External bleeding from a cut or scratch may be so minor that treatment is unnecessary. In contrast, a more extensive wound or cut may produce so much bleeding that stitches are required. Once the bleeding has stopped, however, this type of hemorrhage does not pose a threat to health. Still, there are some types of external bleeding that indicate a serious medical problem that requires prompt attention.
Causes of external bleeding
There are many types of anemia, some of which can cause bleeding problems. For example, bleeding from the nose and gums is a sign of aplastic anemia. Other symptoms include pale skin, breathlessness, fatigue, weakness, and an irregular heartbeat.
After a blow to the head, there may be bleeding from the mouth, nose, and ears, which suggests a concussion or a more severe brain injury. The bleeding may be accompanied by confusion, intense headache, vomiting, and coma.
Bleeding is a symptom of several types of cancer. Most of the bleeding is internal, but there are exceptions. For example, skin cancer is often heralded by a sore or mole that bleeds and fails to heal. A bloody discharge from the nipple is sometimes a symptom of breast cancer. In leukemia there may be prolonged general bleeding from the nose, gums, and mucous membranes. In more advanced leukemia, there may be oozing of blood from the skin.
Vaginal bleeding may be caused by an inflammation of the cervix, the neck of the womb. Bleeding is particularly common after intercourse, and it may be accompanied by an ache in the pelvic area.
In cirrhosis of the liver, which is most often the result of alcohol abuse, there may be bleeding from the nose, vomiting of blood, and blood in the stool.
In dermatitis, the skin becomes inflamed, often with a rash and intense itching. Scratching can break the skin, causing bleeding and possible skin infection. Very often, the dermatitis is related to an allergic reaction; in other instances, it may be from dry skin or chronic eczema. One of the most severe forms of dermatitis is exfoliative, in which there is widespread scaling and shedding of skin, which can result in bleeding.
Extreme dry skin can cause scaling and fissures in the skin. Dry skin also may itch, and scratching can break open the fissures, resulting in bleeding.
In this hereditary disease, the blood fails to clot normally, resulting in severe bleeding. Even a slight scratch can precipitate heavy bleeding. There also may be spontaneous bleeding into the joints and under the skin, as well as bleeding from the gums.
Hemorrhoids are varicose veins that form in the anus. They may be either internal or external, and both types can cause bleeding. Typically, the person notices bright red blood, either in the stool or on toilet paper after wiping. The bleeding is harmless, as are most hemorrhoids, although they may be highly uncomfortable.
Most external bleeding is due to injuries, ranging from minor cuts and scrapes to major lacerations and compound bone fractures in which a broken bone actually protrudes through the skin. An injury that produces heavy bleeding that cannot be stopped requires medical attention.
Many medications can increase bleeding tendencies, usually by interfering with the body's normal clotting mechanisms. Aspirin is perhaps the most familiar example; others include anticoagulants, steroids, certain antibiotics, and arthritis medications.
Everyone develops a nosebleed from time to time, and most are harmless. Sometimes, however, the nosebleed may be difficult to stop, or is a sign of a serious disease such as high blood pressure.
Vitamin deficiencies are rare in this country, but when they occur, abnormal bleeding may be one of the symptoms. A notable example is vitamin C deficiency.
Advice about external bleeding
- Most external bleeding, especially from cuts and other minor wounds, can be stopped by applying pressure and other first aid techniques.
- If a person notices excessive bleeding from even a minor cut, he or she should check any medications to see if they may be interfering with normal clotting. Large doses of aspirin or arthritis medication are especially notorious for producing serious bleeding problems.