The symptoms of internal bleeding do not always correspond to the severity of the bleeding. In cases of trauma, the initial lack of signs or symptoms does not mean that a person is in the clear. It is only later that symptoms may develop and turn severe.
Symptoms of internal bleeding include:
With rapid or massive blood loss, lightheadedness and dizziness are common. In cases where the blood loss is gradual, lightheadedness may only occur when a person tries to stand and the blood pressure drops (called orthostatic hypotension).
Pain is a common symptom of internal bleeding as blood irritates tissues. In some parts of the body, such as the chest, the pain may be confined to the area of bleeding. With others, like the abdomen, the pain may be felt in other parts of the body (known as referred pain). For instance, bleeding near the diaphragm is often felt in the shoulder.
It is common for people to display guarding when internal bleeding occurs. Guarding is an unconscious attempt to keep a person from touching a part of the body that is tender or injured.
Shortness of Breath
Shortness of breath can be a symptom of internal bleeding in any part of the body. With blood loss, there are fewer red blood cells to carry oxygen to tissues. The lack of oxygen causes trouble breathing.
Tingling in Hands and Feet
With blood loss, the body often “clamps down” on blood vessels in the limbs to re-direct blood to important organs. The loss of oxygen to the limbs can cause tingling in the hands or feet. Internal bleeding can also cause hyperventilation (rapid breathing) as the body tries to raise oxygen levels.
Changes in Vision
Changes in vision are common with internal bleeding. They can occur before “blacking out” when the loss of blood is rapid or severe. Other changes may be due to a brain bleed, in which blurred vision and double vision are common.
Nausea or Vomiting
Nausea and vomiting may occur due to the loss of blood or in response to pain. These symptoms are common when the bleeding is in the digestive tract or the brain.
Heavy sweating for no apparent reason (called diaphoresis) can occur when blood loss is sudden or severe. The loss of blood can cause a rapid change in body temperature, which in turn can cause sudden, extreme sweating. People often describe this a “breaking out in a cold sweat.”
Bruising can sometimes indicate where a bleed is occurring. Bruising around the navel, referred to as a Cullen’s sign, suggests bleeding in the belly. Bruising on the flank, known as Grey Turner’s sign, can occur when there is bleeding in the abdomen or retroperitoneal space (where the kidneys are located). Extensive bruising can occur with fractures.
Change in Mental Status
A change in mental status, including confusion and disorientation, is a sign that a lot of blood has been lost. This can include a total loss of consciousness. A change in mental status is a sign of a medical emergency.