What Is Hemorrhage?

Hemorrhage is the medical term for any type of bleeding. A hemorrhage can be internal, such as in the stomach, or external, like a cut on the skin. Injuries, certain medical conditions, and medications can cause hemorrhages that range from minor to life-threatening. Symptoms vary and will depend on where the bleeding is occurring and the amount of blood loss you've experienced.

Your exact treatment plan will depend on the severity of your symptoms and the location of the hemorrhage. First aid measures are often enough to treat minor bleeding. But more severe bleeding requires medical attention and treatment, such as blood transfusions or surgery.

It's common to experience a hemorrhage at some point in your lifetime—as bleeding is common and can affect people of all ages. However, those with bleeding disorders, such as hemophilia or von Willebrand disease, have a higher risk of excessive bleeding and serious complications.

Types of Hemorrhage

Three types of blood vessels carry blood throughout your body: arteries, veins, and capillaries. Arteries carry oxygen-rich blood from the heart to the body's tissues and organs. Veins return deoxygenated blood from the rest of the body back to the heart. Capillaries are tiny blood vessels that connect arteries and veins, helping oxygen and nutrients reach the body's tissues and organs.

Hemorrhages can occur anywhere in the body and commonly affect all three blood vessel types:

• Arterial hemorrhage: When bleeding occurs due to a damaged artery, the blood is bright red and comes out in spurts, matching the heart's rhythm. Arterial bleeding can be life-threatening due to rapid blood loss.
• Venous hemorrhage: When a vein is damaged, dark red blood flows steadily from the affected blood vessel. Venous bleeding is less severe than arterial bleeding but can still be significant and requires prompt treatment. 
• Capillary hemorrhage: Capillary hemorrhage occurs when capillaries—the smallest blood vessels—are damaged. Capillary bleeding is generally slow and oozes or trickles. Though it can be the most painful, it is the least severe type of bleeding and often stops on its own. 
  

Symptoms

Hemorrhage can happen in almost any body part, internally and externally. Your symptoms will vary on the severity of the bleeding and the location of the hemorrhage.

External Hemorrhage Symptoms

External bleeding is visible, making it easier to pinpoint the cause and source of the bleeding. With external bleeding, blood comes through an opening in the skin, usually due to a cut or puncture wound. Symptoms can include:

• Pain
• Swelling
• Bruising

Internal Hemorrhage Symptoms 

With internal bleeding, blood may pool inside the body or exit through the mouth (via vomit), nose, anus (with or without stool), vagina, or urethra (in urine). Symptoms vary depending on where the bleeding is occurring, but may involve:

• Pain in the abdomen
• Chest tightness
• Abdominal swelling
• Skin color changes (pale or bruised skin)
• Fatigue
• Weakness
• Shortness of breath 
• Blurry or double-vision
• Tingling in the hands and feet
• Nausea or vomiting
• Lightheadedness or dizziness 

Hypovolemic Shock Symptoms

Hypovolemic shock occurs when the body loses too much blood. Both external and internal hemorrhages can cause shock when you lose one-fifth (20%) or more of your body's total blood volume. Excessive blood loss is potentially life-threatening because it reduces blood flow and oxygen delivery to vital organs and tissues. 

Signs and symptoms of hypovolemic shock can include:

• Confusion 
• Anxiety or agitation
• Extreme thirst 
• Lethargy
• Cool, clammy, pale, or bluish-colored skin 
• Excessive sweating
• Rapid heart rate
• Decreased urination 
• Loss of consciousness 
  

Causes

Hemorrhages happen when there is damage, injury, or illness to one of your blood vessels. As a result, blood loss can occur. There are many possible causes of bleeding, such as:

• Trauma: Injuries from accidents, falls, or penetrating wounds can damage blood vessels and cause scrapes, cuts, or puncture wounds that bleed from the skin. Injury to an internal organ or blood vessel, such as a crushing injury or gunshot wound, can lead to internal bleeding.
• Medical conditions: Some health conditions can cause bleeding or increase the risk of hemorrhage. These include liver disease, cancer, diabetes, vitamin K deficiency, alcohol use disorder, peptic ulcer disease, high blood pressure, and bleeding disorders such as hemophilia and von Willebrand disease.
• Medications: Aspirin and blood thinners (like antiplatelet and anticoagulant medicines), such as heparin and warfarin, can increase the risk of excess bleeding.

Risk Factors

Anyone can experience hemorrhages, but certain factors can increase the risk of significant blood loss. These include:

• Older age
• Health conditions like high blood pressure, diabetes, or bleeding disorders
• Family history of hemorrhages
• Tobacco and alcohol use

Diagnosis

Minor external hemorrhages, such as a skin scrape or cut, do not always require a diagnosis. Seek medical attention for external hemorrhaging when:

• Bleeding does not stop or is the result of a serious injury
• The wound appears to need stitches 
• There are signs of internal bleeding or shock 
• Your bleeding is due to an animal bite
• The wound contains dirt or debris that is difficult to remove

To diagnose an internal hemorrhage, healthcare providers work to identify the type, location, and severity of the bleeding. Your healthcare provider will begin by carefully reviewing your medical history, such as by asking whether you have had recent injuries or surgeries, any medical conditions you have that increase the risk of bleeding, and your symptoms.

