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What Causes Bleeding Into The Skin?
Most people will experience occasional minor bleeding into the skin or bruising, often following an injury when the blood vessels break. If the bleeding is severe, spontaneous, or chronic, it will generally need medical attention to prevent serious complications.
Minor bleeding into the skin is a common occurrence and is often no cause for concern. A person may experience bleeding into the skin for various reasons.
This article looks at what bleeding into the skin is and what can cause it. It also covers diagnosis, treatment, and when to contact a doctor.
If a blood vessel ruptures, the blood inside can leak into nearby tissues and spaces. This is known as hemorrhaging. When hemorrhaging occurs directly below the skin, the blood can escape into the surrounding skin and cause it to discolor.
Typically, this skin discoloration is a mixed shade of red, blue, black, and purple. On dark skin, it may appear dark purple, brown, or black.
The number and type of blood vessels that rupture will affect the size and appearance of the skin discoloration and the extent of the bleeding.
Breaking only a few small blood vessels or capillaries tends to cause petechial lesions, or petechiae. These are small, red dots under 2 millimeters (mm) in width that appear on the skin's surface.
If more than a few capillaries rupture in the same area, they can cause purpura. Purpura appears as small patches of reddish-purple discoloration. These patches are larger than 2 mm, generally ranging between 4 mm and 1 centimeter (cm) in width.
Neither petechiae nor purpura blanch if pressed. This means that the discoloration does not disappear after applying brief pressure to the area.
Learn more about the differences between purpura and petechial lesions here.
When many capillaries break close together, blood can pool under the skin's surface to form an ecchymosis. This is a bluish-purple or black bruise that can vary in size. However, it is generally larger than 1 cm in width. Ecchymosis is not always the result of trauma and may not include outward swelling, unlike most bruises.
Bruises that result from trauma are usually tender to the touch and may be slightly swollen.
Bruises vary in their healing time from a few days to several weeks, depending on how severe they are. A moderate bruise typically takes around 2 weeks to fade away entirely. Bruises in the lower legs can sometimes take longer to heal.
Hematomas are pools of clotted or partially clotted blood. They are also caused by broken blood vessels. Hematomas can occur in various places in the body. Some can be minor, but some — such as a hematoma in an organ or body cavity — can be serious or life threatening events.
Most people experience some bleeding under the skin and bruising during their lifetime. However, some people are also more prone to bruising than others.
Certain activities may also increase the risk of bleeding into the skin and bruising. For example, hematomas and contusions are common in many sports.
Some other common causes may include:
Bleeding into the skin can also occur as a side effect of chemotherapy, radiation therapy, and many other medical procedures.
Several health conditions and medications can also interfere with the body's ability to form blood clots. This can lead to excessive or spontaneous bleeding and bruising.
Conditions that are likely to increase the risk of bleeding and bruising include:
Some medications can also increase the risk of bleeding and bruising. These include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and blood thinners such as aspirin (an antiplatelet medication) and warfarin (an anticoagulant).
However, one 2019 review questioned the relationship between NSAIDs and increased bleeding. The authors stated that NSAIDs pose little risk of increasing bleeding incidence following some surgical treatments.
A person should always consider the potential side effects before taking medication and seek professional medical help if they are unsure.
If a person seeks medical help for bruising, a doctor will carry out a physical exam to diagnose the cause. This will often involve dating the lesions and assessing their severity.
Accurately diagnosing bruising can be harder on dark skin tones. A 2020 study reported that alternate light sources may assist in bruise detection on dark skin.
A doctor may also seek to establish the cause of bruising by asking a person about aspects of their medical history, including:
If a person is prone to excessive bleeding, it is important to know this as soon as possible. Otherwise, a small injury could unexpectedly become an emergency. Finding out hereditary risk factors at an early age can help prevent problems and complications later on.
A doctor may order further diagnostic procedures if they are unsure of the cause or think that there could be an underlying medical condition. These procedures can include blood and urine tests, imaging studies such as CT scans, and bone marrow biopsies.
There is no specific way to treat minor skin bleeding and bruising. However, some home remedies may help reduce the pain and swelling and promote healing.
Some common home remedies for minor bleeding into the skin and bruising include:
For more severe cases of bleeding into the skin and bruising, or those resulting from an underlying medical condition, a doctor will put together a tailored treatment plan.
Minor bleeding into the skin or bruising that happens from time to time is rarely cause for concern.
However, anyone who experiences bleeding into the skin with no apparent cause or bruising that lasts for longer than 2 weeks should speak with a doctor.
In addition, individuals taking blood thinners and who experience frequent or severe bleeding or bruising should also seek medical attention.
It is also best to contact a doctor if any of the following symptoms accompany the bruising:
A person should seek immediate medical care if they experience any unexplainable bruising that is sudden or severe.
