Health Care and Bruising

Have you ever bumped into furniture or some other large item and felt pain in your body where the accident happened? Do your arms or legs sometimes show up black and blue from hitting them against large objects or perhaps from other incidents? Bruising can occur with the least of bumps, to the most serious of physical trauma, and leave the victim in pain and severe skin discoloration if they are sensitive to that type of physical contact, either from inanimate or living objects.

According to the Mayo Clinic, Most bruises form when small blood vessels (capillaries) near the skin's surface are broken by the impact of a blow or injury — often on the arms or legs. When this happens, blood leaks out of the vessels and initially appears as a bright or dark red, purple or black mark. Eventually your body reabsorbs the blood, and the mark disappears over time. Generally, harder blows cause larger bruises. However, if you bruise easily, a minor bump — one you might not even notice — can result in substantial discoloration. Some people — especially women — are more prone to bruising than are others. As you get older, several factors can contribute to easy bruising, including:

Aging capillaries. Over time, the tissues supporting these vessels weaken, and capillary walls become more fragile and prone to rupture.Thinning skin. With age, your skin becomes thinner and loses some of the protective fatty layer that helps cushion your blood vessels from injury. Excessive exposure to the sun accelerates this process. 

According to BetterMedicine.com, different types of bruises include contusions, hematomas and purpura:

Contusions are common types of bruises that are caused by trauma, often blunt-force injury, that damages and breaks open the tiny blood vessels in the tissues of the skin, mucus membranes or other organs. Contusions are often accompanied by pain and swelling due to the body’s inflammatory response to injury. This is why a bruise on your shin caused by bumping a table can become swollen. When a contusion develops in your skin, it turns red, then black and blue or purple, and finally a greenish-yellow shade as the blood is broken down and absorbed by the body. Bone contusions and deep muscle contusions can be very painful and take longer to heal than contusions that only affect the skin tissues. The most serious type of contusions are contusions of important organs, such as the brain, kidneys, spleen, liver, lungs and heart. These contusions can be life threatening and are generally caused by severe trauma, such as a fall from a significant height, being hit by a car, serious crush injury, or motor vehicle accident, especially without wearing a seat belt.

Hematomas are a type of bruising in which there is significant bleeding that results in a collection of blood that pools at the site of injury. Hematomas can be caused by the same forces that cause contusions but generally cause more pain, swelling and complications than contusions. Hematomas can be also be caused by surgical procedures or spontaneous rupture of a blood vessel, such as a ruptured aneurysm. Hematomas can occur in any area or organ of the body, and when they occur in certain organs, such as the brain or spleen, they can be life threatening. Common hematomas include:

• Epidural, subdural and intercerebral hematomas are collections of blood in the brain and/or under the skull, which can cause a critical increase in pressure in the skull and brain.
• Nasal septum hematoma is a collection of blood that pools in the septum that divides the nose.
• Subcutaneous hematoma is a collection of blood that pools just beneath the skin.
• Subungal hematoma is a collection of blood that pools under a fingernail or toenail.
A shearing injury can also cause a hematoma in major organs. For example, shaking a baby can cause dangerous shearing forces inside the brain, a brain hematoma, irreversible brain injury, and death.

Purpura is caused by spontaneous leaking of blood from tiny blood vessels (capillaries). It is a type of bruising that causes purple or red flat spots or patches on the skin and mucus membranes. Purpura that results in tiny spots on the skin is called petechiae. A large area of purpura is called ecchymosis, although any type of bruising of the skin is often referred to as ecchymosis. Purpura is not caused by trauma, as are contusions, but by a variety of medical diseases, disorders and conditions including:

• Autoimmune diseases, such as lupus and rheumatoid arthritis.
• Certain infectious diseases, such as meningitis, mononucleosis and measles.
• Certain medications, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, antihistamines, and blood thinners.
• Insect bites.
• Leukemia.
• Thrombocytopenia (low platelet count that causes problems with clotting).
• Vasculitis (inflammation of blood vessels).

If you experience easy or frequent bruising, especially if it is associated with nosebleeds or bleeding gums, seek prompt medical care. If you, or someone you know, develops petechiae, which are small, flat, purple-colored spots that can indicate meningitis or other serious conditions, seek immediate medical care (call 911).

