How to recognize internal bleeding

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Internal bleeding arises if there is a ruptured artery, capillary or vein inside the body. Oftentimes, the bleeding is visible but not evident in some cases.

It is important to note that capillary bleeding can be obvious beneath the skin as bruising. This is not considered serious but can be quite painful if touched. In case an injury occurs in the head, it requires an assessment by a doctor.

As for internal bleeding from the veins or arteries, it is usually deeper beneath the skin surface and result to significant blood loss. This can occur in the chest, abdomen, digestive system or tissues close to the large bones such as the pelvis and femur.

After some time, internal bleeding becomes evident with possible indications such as vomiting up blood or drainage of fluid from the ears.

What are the indications of internal bleeding?

  • Initially, the individual might have no symptoms, but if an organ is bleeding, this can cause pain. The pain might be overlooked upon initial assessment or the individual is distracted by other injuries or issues.
  • The individual might not be able to express pain if confused, drowsy or unconscious. In such cases, it is vital to be aware when assisting an injured individual that has apparent indications or one without any symptoms.
  • After some time, internal bleeding becomes evident with possible indications such as vomiting up blood or drainage of fluid from the ears.
  • Other vague indications that might be present include generalized pain or rigid, tight abdominal muscles.

Classification of internal bleeding


The bleeding from an injury can be seen. In some cases, the bleeding is contained inside the body such as the abdomen or skull. This classification of internal bleeding is easy to identify and can be seen exiting from the following:

  • Ears – bright, sticky blood or blood combined with clear fluid
  • Lungs – bright red, frothy blood being coughed up
  • Stomach – bright, coffee-colored or dark red vomit
  • Intestines – bright red or tarry blood
  • Urinary tract – dark red or pinkish-tinged urine
  • Anus or vagina – red blood mixed with mucus
  • Beneath the skin – dark or purplish discoloration due to the presence of blood beneath the skin

Concealed bleeding

This type of internal bleeding is not evident initially but the symptoms start to manifest over time with the following:

  • “Guarding” behavior over the affected area
  • Nausea and/or vomiting
  • Tight, rigid abdominal muscles
  • Specific or vague discomfort, pain or tenderness
  • Evident swelling of the abdomen
  • Low blood pressure which results to weakness and dizziness. If it is too low, it can lead to loss of consciousness
  • Gradual progression to shock with symptoms such as extreme thirst, pale or clammy skin, rapid weak pulse and breathing

Remember that internal bleeding can be dangerous if not promptly treated.

Disclaimer / More Information

The information posted on this page on internal bleeding is for learning and educational purposes only. To learn to recognize the indications, register for first aid training at one of our training centers located throughout Canada. The training centers are in Edmonton, Calgary, Vancouver, Kelowna, Saskatoon, Victoria, Surrey, Mississauga, Winnipeg, Red Deer, Toronto, Ottawa and Halifax.

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