A person may experience bleeding into the skin and bruising for a variety of reasons. Causes can include minor injuries, trauma from surgical procedures, and certain medications.
Bleeding into the skin may also occur due to other health conditions, such as liver disease, meningitis, or Marfan syndrome.
Most small bruises will heal naturally with rest. Compression, elevation, and medications such as bromelain may assist in the healing process.
If a person experiences persistent, severe, or unexplained bleeding into the skin, they should seek immediate medical care.
Severe Anemia Linked To Seven-fold Increased Risk Of Death Or Life-threatening Bleeding After Childbirth
Pregnant women with anemia are substantially more likely to suffer life-threatening bleeding after childbirth, according to a new study published in the journal The Lancet Global Health.
In a clinical study of more than 10,500 women giving birth in four low-and middle-income countries, a reduction in hemoglobin, the protein in red blood cells that carries oxygen, of 10 grams per liter of blood just before birth increased the risk of life threatening bleeding after childbirth by 23%.
Women with severe anemia (70 grams or less of hemoglobin per liter of their blood) are seven times more likely to die or to become dangerously ill than those with moderate anemia (between 70 and 99 grams of hemoglobin per liter of blood).
Despite the strong association, anemia was not recorded as the cause of severe bleeding in any of the women studied, with the authors stressing that efforts to prevent and treat anemia in women of child-bearing age must be strengthened.
Iron deficiency is the most common cause of anemia. Poor access to a healthy diet, infectious diseases (such as malaria or HIV) and untreated heavy menstrual bleeding are the main causes of iron deficiency in young women.
Severe bleeding after birth, known medically as postpartum hemorrhage (PPH), is the leading cause of maternal death, killing more than 70,000 mothers each year, mostly in low-or middle-income countries.
Links between maternal anemia and PPH have been suggested before but previous studies have been limited by small sample sizes and did not consider different severities of anemia.
In this study, a research team, including from the London School of Hygiene & Tropical Medicine (LSHTM) analyzed data from the ongoing WOMAN-2 clinical trial. In all, 10,561 pregnant women (average age of 27 years old) who were due to give birth vaginally in hospitals in Pakistan, Nigeria, Tanzania and Zambia between 2019 and 2022 were recruited.
Hemoglobin measurements were taken after the women arrived at hospital and just before they gave birth. Doctors assessed whether the new mothers experienced PPH within 24 hours following birth, according to one of three definitions: estimated blood loss of 500 milliliters or more or bleeding sufficient to cause low blood pressure or a rapid pulse (Clinical PPH); estimated loss of 500 milliliters or more (PPH defined by the World Health Organization); calculated estimated blood loss of over 1000 milliliters based on changes in hemoglobin levels and body weight (calculated PPH).
Overall, 742 (7%) of women in the study developed clinical PPH. Those with moderate anemia had a 6.2% chance of experiencing PPH after childbirth, with the risk increasing to 11.2% if their anemia was more severe. According to the study, a 10 gram per liter decrease in the amount of hemoglobin in the blood resulted in a 16% to 23% increase in the likelihood of developing PPH, depending on the definition used. Women with severe anemia were seven times more likely to die or nearly die as a result of severe bleeding than those with moderate anemia.
The authors highlight several limitations of the study, such as potential inaccuracies in estimates of blood loss which they believe may have lessened the observed association between anemia and PPH. As every woman in the trial had either moderate or severe anemia before giving birth, no conclusions can be made about risks for women with milder forms of the condition.
Although such questions will need to be addressed, the authors conclude that the current findings signal the pressing need to not only treat anemia in women of childbearing age but also prevent it if fewer mothers are to lose their lives.
Dr. Ian Roberts, Professor of Public Health at LSHTM, said, "Severe bleeding after childbirth kills one woman every six minutes and anemia greatly multiplies the risk of bleeding and death. Worldwide, half a billion young women are anemic and 20 million are severely anemic. Anemia prevention has been overlooked by the World Health Organization in its efforts to cut deaths from PPH. We need urgent changes in policy and practice."
Obstetrician Professor Rizwana Chaudhri, Head of Translational Research at Shifa Tameer-e-Millat University and lead investigator in Pakistan, said, "We have robust data to show that anemia is an important risk factor for PPH that urgently needs to be addressed before women give birth. The ongoing WOMAN-2 Trial will build on this evidence and find out whether tranexamic acid can be used as an effective intervention for PPH prevention in anemic women."
Raoul Mansukhani, Research Fellow in Medical Statistics at LSHTM, said, "Our study is the first to examine the link between prebirth hemoglobin and PPH in a large sample of women from countries where anemia is common. Our results show that the lower the hemoglobin the higher the risk of severe bleeding and death. Anemia is common and dangerous. Preventing and treating anemia, must be a priority to reduce maternal deaths in these countries and globally."
