Bruise – causes, treatment and prevention

The bruise is bleeding under the skin without an open wound. The blood that has escaped can therefore not drain to the outside, it remains under the skin and forms the well-known bruise there.

Hematomas are usually harmless unless they occur in dangerous places where they can impede the flow of substances in the body or press on vital organs and impair their function.

The bruise is removed by the body itself after some time and changes its color depending on the stage until it disappears completely. If the bruise is close to the skin’s surface, the typical discoloration quickly occurs. But sometimes this can take a while. Also, the visible staining is less the deeper the bruise is under the skin.

Depending on where in the body the bruise occurs, there are different forms: The subcutaneous bruise occurs directly under the skin. Intramuscular bruising occurs within muscle tissue. The periosteal hemorrhage, on the other hand, is located within the periosteum.

causes

Bruising often occurs as a result of external violence. A bruise can be caused by injury from a blunt object or in a manner that does not result in an open wound.Possible forms of trauma include blows, falls or sports injuries such as sprains. But surgeries can also cause hematomas. The blood then flows out of the injured vessel into a body cavity or into surrounding tissue.

A bruise also occurs when the site of the injury is too deep in the body for an open wound to develop, for example when the capsule of a finger is torn.

In any case, when a bruise occurs, a blood-carrying medium, such as a vein, ruptures and the blood escapes until it clots. A bruise can also develop in organs. It can also occur as a result of vascular damage, for example in arteriosclerosis .

When to the doctor?

While a bruise or hematoma is often painful and visually unsightly, it is not necessarily dangerous and can usually be treated on your own. It is often sufficient to cool the affected area, then to rest it and, if it is possible and felt comfortable, to raise the affected area.

This causes the blood vessels to constrict, reducing blood flow to the site of the injury. The hematoma does not spread further, but slowly resolves. There are also various ointments and creams that dissolve bruises. They contain, for example, the active ingredient heparin or arnica.

A visit to the doctor is only recommended for very large and very painful bruises. In the worst case, they can seriously disrupt blood circulation and even cause tissue death in the affected area. You should also see a doctor if you have deep-seated bruises or bruises that keep getting bigger despite cooling and immobilisation. The same applies to people with bleeding disorders and those who are being treated with strong blood thinners.

symptoms and course

A bruise is very easy to spot when it’s harmless. A reddish to purple-green color change is noticed at the affected area, which becomes yellowish over time and finally fades more and more.

Sometimes the area hurts when pressure is applied or is accompanied by a throbbing, mild to moderate constant pain shortly after it develops, but which soon subsides.

If there is significant blood loss or a mild shock reaction, dizziness may also occur shortly after the injury . Bruises in deeper regions of the body are often not visible and are only noticed when pain occurs.

Hematomas are particularly dangerous in the brain and are often only noticed on the basis of non-specific symptoms and suspected investigations. A bruise can be associated with severe pain. These are caused by the pressure that the leaked blood exerts on the surrounding tissue.

A bruise can also swell massively, especially if the bruise is deeper under the skin. The color of the bruise as it forms and heals is initially dark red.

When blood starts clotting, it changes to reddish-blue, then to dark blue after two days. This happens because of the enzyme-induced breakdown of hemoglobin. After another three days, the color changes to green, then from about seven days to reddish-yellow. The latter colors result from the breakdown of hemoglobin into bile pigment.

In the case of a bleeding disorder ( hemophilia ), a bruise can also occur without any traumatic influence. Blood thinning medications can increase the risk of bruising.

Diagnose

A bruise can usually be diagnosed by the typical clinical picture. Swelling , coloration, and extent of the hematoma provide information about its severity. In the case of extensive and very painful hematomas, a doctor should be consulted. Imaging methods such as X -rays or ultrasound can be used to rule out more serious injuries.

complications

A bruise is in most cases free of complications and therefore of little concern. Bruises are often perceived as unpleasant for visual reasons. However, they can be hidden in a few steps with various make-up products. When using these products, make sure that they are compatible with the skin. Alternatively, a hypersensitive reaction occurs. In most people, this manifests itself in the form of skin reddening or itching . In some cases, a bruise causes blood to clot in a joint. This can have problematic consequences.

The affected joint can only be moved to a limited extent or not at all. This applies to the period until blood clotting has been broken down or eliminated. The joint should be immobilized or at least rested while the coagulated blood is broken down. Blood coagulation is usually initiated by administering medication. Attention should be paid to the side effects of the preparations. Large and particularly painful bruises should be examined urgently by a doctor. In most cases, the person affected also suffers from injuries that can be found deeper in the skin. This can be broken bones , bruises or, in particularly bad cases, damage to internal organs. Damaged organs can lead to malfunctions or failures.

treatment and therapy

A harmless, visible bruise usually does not need to be treated, it will go away on its own. In the case of unpleasant pain, treatment can be carried out by immediately cooling the affected part of the body. Pain-relieving, cooling creams or ointments can be applied here. On the one hand, this relieves the pain and, on the other hand, the spread is contained because less blood escapes because the veins contract. Elevation of the affected area can also be carried out. Also, the part of the body where the bruise is located should not be put under too much strain. Otherwise the bruise can spread further.

If the blood that has escaped has gotten into a joint space, you need a bandage that immobilizes the affected area. Movement hurts and is often performed involuntarily; also, if the ruptured blood vessel is overstressed, it could rupture again and make the bruise worse.It can rarely happen that a bruise does not heal automatically. Then it comes to inflammation or encapsulation. This occurs primarily when the bruise is relatively large.

Large bruises can also negatively affect the ability of joints and muscles to function. Such a bruise must then be treated surgically.

The bruise is then emptied under local anesthesia. When a bruise is near joints, it always requires surgery. The treatment of hematomas, which cannot be seen immediately and which may be in dangerous places, is different.

A bruise can be particularly dangerous if it is in the area of ​​the brain (cerebral hemorrhage). Internal bruising can be just as dangerous. Even with blood-thinning medication or hemophilia , a bruise can be dangerous and, as already mentioned, occur very easily.

As a rule, hematomas can now be treated well by either removing them or dissolving them with medication. It is important that they disappear as quickly as possible so that they no longer impair the functions of the organs and the person can recover without consequential damage. This treatment takes place in the hospital so that the doctors treating you are on the spot immediately if complications arise.

outlook and prognosis

The prognosis for a bruise is usually extremely good. Small bruises will heal on their own within a few days. Moderate bruises that are cooled immediately after they appear will generally resolve within a week to 10 days. During the healing process, the color of the affected area changes. It is initially red-blue and gradually turns brown-green after a day or two. In some cases, there is also a yellowish discoloration. These are signs of optimal healing.

The body transports the accumulated blood away and the swelling is minimized at the same time. Significant improvements can often be seen within a few hours. For larger bruises, the healing process takes about two to three weeks. If complications occur, the prognosis depends on the corresponding events. A bruise in the immediate vicinity of a joint leads to a doctor’s visit due to the symptoms. He will perform surgery or put a drain to remove the bruise.

If the bruising spreads widely, there is a risk of a life-threatening situation. In these cases, a large blood vessel has been injured, resulting in a large amount of blood loss. Shock can occur if left untreated. In the case of a bruise that does not subside, there is another underlying disease that must be clarified.

prevention

The main way to prevent a bruise is to take protective measures in situations where it could occur, such as during sports or at work. If an injury does occur, it should be immediately cooled to prevent a large, painful bruise from forming. If you’re quick enough, the cold reduces circulation enough for the blood to clot without any visible bruising at all.

The only effective way to prevent bruising is to avoid accidents. Appropriate protective equipment should be worn for activities or sports with a high risk of accidents.