive blood loss.
Internal bleeding may be much more difficult to identify. It may not be evident for many hours after it begins, and symptoms may only occur when there is significant blood loss or if a blood clot is large enough to compress an organ and prevent it from functioning properly.
Internal bleeding occurs when damage to an artery or vein allows blood to escape the circulatory system and collect inside the body. The amount of bleeding depends upon the amount of damage to an organ, the blood vessels that supply it, and the body's ability to repair breaks in the walls of the blood vessels. The repair mechanisms available include both the blood clotting system and the ability of blood vessels to go into spasm to decrease blood flow to an injured area.
People who take blood-thinning or anti-clotting medication are more prone to bleeding than people who do not take these medications. These individuals may experience significant bleeding even with relatively minor injury or illness, and the risk of bleeding needs to be balanced against the benefits of taking the medication. A variety of "blood thinning" medications are now prescribed for many diseases.
Anticoagulation medications include:
- warfarin (Coumadin)
- enoxaparin (Lovenox)
- rivaroxaban (Xarelto)
- edoxaban (Savaysa)
- dabigatran (Pradaxa)
Antiplatelet medications include:
- clopidogrel (Plaxiv)
- prasugrel (Effient)
- ticagrelor (Brillanta)
Learn more about: Effient
Some people have genetic or inborn errors of the blood clotting system. Minor injuries may cause major bleeding in these people. Hemophilia and von Willebrand disease are two examples of hereditary clotting disorders.
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