During the physical examination, your healthcare provider will check your vital signs, including your heart rate, breathing rate, and body temperature. They will also carefully examine your body for signs of internal bleeding, such as bruising, swelling, pain, and tenderness.

Diagnostic tests can help determine the source and severity of bleeding. These tests may include:

• Blood tests: Check for anemia, blood clotting problems, infection, and overall blood counts 
• Imaging tests: Computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound scans provide detailed images of internal organs and tissues to help identify the location and severity of bleeding
• Angiography: Uses a dye and X-rays to visualize how blood flows through blood vessels and help identify the source of bleeding
• Endoscopy: If your healthcare provider suspects internal bleeding in the gastrointestinal tract, they may perform an endoscopy, which involves inserting a long, flexible tube down your throat to visualize the digestive tract and look for the source of bleeding

Treatment

The primary goal of treating hemorrhage is stopping the bleeding, addressing underlying causes, and preventing complications. Your exact treatment plan will depend on how severe your bleeding is and whether the hemorrhage is external or internal. In most cases, first aid and in-hospital medical treatments can improve symptoms and stop blood loss.

First Aid

First aid for minor external hemorrhages includes:

• Cleaning the affected area with mild soap and water and a sterile cloth 
• Applying pressure to the wound
• Bandaging the wound to stop the bleeding
  

Severe external bleeding requires immediate medical attention. If someone you know is bleeding heavily, call 911 and:

• Cover the wound with a clean cloth 
• Use a tourniquet (a band that you tie 2 to 3 inches above the bleeding site) if the wound is on an arm or leg 
• Pack the wound with gauze or a clean cloth if a tourniquet is unavailable 
• Apply direct pressure to the wound until emergency medical technicians arrive
  

In-Hospital Treatments

Internal bleeding and severe external hemorrhaging require prompt emergency medical care. Healthcare providers will assess the source and severity of bleeding to determine the most appropriate treatment, which may involve:

• Stitches (sutures) or staples: Close an open wound to stop bleeding and prevent bacteria and other harmful pathogens from entering the body
• Surgery: Surgical procedures may be necessary to stop bleeding from major blood vessels or to repair damaged organs or body tissues
• Blood transfusion: Donated blood is provided through an intravenous (IV) line to replace any blood you've lost and improve oxygen delivery throughout the body
• Medications: Medicines help stop and stabilize blood pressure, which may include tranexamic acid (controls bleeding), vitamin K (promotes blood clotting), and desmopressin (increases blood clotting)

How to Prevent Hemorrhage 

It is not always possible to prevent hemorrhaging, especially in the case of an accident or when you have an undiagnosed bleeding disorder. Preventative measures may help lower your risk of bleeding, such as: 

• Prioritize safety: Practice caution and follow safety protocols while engaging in activities with a higher risk of injury, such as sports or work involving heavy machinery. Keep sharp objects (e.g., knives) away from small children and wear a seatbelt when traveling in a vehicle.
• Manage health conditions: Take your medications as prescribed if you have a bleeding disorder or a health condition associated with an increased risk of bleeding. 
• Get regular medical check-ups: Routine medical checkups can help identify and manage underlying conditions or genetic factors that may increase your risk of bleeding. 

Complications 

Seeking prompt treatment can help prevent complications of uncontrolled bleeding. Possible hemorrhage-related complications include: 

• Hypovolemic shock: A medical emergency that occurs when your body loses a significant amount of blood quickly, causing a potentially life-threatening drop in blood pressure, decreased oxygen throughout the body, and possible organ failure
• Organ failure: Damage to vital organs, such as the brain, lungs, and liver, can occur when organs do not get sufficient blood and oxygen
• Anemia: Severe or prolonged bleeding can lead to anemia, which causes fatigue, weakness, and shortness of breath
• Death: Excessive blood loss can be fatal if not treated promptly
  

A Quick Review

A hemorrhage is any type of bleeding from a damaged blood vessel. Bleeding can be minor, such as from a paper cut or scrape on the knee, or major, or severe, such as from an internal organ due to an injury or illness. Traumatic injuries, medical conditions (e.g., blood disorders), and certain medications can also cause or increase the risk of hemorrhage.

Depending on the type and severity of your hemorrhage, symptoms may include pain, pale skin, shortness of breath, dizziness, weakness, and rapid pulse. Treatment will also depend on the location of the bleeding and your symptoms. First-aid measures, such as applying pressure to the wound and covering it with gauze or a bandage, are often enough for minor bleeding. Major bleeding requires prompt medical treatment, which may include surgery, medications, or transfusions.

An internal hemorrhage or severe external hemorrhage can be life-threatening if left untreated. If you or someone you know is experiencing internal or external hemorrhage symptoms, seek immediate medical attention.