Bruising: Which hematomas are harmless and which have to be examined by a doctor

Bruising: Which hematomas are harmless and which have to be examined by a doctor

Bruising can be associated with serious illnesses
Every person shows bruises (hematomas), which can be recognized as bruises, if, for example, the blood vessels under the skin and in the deeper tissue layers are damaged in the event of a fall. First there is redness and swelling, later the color of the hematoma changes and the typical bruises appear. These are mostly harmless.

However, if, in addition to skin discoloration, swelling and slight pain, other or more severe symptoms appear, medical help should be sought urgently.

Some people suffer from bruising even with light impacts, others are inherently more resilient and only show corresponding hematomas with stronger impacts, blows or bruises. "A bruise is a bleeding in the body without blood leaking out," quotes the news agency "dpa", the leading doctor for intensive care medicine and infectious diseases at the Johanniter clinics in Bonn, Peter Walger. This bruise is caused by a pinch of tissue that causes microvessels to tear under the skin, adds Munich-based sports medicine professor Professor Martin Halle to the news agency.

After three weeks, bruising should have subsided
Children, in particular, often have bruises as a result of their falls and collisions in the playground or kindergarten, but they can also be found in older people, among other things, due to the weakening of the vascular elasticity. If blood vessels inside the body are damaged, the blood can run into the subcutaneous tissue or collect in body cavities, for example.

When the blood clots, the color of the hematoma changes to dark blue, later the hematoma becomes even darker and then yellow-green. After about two weeks, minor bruises have usually subsided. "In general, it takes two to three weeks for the blood cells to break down," Professor Reiner Hartenstein from the professional association of German internists told "dpa". The changes in color make the stages of the degradation process clear, the expert explains.

Have the causes of suddenly occurring hematomas checked
People who have to take blood-thinning or anticoagulant drugs are particularly susceptible to the formation of hematomas. Patients with diseases that cause disturbed blood coagulation also show increased spontaneous bleeding.

The bruising is a risk for both groups, which is why a prompt medical examination is necessary and appropriate medical measures may have to be taken. In general, suddenly occurring bruises, the causes of which are unclear to those affected, should be clarified by a doctor, Professor Walger told "dpa". The trigger could be a harmless tendency to bruise, but possible causes are also side effects of a medication, a disturbed blood clotting due to a previously unknown disease or even a tumor.

If blood clotting is impaired, bruising increases
After severe falls or bumps, hematomas can occur as a result of broken bones (fractures) or torn ligaments (ruptures). In both cases, sufferers usually have severe pain and show movement restrictions as well as a significant swelling of the corresponding part of the body. If a fracture or rupture is suspected, medical advice should be sought and medical care provided. Otherwise, the risk of complications and damage increases. If bruises occur again and again for no apparent reason, it must be checked whether serious illnesses are the cause of the hematoma.

For example, hemophilia is a disordered blood clotting, which is the cause of the bruises. Even with the most common congenital disease with increased bleeding tendency, the Willebrand-Jürgens syndrome, sufferers suffer from a disorder of blood clotting. In addition, there are numerous other diseases such as the liver or the hematopoietic system, in which hematomas can occur more often.

Medicines as triggers for hematomas?
Medicines whose active ingredients favor the appearance of bruises are, for example, acetylsalicylic acid (ASA) or coumarin derivatives because they have an effect on blood clotting. Many people are not aware that with ASA-containing painkillers they also impair the function of the platelets over several days and thus inhibit their blood clotting.

Hematomas due to the consumption of cortisone are also possible because this affects the skin structure. In the event of sudden, apparently groundless, bruising, a possible connection with the intake of medicines should therefore be checked urgently.

When to the doctor?
Medical assistance should also be sought if hematomas are accompanied by symptoms such as severe swelling and pain, poor circulation, dizziness, impaired bodily functions or fever. Increased caution is also advised when there are complaints on the abdomen, chest or head. Hematomas are not always visible here, since bleeding inside the body can occur, which can be life-threatening. For example, bleeding in the abdomen can cause abdominal pain and circulatory problems. Hemorrhages, which are also particularly threatening, are often associated with headaches and neurological disorders such as paralysis or impaired consciousness.

Cool and hang up
For common hematomas, the so-called PECH rule is a good approach for primary care: break, ice, compression, high camp. With timely cooling, the blood leakage into the tissue can be reduced, thus reducing the swelling. However, ice should never be placed directly on the skin, but a thin cloth should always be placed between the skin and the cooling, as otherwise there is a risk of cooling and skin damage. The damaged tissue is relieved by the elevated position. Subsequent cooling of the bruise is pointless, emphasizes Professor Halle. This must happen immediately after the fall or impact. In the further course, however, ointments can be used to support the swelling and inflammation, which should promote the healing of the hematoma. (fp)

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