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A bruise, also called a contusion, occurs when an injury breaks blood vessels under your skin. This causes blood to leak into the tissue beneath your skin, resulting in a visible blue-black spot.
In addition to appearing just under the surface of your skin, bruises can also develop in the deeper tissues of your body. Internal bruising can occur in the muscles of the legs and back. It can also occur in internal organs, such as the liver and spleen.
Read on to find out more about the symptoms, causes, and treatments.
Symptoms of internal bruising can include:
- pain and tenderness in the region of the injury
- bruising under the skin of the injured site, in some cases
- limited range of motion in surrounding joints (muscle bruising)
- hematoma, a pool of blood that collects around the injured site
- blood in urine (kidney bruising)
Seek immediate medical attention if you observe any of the following symptoms. They may indicate more severe internal bleeding or shock:
- symptoms that don’t get better or get worse
- fever of 100.4°F (38°C) or higher
- pain, numbness, or weakness in one or both legs (back bruising)
- nausea or vomiting
- rapid pulse
- pale skin
- shallow breathing
- dizziness or fainting
- confusion
Internal bruising can occur in many ways, typically through an accident or some kind of blunt trauma.
Legs
Bruising in the legs is very common in people who play sports. Direct blows or falls typically cause the injury. When the injury occurs, the muscles of your leg become compressed and are crushed in an unnatural way.
Bruising in the legs often occurs in the quadriceps muscle at the front of your thigh, an area that can be prone to direct blows.
Stomach or abdomen
Bruising in your stomach or abdominal area is typically caused by:
- direct blows to your abdomen
- a fall in which you injure or land on your stomach
- accidents, such as a car accident
The trauma from the injury causes blood vessels in the affected tissue to break open. This leads to bruising.
Back or spinal cord
Similar to bruising of the stomach or abdominal area, bruising of the back or spinal cord can occur in the event of a fall, accident, or injury. Bruising typically occurs when an area of the back is compressed due to the accident or injury.
Head and brain
Brain bruising can occur due to a blow to the head or a whiplash injury, often in the event of a car accident.
Bruising can occur through what’s called a coup-contrecoup injury. The initial bruising, called the coup, happens at the site of the trauma. As the brain is jolted from the injury, it can hit the skull and cause another bruise, called the contrecoup.
Treatment for internal bruising can be very individualized, depending on both the location and the severity of the bruising.
Legs
Treatment for bruising in the leg involves following the RICE formula:
- Rest. Avoid further strenuous activities.
- Ice. Apply ice to the affected area for 10 to 30 minutes at a time.
- Compression. Use a soft wrap, such as an ACE bandage, to compress the injured area.
- Elevation. Raise the injured area above the level of the heart.
In cases of more severe bruising in which you can’t put weight on the injured leg, you may need crutches until the injury has healed sufficiently. Your doctor may also suggest that you take medication for pain relief, such as ibuprofen (Advil).
Avoid applying heat to and massaging the affected area while it’s healing.
Before you can increase your activity level, you’ll need to rehabilitate the injured area. This may take several weeks, depending on the extent of your injury. The initial steps involve stretching exercises to help you regain your range of motion in the affected area.
After that, your doctor will give you both strengthening and weightlifting exercises to help you get back to your full strength and endurance.
Stomach or abdominal area
Treatment for bruising in the abdominal area is dependent on both the location of and how severe the injury is. In some cases, your condition will need to be monitored in a hospital. Treatment may include:
- avoidance of strenuous activities or bed rest
- medication to control pain, either over-the-counter or prescribed by your doctor
- intravenous (IV) fluids
- testing for additional injury or blood loss
- blood transfusion
- surgery to drain excess fluid from your abdomen or to find and stop the source of bleeding
Back or spinal cord
For bruising of the back, your doctor will recommend rest. Avoid strenuous activities or lifting anything that’s heavy. Your doctor may recommend applying ice to the site of injury. This will help lessen pain and swelling. They may also prescribe pain medication.
A damaged or bruised spinal cord can’t be repaired, but doctors and researchers continue to investigate ways to regenerate damaged spinal tissue. You may need surgery to help stabilize the injured area or to relieve pressure. Treatment and rehabilitation will likely be long term.
Head and brain
Like many cases of internal bruising, treatment for bruising of the head and brain is very dependent on the severity of the injury. Treatment can include:
- applying ice to the site of injury
- bed rest
- observation at the hospital
- monitoring for increased pressure within the skull
- assistance with breathing, such as being placed on a ventilator or breathing machine
- surgery to relieve pressure on the brain
The outlook for internal bruising is dependent on both the location and the severity of the bruising. In cases of mild bruising, your doctor may recommend home care that involves rest, application of ice, and control of pain. Cases of more severe internal bruising may require observation at the hospital or surgery to treat.
Many cases of internal bruising are a result of blunt trauma, a fall, or an accident. Because of this, it’s important to reduce risks when possible.
Always wear your seatbelt while driving. Make sure to wear the proper protective equipment when playing sports. It’s important to make sure that you’re as protected as possible should an accident occur. Doing so will help prevent many bruises.