You know how a bruise changes color over time? That's your body fixing the bruise by breaking down and reabsorbing the blood, which causes the bruise to go through many colors of the rainbow before it eventually disappears. You can pretty much guess the age of a bruise, according to KidsHealth.org, just by looking at its color:

--When you first get a bruise, it's kind of reddish as the blood appears under the skin.
--Within 1 or 2 days, the hemoglobin (an iron-containing substance that carries oxygen) in the blood changes and your bruise turns bluish-purple or even blackish.
--After 5 to 10 days, the bruise turns greenish or yellowish.
--Then, after 10 or 14 days, it turns yellowish-brown or light brown.
--Finally, after about 2 weeks, your bruise fades away.

It's hard to prevent bruises, but you can help speed the healing process. When you get a bruise, you can use stuff you find right in your freezer to help the bruise go away faster. Applying cold when you first get a bruise helps reduce its size by slowing down the blood that's flowing to the area, which decreases the amount of blood that ends up leaking into the tissues. It also keeps the inflammation and swelling down. All you have to do is apply cold to the bruise for half an hour to an hour at a time for a day or two after the bruise appears.

You don't need to buy a special cold pack, although they're great to keep on hand in the freezer. Just get some ice, put it in a plastic bag, and wrap the bag in a cloth or a towel and place it on the bruise (it isn't such a good idea to apply the ice directly to the skin). Another trick is to use a bag of frozen vegetables. It doesn't matter what kind — carrots, peas, lima beans, whatever — as long as they're frozen. A bag of frozen vegetables is easy to apply to the bruise because it can form to the shape of the injured area. Also, like a cold pack, it can be used and refrozen again and again (just pick your least-favorite vegetables as it's not a good idea to keep thawing and freezing veggies that you plan to eat!).

Another way to help heal your bruise is to elevate the bruised area above the level of your heart, according to KidsHealth. In other words, if the bruise is on your shin, lie down on a couch or bed and prop up your leg. This will slow the flow of the red blood cells to the bruise because more of the blood in your leg will flow back toward the rest of your body instead of leaking out into the tissues of your leg. If you keep standing, more blood will flow to your bruised shin and the bruise will grow faster.

According to MedicineNet.com, on occasion, instead of going away, the area of a bruise will become firm and may actually start increasing in size. It may also continue to be painful. There are two major causes for this. First, if a large collection of blood is formed under the skin or in the muscle, instead of trying to clean up the area, the body may wall the blood off causing what is called a hematoma. A hematoma is nothing more than a small pool of blood that is walled off. This may need to be drained by your health-care practitioner.

A second and much less common problem occurs when the body deposits calcium, the material that makes up the majority of bone, in the area of injury. The area becomes tender and firm. This process is called heterotopic ossification or myositis ossificans. This condition is diagnosed by x-ray and requires a trip to your health-care practitioner.

The terminology describing different types of bruising often refers to not only their appearance but also to their cause. Petechiae refer to very small, 1- to 3-millimeter accumulations of blood beneath the skin. These can appear like multiple tiny red dots on any part of the body (most commonly the legs). Most often these are multiple, and they can suggest that there is serious health problem present. Examples of these are an infection of the valves of the heart (endocarditis) or abnormal function of the blood-clotting elements (platelets). Bruising around the navel (belly button) can be a result of bleeding within the abdomen. Bruising behind the ear (Battle's sign) can indicate that there is a skull fracture. Lastly, bruises that are raised, firm, multiple, and occur without any injury can be a sign of various types of "autoimmune" diseases (diseases in which the body attacks its own blood vessels). Each of these should be evaluated by a health-care practitioner.

Also, avoid taking the medications that can contribute to bruising, according to MedicineNet. If you have any questions about whether or not your medication can contribute to bruising, ask your health-care practitioner or pharmacist. Do not stop any prescription medications without first contacting your health-care practitioner. Finally, pressure applied to the area (by hand, not with tourniquets) can reduce bleeding. People who take medicines that reduce clotting ("blood thinners") or have clotting abnormalities should seek the advice of a physician or other health-care provider immediately, as should the elderly or those who have experienced significantly severe trauma.

Bruising can be caused by many reasons; but they are never to be taken lightly if the bruised area has been exacerbated by a serious health reason or physical issue, or if the bruising appears to be life threatening or critical. Make sure that your doctor is aware of any serious bruising issues, or if you are the caretaker of anyone who has suffered a serious trauma with bruising or from other reasons they have been bruised. Use common sense to treat bruises, and follow up with your primary care provider if there are any complications or additional problems concerning the healing process or other side effects. Use medication correctly to resolve any bruising issues. Bruises are not pretty, but they can be treated.

Until next time.