More information: Raoul Mansukhani et al, Maternal anaemia and the risk of postpartum haemorrhage: a cohort analysis of data from the WOMAN-2 trial, The Lancet Global Health (2023). DOI: 10.1016/S2214-109X(23)00245-0
Read more about the WOMAN-2 trial here.
Citation: Severe anemia linked to seven-fold increased risk of death or life-threatening bleeding after childbirth (2023, June 29) retrieved 29 June 2023 from https://medicalxpress.Com/news/2023-06-severe-anemia-linked-seven-fold-death.Html
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Bleeding After Sex: Doctors Explain The Possible Causes Of Light Spotting After Sex
Noticing light spotting, bleeding or pink discharge after sex can feel scary. You're not on your period and there's no pain during sex – it might leave you feeling worried and concerned about your health. Often our minds jump to the very worst case scenario, such as the bleeding after sex being a sign of a gynaecological cancer. Perhaps, you might also be thinking light spotting after sex could mean you're pregnant.
So, why am I bleeding after sex?While it's important to book in with your GP to have it checked out, it's also highly unlikely to be caused by something sinister, says Dr Claire Bailey, Consultant Gynaecologist and founder of The Vulval Clinic: "Bleeding after sex is a common symptom and there are several reasons why it can happen. This can range from light spotting to a heavier 'period-like' bleed. While spotting after intercourse is normal, if you've experienced bleeding for more than three months then you should see a specialist."
As Dr Pixie McKenna, GP at The London Clinic adds, "Bleeding after sex can be seen as an embarrassing symptom, meaning people will often put off going to the doctor about it, but we're not bothered, so you shouldn't be either. We're not there to stand in judgment."
Spotting following intercourse can be caused by a myriad of reasons, she explains – all of which are detailed below – and Dr McKenna also wants to advise that an examination is likely to be necessary. "If you go and see a GP or another healthcare professional about post-coital bleeding, anticipate that you're going to have an examination."
While these sort of check-ups aren't something any of us relish, (much like smear tests) they're incredibly important and will be over in minutes (if you're nervous, it can help to let your doctor know beforehand, as they may be able to offer extra support).
Is it normal to bleed after sex?According to gynaecological cancers charity, The Eve Appeal, bleeding and light spotting after sex is more common than you might think if you're pre-menopausal. "Most of the time it isn't something to worry about," they say. "But do still note it down if it's something you experience, as well as whether or not you experience any pain – it's always worth investigating."
The NHS website refers to bleeding after sex as "postcoital bleeding" and also say that you can visit a sexual health clinic (or GUM clinic) for advice. They add that "in rare instances, bleeding and light spotting after sex can be a sign of cervical or vaginal cancer", and that you may also need to take a pregnancy test when you visit a healthcare professional to discuss it.
What causes light bleeding and spotting after sex?An STI
"Sexually Transmitted Infections (STIs) are certainly a very common thing to consider if you've bled after sex, even if you haven't had any other symptoms, like discharge, pain or change in your urination," says Dr McKenna. "A lot of people with vaginas who've had an unprotected sexual encounter will look for the morning after pill but, in the absence of symptoms, may not go any further in terms of checking themselves for STIs." It's important to detect if you have an STI, particularly chlamydia, as it can have long-term consequences, such as ultimately leading to infertility.
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"Even if you last had unprotected sex months ago, but you've only just started post-coital bleeding, don't rule out an STI, adds Dr McKenna. "The length of time after contracting an STI that you'd bleed very much depends on the person, so the fact that you might have started bleeding now and you only had sex two months ago is irrelevant." The majority of STIs can be cured quickly and easily through medicine, and can be checked for via swabbing or a quick blood test.
Pelvic Inflammatory Disease
This usually occurs as a long-term result of an undetected STI, and can also lead to bleeding or light spotting after sex, or even sometimes during. "It can be down to a number of infections, one of which is chlamydia, but it can also be gonorrhoea, mycoplasma, ureaplasma, or anything really," says Dr McKenna, who notes that on rare occasions Pelvic Inflammatory Disease (PID) can also be caused by infections that haven't been transferred sexually.
Look out for other symptoms such as a niggly, low-grade pelvic pain, discharge, as well as urinary issues if you think you might have PID. "I've had patients in the past who thought they were experiencing recurring cystitis, when actually they had a sexually transmitted infection that took a while to diagnose."
As Dr Bailey also warns, PID can have long-term consequences so it's wise to get it checked out ASAP.
Vaginal dryness
Vaginal dryness could be another potential cause of bleeding after sex, as not being fully lubricated down there (sometimes diving straight into penetration doesn't allow enough time to get wet) can lead to vaginal tearing.
