How Do You Get Internal Bleeding? Causes And Signs

Internal bleeding happens when blood escapes from blood vessels inside the body, not from a visible cut or wound. It can occur anywhere in the body, from the brain and chest to the abdomen and muscles. The causes range from physical trauma, like a car accident or a fall, to medical conditions that weaken blood vessels or interfere with clotting. The signs vary widely depending on where the bleeding is, how fast it is happening, and how much blood is lost. This article covers the most common causes and the signs you need to know.

What Are the Most Common Causes of Internal Bleeding?

Trauma is the most straightforward cause. A blunt force injury from a car crash, a bad fall, or a sports collision can damage organs or rupture blood vessels. The spleen and liver are especially at risk because they are large and have a rich blood supply. A fractured bone can also cause internal bleeding, particularly a broken pelvis or femur. These bones have major arteries running near them, and a sharp bone fragment can tear the vessel.

Medical conditions are another major category. A bleeding ulcer in the stomach or small intestine is a common cause. The CDC reports that about 1 in 10 people will develop a peptic ulcer at some point in their lives, and bleeding is the most common complication. Other conditions include diverticulosis, where small pouches in the colon bleed, and colitis, which is inflammation of the colon. Esophageal varices — enlarged veins in the esophagus often caused by liver disease — can rupture and bleed heavily.

Blood clotting disorders also cause internal bleeding. Hemophilia, von Willebrand disease, and low platelet counts from conditions like leukemia or chemotherapy all make it harder for the body to stop bleeding once it starts. Medications that thin the blood, such as warfarin, apixaban, and rivaroxaban, also increase the risk. Research published in the Journal of the American Medical Association found that anticoagulant use is linked to a significantly higher rate of gastrointestinal bleeding.

What Are the Early Signs of Internal Bleeding?

Early signs depend entirely on where the bleeding is happening. If the bleeding is in the digestive tract, the first sign might be blood in the vomit or stool. Vomit that looks like coffee grounds means blood has been in the stomach for a while and has been partially digested. Black, tarry stool — called melena — indicates bleeding higher up in the gastrointestinal tract, like the stomach or small intestine. Bright red blood in the stool suggests bleeding lower down, such as in the colon or rectum.

Bleeding inside the abdomen can cause pain, swelling, and tenderness. The area may feel firm or tight to the touch. You might also feel dizzy, lightheaded, or unusually weak. These are signs that the body is losing blood volume. The heart has to work harder to pump what blood remains, which can cause a rapid heart rate and low blood pressure. As of 2026, the American College of Surgeons recommends that anyone with unexplained abdominal pain and signs of shock — pale skin, confusion, rapid breathing — be evaluated for internal bleeding immediately.

Bleeding in the brain is a medical emergency with its own set of signs. A sudden, severe headache is the most common symptom. This is often described as the worst headache of your life. Other signs include confusion, difficulty speaking, weakness on one side of the body, vision changes, and loss of consciousness. The National Institute of Neurological Disorders and Stroke states that a stroke caused by bleeding in the brain accounts for about 13% of all strokes. Time is critical — early treatment can prevent permanent brain damage.

How Do You Get Internal Bleeding from Medications?

This is a question many people do not think about until it is too late. Nonsteroidal anti-inflammatory drugs, or NSAIDs, are a common cause. Ibuprofen, naproxen, and aspirin can irritate the lining of the stomach and small intestine. Over time, this irritation can lead to ulcers that bleed. The risk is higher with long-term use, high doses, or if you are over 60. Research from the American Gastroenterological Association estimates that NSAID use causes about 100,000 hospitalizations and 16,500 deaths per year in the United States from gastrointestinal complications.

Blood thinners are the other major medication category. Warfarin, apixaban, rivaroxaban, and dabigatran are prescribed to prevent strokes and blood clots. They work by interfering with the body’s clotting system. This is beneficial when you need to prevent a clot, but it also means that any small bleed — from a minor injury or an ulcer — can become a serious internal bleed. The risk is highest in the first 30 days of starting a new blood thinner. The FDA requires a black box warning on these medications about the risk of serious or fatal bleeding.

