Bruises are areas of discolored skin that occur when small blood vessels under the skin break and leak red blood cells into the soft tissues. The purplish discolorations are known as purpura.

Also known as contusions or hematomas, bruises are often due to trauma such as falls and blows from objects or people. Some conditions and medications can make people bruise more easily.

In order to care for a bruise properly, patients should apply ice to the injury, elevate the injury when possible, and rest the injured area. Patients experiencing pain may benefit from taking acetaminophen or another form of pain medication.

Bruises can last anywhere from days to months, but most disappear after a couple of weeks. Although most heal well on their own, complications may develop. Patients should seek medical treatment if a sensation of extreme pressure develops in a bruised area. This may be a sign of compartment syndrome, a rare condition in which an increase of pressure on the soft tissues and structures beneath the skin reduces the supply of blood and oxygen to the tissues. It is a potentially life-threatening complication that often requires surgery to relieve the pressure.

A physician should also be contacted if:

• A patient who usually do not bruise suddenly begin to bruise.
  
  
• An unusually large or painful bruise develops (especially if it appears to develop without an injury, fall or other recognizable cause).
  
  
• A patient bruises easily and experiences abnormal bleeding elsewhere (e.g., nose, gums, eyes, urine).
  
  
• Bruises appear in combination with headaches or persistent pain.   

A bruise is an area of discoloration on the skin caused when blood vessels under the skin break and leak red blood cells. Also known as contusions or hematomas, bruises are commonly caused by trauma such as falls, car accidents, sports injuries and blows from objects or other people.

Some people bruise more easily than others. Women, for example, are more likely to bruise than men. Several factors make some people more susceptible to bruising. These include:

• Certain medications, such as those that decrease the ability of the blood to clot (e.g., aspirin) and those that thin the skin (e.g., corticosteroids), make people more susceptible to bruising.
  
  
• Certain dietary supplements (e.g., garlic, ginger, ginkgo biloba). These supplements may decrease the ability of blood to clot, and therefore increase the risk of bruising as well.
  
  
• Some conditions (e.g., hemophilia) can increase the risk of bleeding under the skin.

In addition, people may begin to bruise more easily as they grow older because the blood vessels become more fragile and the overlying skin becomes thinner.

There are three major types of bruises – subcutaneous (beneath the skin), intramuscular (within the underlying muscle) and periosteal (bone bruise). In addition to skin discoloration, bruises can cause pain and swelling. Periosteal bruises are the most severe and painful.

Bruises can last anywhere from days to months, but most disappear after a couple of weeks. When they first develop, bruises appear pinkish-red or purplish in color. The discoloration is medically known as purpura. A bump may develop at the site and may swell and be tender to the touch. When muscles have been bruised, the affected area may be painful to use.

Proper first aid for a bruise includes:

1. Apply ice. Placing ice on the bruise reduces swelling and helps it heal faster. The ice, which should be wrapped in a cloth to protect the skin, can be placed on the bruise for up to 15 minutes per hour. This can be done for a day or two after the injury or until swelling subsides. Warm compresses can then be used to help speed reabsorption of the blood.
   
   
2. Elevate the injury. When possible, patients should keep the bruised area raised above the level of the heart. This prevents blood from pooling in the injured tissue.
   
   
3. Rest the area. Patients should avoid overworking the muscles in the area of the bruise.
   
   
4. Take pain medication. If necessary, patients can reduce pain by taking acetaminophen or another form of pain medication. However, taking pain medications that thin the blood, such as aspirin, can exacerbate bruising.

Bruises usually heal well on their own. Over time, the body reabsorbs the blood and the discoloration disappears. However, in some cases complications may develop. Having a sensation of extreme pressure in a bruised part of the body is a reason for concern. This is especially true when the affected area is large or extremely painful. A feeling of pressure may indicate compartment syndrome, a rare condition in which an increase of pressure on the soft tissues and structures beneath the skin reduces the supply of blood and oxygen to the tissues. Compartment syndrome is a potentially life-threatening condition. When it occurs, surgery is often needed to relieve the pressure.

In general bruises are mild injuries and heal naturally in a few days or weeks. However, in certain circumstances, a physician should be contacted. These include:

• Patients who usually do not bruise suddenly begin to bruise (particularly after starting a new medication).
  
  
• Patients develop unusually large or painful bruises, especially when they appear to develop without an injury, fall or other recognizable cause.
  
  
• Patients bruise easily or experience abnormal bleeding elsewhere (e.g., nose, gums, eyes, urine).
  
  
• Patients are unable to move a joint in an area near the bruise.
  
  
• Bruises become increasingly painful or swollen.
  
  
• Bruises occur near the eye.
  
  
• Bruises appear in combination with headaches or persistent pain.

These developments require medical attention because they may signal a more serious underlying condition, such as a blood-clotting disorder or blood-related disease. Blood tests may be needed to determine blood platelet levels or the ability of the blood to clot.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following bruise-related questions:

1. How serious is my bruise?
   
   
2. What first aid steps should I take for a bruise?
   
   
3. When should I seek medical treatment for a bruise?
   
   
4. I seem to bruise more easily than others. Is this a cause for concern?
   
   
5. I am bruising more than usual lately. Is this a cause for concern?
   
   
6. How long will my bruise last?
   
   
7. Could one of my medications be causing me to bruise?
   
   
8. Could my bruising be a sign of an underlying medical condition?