Bleeding, internal

It is sometimes difficult to know when a person is bleeding internally, especial­ly in the absence of an injury. In most cases, however, internal bleeding is indicated by the presence of blood in the vomit, stool, or urine, or by coughing up blood.

Extensive internal bleeding can result in shock. Symptoms to watch for include feelings of anxiety and light­headedness; fainting; dilated pupils; cold, clammy skin; paleness; rapid, shallow breathing; shortness of breath; and a swollen abdomen. Even though there are no obvious indications of hemorrhage, shock is always serious and requires immediate attention.

More often, internal bleeding entails chronic loss of small amounts of blood. Unless this type of hidden, or occult, bleeding is detected and treated, it can lead to severe anemia. This type of bleeding may also indicate a serious underlying disease, such as cancer.

Causes of internal bleeding

Bleeding is common in many types of cancer. Sometimes the bleeding is obvious, but more often, cancer-related bleeding is internal, with perhaps some external manifestations. For example, blood in the stool can indicate cancer of the colon or rectum, while vaginal bleeding could suggest cancer of the cervix, uterus, or ovary. Blood in the urine may signify kidney or bladder cancer. One sign of stomach cancer is vomiting blood; esophageal cancer can also produce vomiting or spitting up blood.

In this disease, which is most commonly caused by alcohol abuse, scar tissue forms in the liver and obstructs the flow of blood. In the advanced stages of cirrhosis, there may be heavy bleeding into the esophagus.

Colon polyps
Colon polyps are small, grape-like growths that form clusters inside the large intestine. Some are hereditary (familial polyposis) and have a high probability for becoming cancerous. More often, they are harmless; both types, however, are a common cause of hidden intestinal bleeding.

In diverticulosis, small out­pouches form along weakened segments of the colon wall. Sometimes these pouch­es become impacted with fecal material, causing inflammation. In severe cases, one or more of these outpouches may rupture, causing bleeding and spilling the colon contents into the abdominal cavity. This can lead to life-threatening peritonitis.

Gastric disorders
Gastrointestinal bleeding may be caused by a variety of disorders, as well as by certain medications. Aspirin, for example, can be the culprit if taken often and in high doses. Gastrointestinal bleeding ranges from mild to severe, and in conditions such as a peptic ulcer, it can cause massive hemorrhage and death if treatment is delayed. If massive bleeding occurs, other symptoms may include pain, heavy perspiration, vomiting blood, bloody stools, and shock.

This is an inborn defect of blood coagulation. It affects only males, although women carry the causative gene. Children who have it often bleed into the joints, resulting in joint pain, swelling and deformity. Even a trivial injury can result in severe internal and external bleeding.

Some forms of leukemia can cause internal bleeding. Other symptoms may include high fever, joint pain, fatigue, pallor, and abnormal blood counts.

Marfan's syndrome
This inherited disorder can cause weakness of the aorta, the largest artery that carries blood from the heart for distribution to all parts of the body. Severe, internal bleeding can occur if an aneurysm develops and ruptures.

Miscarriage and menstrual disorders
Severe vaginal bleeding may occur during a miscarriage. It also may be a sign of approaching menopause or failure to ovulate. Vaginal bleeding that is unrelated to pregnancy or menstruation is a common sign of cancer.

Vascular disorders
These are disorders of the blood vessels in which inter­nal bleeding is a likely symptom. Purpura, in which blood vessels are fragile and the person bruises easily, is one of the most common of these disorders. There may also be fever and joint pain.

Advice about internal bleeding

  • In most instances, there are no first aid techniques for stopping severe internal bleeding. Call an ambulance at once, or take the victim to the nearest hospital emergency room.
  • Black tarry stools are a sign of possible hidden internal bleeding that always should be checked by a doctor.


This article was last reviewed December 16, 2005 by Dr. James Krider.

Acute gastritis
Acute intestinal bleed
Bladder cancer
Bleeding abnormalities
Cervical cancer
Chronic gastritis
Colon cancer
Colon polyps
Endometrial cancer
Esophageal cancer
Hereditary colon polyps
Hidden intestinal bleed
Kidney cancer
Marfan's syndrome

Ovarian cancer
Peptic ulcers
Stomach cancer
Stomach ulcers
Ulcerative colitis
Uterine cancer
Vascular bleeding

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