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Bruising

Bruising is the result of bleeding under the skin, which damages the small blood vessels but does not break the skin. It usually occurs as a result of physical trauma to the tissue. It is extremely common in children, but can occur at any age.

  • Bruises often appear reddish, before gradually changing colour
  • Some people can be more prone to bruising than others
  • Usually no treatment is needed, and the bruise will disappear within two weeks

If you have a bruise which is still visible after two weeks, or if you are worried about internal bruising, you may want to speak to a GP. Our GMC-registered clinicians can issue advice, prescriptions and referral to specialists, where suitable, via our online video consultation service. They are available between 9.30am and 4.30pm, Monday to Friday. 

Bruising
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Possible causes

What causes bruising?

Bruising is usually caused by accidental trauma. A bruise forms an oval shape, and commonly affected areas include the knees and elbows. This can often recur as a result of falling, particularly for children and older people, where the skin is thinner or less developed, and the tissue underneath more fragile.

If bruising is excessive or occurs very easily, this can be an indication of an underlying medical condition. These include:

Vascular disorders

    • Easy bruising syndrome: This is a harmless disorder which often occurs in women, and simply means that exposed areas can bruise easily from minor trauma.
    • Ehlers-danlos syndrome: a group of inherited skin tissue disorders, of which bruising is a common symptom.
    • Osteogenesis imperfecta: A genetic disorder which makes bones brittle and very prone to breaking.

Platelet disorders

    • Henoch-Schonlein purpura (HSP): this is also a genetic disorder, which causes inflammation of small blood vessels.
    • Acute idiopathic thrombocytopenic purpura: An immune disorder which presents in childhood, and stops the blood from clotting because of low platelet levels.
    • Aplastic anaemia: a condition where the bone marrow is damaged, leading to a deficiency of red blood cells.

Coagulation disorders

Haemophilia: a genetic disorder which stops the blood from clotting properly. When a person with the condition bleeds, they bleed for much longer than usual.

Von Willebrand disease (VWD) is the most common coagulation disorder, and is caused by a lack of the Willebrand factor, which is a key protein needed for clotting.

Using certain medications can also make a person more prone to bruising: 

  • Corticosteroids can damage blood vessels and lead to skin atrophy over time. 
  • Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) can inhibit platelet function
  • Warfarin can stop the blood from coagulating properly

Diagnosing the cause of bruising

In order to diagnose the cause of bruising, a doctor will look to establish what your medical history is, to help determine whether the bruise is a result of physical trauma or an underlying medical condition. 

A doctor will ask you what other symptoms you are experiencing with the bruising, which could indicate a possible platelet or coagulation disorder. A clinician may ask if you have experienced nosebleeds, or excessive bleeding in other areas. If excessive bleeding or bruising has occurred directly after trauma, this would suggest a platelet disorder, whereas delayed bleeding could suggest a coagulation disorder such as haemophilia.

A clinician may also ask you about your family history, and if any platelet, coagulation and vascular disorders have occured in the family. It’s important for a doctor to build up a picture of your general health, and whether warning signs such as weight loss or a fever have manifested alongside the bruising.

Once your patient history has been established, a doctor will look at the bruises and conduct a further examination of the body. A doctor will see how the bruising is distributed, and look for any indications of a bleeding disorder. For instance, if bruises have materialised on the torso.

Bruising on the arms and legs is more common, whereas bruising on the hands or shins is more prevalent in older people.

Besides a physical examination, a urine test may be conducted, which can indicate an underlying bleeding disorder. If bruising is still unexplained, a full blood count with a platelet count should be taken. If a doctor suspects any kind of liver or thyroid dysfunction, they may carry out some function tests, but this is rare.

Our video consultation service is available should you wish to speak to a clinician securely online. Our GPhC-registered clinicians can help to determine a diagnosis and clarify if you need to be seen by a GP in person.

Page last reviewed:  11/06/2020
Types of Treatment

How is bruising treated?

How bruising is treated depends on what the underlying cause is, and whether there is a condition that has caused the bleeding, as opposed to trauma.

If there is no suspected underlying cause for bruising, a doctor will usually recommend painkillers, such as paracetamol. A doctor will, if possible, advise you not to use the drug which has led to bruising, and to monitor whether this is an effective solution. For example, if abnormal clotting has been caused by taking warfarin, finishing the remaining dosage and then ceasing to use the treatment may be advised.

There isn’t always specific treatment available for underlying disorders. For example, there is no specific treatment for HSP, but taking rest can help, and over-the-counter painkillers and NSAIDs can help to relieve joint pain.

The vascular disorder, Ehlers-Danlos syndrome, is mostly treated with physical therapy to strengthen the connective tissue in the joints. It may be necessary to get a brace in order to prevent any potential dislocation. 

For a blood clotting disorder, treatment for conditions such as haemophilia is called replacement therapy. It involves injecting clotting factors into the vein, which help to replace the specific clotting factor that is low. It takes about 15 minutes for the drip to complete an injection, and the process of regular therapy is called preventive prophylactic therapy.

A doctor is likely to refer you to a haematologist if further investigations reveal a low platelet count, or a clotting screen which is abnormal. You will be referred to a hospital urgently if the bruising is a result of active bleeding that is not stopping.

Bruising is a very common symptom of physical trauma which doesn’t usually necessitate any kind of treatment. However, if you are worried about the possibility of an underlying disorder and would like to speak to a doctor online, you can do so by using our video consultation service. One of our registered clinicians can help to determine whether your symptoms warrant further investigations. They are available for consultation between 9.30am-4.30pm, five days a week.

Page last reviewed:  11/06/2020
Questions and Answers

How long is it normal to have bruising for?

If the bruise has been caused by trauma, within one to two days, the bruise will usually turn to a purple colour, before turning green/yellow after five to ten days and disappearing altogether after a couple of weeks. 

Bruising from platelet, vascular or coagulation disorders may take much longer to disappear, depending on how severe the bruising is.

Is bruising serious?

Bruising is usually a symptom of basic physical trauma, from a fall or accidental forceful contact with an object. However, bruising can also be an indication of a serious condition. If bruising occurs without an obvious reason, does not begin to heal, or is concurrent with symptoms such as fever, you should seek urgent medical attention.

Can I get treatment for bruising?

There is no specific treatment for bruising from simple trauma, and there isn’t specific treatment for underlying conditions in some cases. A doctor will recommend taking over-the-counter painkillers for bruising from simple trauma, whereas for disorders such as haemophilia, replacement therapy is required. 

How can I prevent bruising?

There is no way of preventing a bruise, but there are ways you can speed up the healing process. Using a cold compress can stop the bruise from swelling and reduce its size. Elevating the bruised area can lessen the blood flow to it, which will also help to reduce the swelling.

Can I speak to a doctor about bruising?

If you would like to speak to a doctor online about bruising, our GMC-registered clinicians are available for consultations via our video consultation service. From 9.30am-4.30pm, Monday to Friday, they can issue advice about symptoms and treatment, and provide prescriptions and referrals to specialists, where appropriate. 

Page last reviewed:  11/06/2020

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