Some people report that taking these medications with food or switching to a different brand reduces the risk. This is widely claimed though strong evidence is limited. What the evidence does show is that the risk of bleeding increases with age, with kidney disease, and with the use of multiple medications that affect clotting. If you take a blood thinner, you should know the signs of internal bleeding and discuss any unusual symptoms with your doctor immediately.

What Does Research on Internal Bleeding from Trauma Show?

Trauma is the leading cause of internal bleeding in people under 45. Research published in Trauma Surgery & Acute Care Open found that blunt force trauma from motor vehicle crashes accounts for nearly 60% of all intra-abdominal injuries. The spleen is the most commonly injured organ, followed by the liver. A ruptured spleen can cause massive internal bleeding in a short time. The study found that patients with a ruptured spleen who did not receive treatment within 60 minutes had a significantly higher mortality rate.

Falls are another major cause, especially in older adults. The CDC reports that falls are the leading cause of traumatic brain injury in people aged 65 and older. A fall from standing height can cause a subdural hematoma — bleeding between the brain and its outer covering. This type of bleeding can be slow, with symptoms appearing hours or even days after the fall. This is why doctors often tell older adults who have fallen and hit their head to watch for confusion, drowsiness, or headache over the next 24 to 48 hours.

Sports injuries also cause internal bleeding, though less often than car crashes or falls. A direct blow to the abdomen from a football tackle or a hockey puck can damage the spleen or kidney. The risk is higher in sports with high-speed collisions or hard projectiles. Protective gear reduces but does not eliminate the risk. Some studies suggest that wearing proper padding reduces the risk of serious internal injury by about 50%, but the evidence is based on observational data rather than controlled trials.

How Do You Get Internal Bleeding Causes And Signs in Different Body Areas?

The signs of internal bleeding in the chest can be subtle at first. A small amount of blood around the lungs may cause only mild chest pain and shortness of breath. But as the blood accumulates, it can compress the lung and make breathing much harder. This is called a hemothorax. A tear in the aorta — the large artery coming out of the heart — is often fatal within minutes. The American College of Surgeons notes that only about 10 to 20% of patients with a ruptured aorta from trauma survive long enough to reach a hospital.

When Should You Go to the Emergency Room for Internal Bleeding?

Internal bleeding is not something to wait and see about. If you have any of the following signs, go to the emergency room immediately. The first is a sudden, severe headache that feels different from any headache you have had before. The second is vomiting blood or material that looks like coffee grounds. The third is passing black, tarry stool or large amounts of bright red blood from the rectum. The fourth is a rapid heart rate, pale skin, and feeling faint or confused — these are signs of shock.

Abdominal pain that gets worse over time, especially after an injury, is another red flag. So is coughing up blood. If you are on a blood thinner and you hit your head, you should go to the ER even if you feel fine. The bleeding can be slow and the symptoms can take hours to appear. The Centers for Disease Control and Prevention recommends that anyone on anticoagulants who experiences a head injury be evaluated by a doctor within 24 hours, even if there are no immediate symptoms.

Some people report that cold packs, rest, or pressure can help stop internal bleeding. This is not accurate for internal bleeding that is already happening. Cold packs can reduce swelling from a bruise but will not stop bleeding inside the body. Pressure cannot be applied to an internal bleed. The only treatment is medical care — often surgery, blood transfusions, or medications to reverse the effects of blood thinners. Do not try to manage it at home.

Common Misconceptions About Internal Bleeding

One common myth is that you can always see blood when you have internal bleeding. This is false. Bleeding in the brain, chest, or abdomen may not produce any visible blood at all. The only sign might be pain, confusion, or a drop in blood pressure. Another myth is that internal bleeding always causes severe pain. Bleeding in the gastrointestinal tract can be painless. A person might not know they are bleeding until they see black stool or feel dizzy from blood loss.

Another misconception is that if you feel fine after an injury, there is no internal bleeding. This is dangerous. A slow bleed can take hours to cause symptoms. A subdural hematoma in the brain can take 24 to 48 hours to produce noticeable signs. A slow bleed in the abdomen can cause symptoms to appear only after a liter or more of blood has been lost. The body can compensate for some blood loss by increasing heart rate and constricting blood vessels, which masks the problem until it becomes critical.