"If penetration occurs in a woman who is not aroused, it is possible for tears to occur, usually at the entrance of the vagina. These splits or fissures can bleed during sex and are often very tender," explains Dr Bailey.
The menopause, although unlikely for younger women, could also be a cause, as the tissues of the vagina become dry and atrophic due to a lack of oestrogen. This could also be the case for people with a very low body mass index (BMI).
"Anyone who has a skin condition around their vagina which make the skin more likely to bleed, such as psoriasis, could also consider that a possible cause," adds Dr Mckenna, advising foreplay and a water-based lubricant to ease any vaginal dryness. "Keep the lube as boring and as basic as possible. Go for the most straight forward option."
Pregnancy
"Pregnancy can cause bleeding after sex," says Dr McKenna, advising a pregnancy test if you're concerned. She does, however, note that it's probably worth exploring other options – STIs and other cervical issues – alongside this unless you're expecting to be pregnant. If you're already aware that you're expecting, bleeding during pregnancy could be worrying, but a visit to your GP should hopefully alleviate any concerns. It certainly isn't always cause for concern (but it's best to double check).
Contraception
"Hormone contraceptive coils can cause bleeding with intercourse," says Dr Bailey. "The Mirena and Kyleena coils contain a progesterone which is slowly released over five years and keeps the lining of the womb very thin. This often leaves people without periods, but many users note they have light bleeding after sex."
As the bleeding is so light for many people, it's not a deterrent for getting these coils and usually doesn't need medical attention. However, if you're concerned, book an appointment with your GP.
Rough sex
It makes sense that sex, when it's a little more on the vigorous side, could cause friction and therefore enough trauma to potentially make you bleed, says Dr McKenna, adding that "sex with a new partner, different positions or something you're not particularly used to" can also have the same effect.
She notes, "If you've got a partner with any body piercings, they can obviously cause bleeding on occasion too." Dr McKenna clarifies that if this is the case, a GP appointment isn't strictly required. "[You can] do the analysis yourself to work out whether it's likely."
If you haven't consented to sex being rough (or have experienced something during sex that made you feel uncomfortable), it could be a warning sign that you're in an unhealthy relationship and you should seek support.
Not having had sex in a long time
While Dr McKenna confirms this can lead to bleeding – "a one-off bleed after restarting your sexual career after a long break is probably innocuous," she says – she does clarify that any recurrence would rule this out as a cause. If that's the case, she advises, "You've got to be sensible and get it looked at, because none of us can look at our own cervix. Even if you're a doctor and you've got the best equipment in the world, somebody else has got to do it for you. It's very important."
Colin Anderson/Blend Images//Getty Images
Cervical ectropion
Dr McKenna likens a cervical ectropion to a gynaecological version of walking around with the inside of your lip exposed. "The cells inside your cervix can sometimes poke out externally and, just like the soft part of the lips, the lining is more delicate so it's going to get very irritated," she explains. "The inner cells poke out to the outside and they can become weak, meaning they can bleed on contact."
This kind of contact could be made by a penis during sex. She notes that ectropion is more commonly seen in those on the pill and explains that it's normally not a cause for concern long-term. "It can settle down if you remove the thing that's causing it, so changing or coming off the pill," she says, adding that a chat with your GP can decide if this is the best move for you. Doctors can also decide to cauterise an ectropion, which effectively burns the cells off using silver nitrate to make the tissues react, then heal.
Cancer
Cervical cancer is the most common cancer in women under 35, so it's obvious that this could be a concern for young people who bleed during, or after, sex – but it still doesn't make it likely. Still, as a possible symptom, Dr Bailey suggests being checked by a doctor to be on the safe side. "Having regular cervical smear tests can ensure your risk of developing cervical cancer is low."
Bleeding during sex could also be an indication of any of the five gynaecological cancers, not only cervical, Dr McKenna notes, adding that other symptoms are likely to be present if a cancer is the cause.
"With vulval cancer, women will have had some type of lesion, growth or some type of change in the external skin of their genitals," she adds. "Many of us don't continually examining our bits and sometimes we don't really know what we're looking for anyway because we're not hugely familiar with our own anatomy. So if in doubt, get checked out."
Severe thrush
"If you had a bad thrush infection that was affecting your vulva, becoming vulva vaginitis, then the trauma of sex could cause this to bleed," says Dr McKenna, adding that it's extremely rare. The reason for bleeding in this instance would be due to inflammation and irritation externally to your genitals.
Polyps
Polyps, which Dr Bailey describes as "benign fleshy growths" which can appear anywhere on the body, can be a cause of bleeding after sex when they grow on the cervix. "These growths bleed with contact, like penetration." However, the doctor says that these unwanted guests can be removed easily without the need for anaesthesia.
This article is not intended to be a substitute for professional medical advice or diagnosis. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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