Hematoma vs. Hemorrhage Differences and Similarities

Picture of a ruptured blood vessel.

• A hematoma is localized bleeding outside of blood vessels. A bruise (also called contusion) is an example of a type of mild hematoma. 
• A hemorrhage is profuse bleeding from a ruptured blood vessel or copious blood loss.
• A difference is that a hematoma is enclosed bleeding within the tissues, while hemorrhage can be internal (inside the body) or external (visible out the outside of the body). 
   

• Trauma: Both hematoma and hemorrhage can be caused by trauma, ranging from minor bumps to falls and car accidents.  Other causes of hematoma and hemorrhage include surgery or injections with needles.
• Hematoma medications and bruising: Some medications and medical conditions can predispose people to bruise and bleed more easily. 
• Medication Risk: Medications that can increase the risk of hematoma and hemorrhage include
  • blood thinners, 
  • aspirin, and 
  • nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin).
• Blood thinners and supplements: Blood thinners aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs). Some supplements can also increase the risk of bruising and bleeding, include
  • vitamin E,
  • garlic supplements, and
  • Gingko biloba.
• Medical conditions: Medical conditions that can increase the risk for developing hematomas and hemorrhages include
  • chronic liver disease,
  • excessive alcohol use,
  • bleeding disorders,
  • blood cancers, and
  • low platelet count (thrombocytopenia).

The most obvious difference between a hematoma and a hemorrhage is that a hemorrhage may bleed externally. Hemorrhages may also bleed internally and this would not be visible. 

• Hematoma symptoms may include bluish or purplish discoloration of the skin (a bruise) or a lump under the skin. 
• Signs and symptoms of hemorrhage and hematoma differ greatly depending on their location in the body and can range from mild to severe. 
• Both hematomas and hemorrhages can cause irritation and inflammation. This can result in pain, swelling, and redness in the local area. 

Types of Hematomas

Hematomas may be internal (inside the body and not visible to the naked eye) or external (on the outside of the body and visible). Hematomas may be named for their location, for example:

• Subdural hematoma: a collection of blood located between the brain and the outer lining of the brain (dura) 
• Intracranial epidural hematoma: located between the skull and outside the lining of the brain 
• Subungual hematoma: located under a fingernail or toenail
• Hepatic hematoma: within the liver
• Intra-abdominal, peritoneal, or retroperitoneal hematoma: located inside the abdominal cavity

Types of Hemorrhages

• Minor or severe hemorrhage: Hemorrhages may be minor or severe. 
• Minor traumatic bleeding hemorrhage: (minor hemorrhage) that results from small wounds is not considered dangerous. Bleeding stops from these types of wounds stops on their own.
• Severe traumatic bleeding hemorrhage: Severe traumatic bleeding causes a large amount of blood loss and if bleeding is not stopped and the wound is not tended to, a person may die within from loss of blood.
• External bleeding hemorrhage: Hemorrhages may also be internal or external bleeding. 
• External types hemorrhage: of hemorrhages (bleeding) are characterized by blood flowing from orifices on the body such as the nose, mouth, ears, urethra, vagina, or anus. 
• Internal hemorrhage: Internal hemorrhages occur in the blood vessels: arteries, veins, and capillaries, and can also occur in the brain

For simple, minor hematomas and hemorrhages, first aid can be employed. 

• Most bruises can be treated using RICE: 
  • Rest
  • Ice: Apply ice for 20 minutes at a time, several times daily as needed
  • Compression: Use of elastic (ACE) bandages
  • Elevation: Elevate the injured area above the level of the heart 
• First aid for bleeding includes:
  • Stopping the bleeding with direct pressure
  • Gently cleanse the wound with soap and water and rinse well (do not use peroxide or alcohol)
  • Apply antibiotic cream
  • Cover with a bandage

Always wash hands thoroughly with soap and water for at least 20 seconds before and after first aid treatments. 

• External hematomas and hemorrhages can often be diagnosed with a physical examination. 
• In some cases, blood tests may be ordered to evaluate a person with hematoma or hemorrhage to see if there is an underlying condition that may be causing the bruising or bleeding.
• Internal hematomas and hemorrhages may require imaging tests, such as:
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI) 

First Aid and Home Treatments for Hematomas and Hemorrhages

• Mild hematomas (bruises) often go away on their own without medical interventions, and first-aid treatment. Ice and compression to the area may be all that is needed for mild external injuries.
• Mild hemorrhages (bleeding) from small cuts or scrapes usually do not require medical intervention and wounds will heal properly if they are cleaned and covered. 
• Pain from hematomas or hemorrhages may be treated with over-the-counter (OTC) pain medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) but some in some patients, the use of ibuprofen is not recommended as it may increase bleeding. Consult with your doctor before using ibuprofen and similar drugs for pain.

Medical Treatment for Hematomas and Hemorrhages

• More severe hematomas and hemorrhages or those located in certain parts of the body may require medical or surgical treatment. 
• Surgery may need to be surgically drained. 
• If underlying conditions cause hematomas, treating the contributing factor can often treat the hematoma. 
• Medical treatment for hemorrhage depends on the location and severity and may involve direct pressure, wound care with or without suturing, and minor or major surgery in some cases. 

• The prognosis and survival rate for minor hematomas and hemorrhages is very good. Most will not lead to any serious illness or disability. 
• The location and severity of a hematoma or hemorrhage play a role in its prognosis. 
• Hematomas and hemorrhages in sensitive parts of the body, such as the brain or spine, will require medical treatment and can lead to serious complications or death if not treated promptly. 

• Preventing of all hematomas and hemorrhages may not be entirely possible. Small cuts, scrapes, and bruises happen to everyone at some point. 
• In the elderly or patients who take blood thinners or anti-platelet medications falls may cause hematoma or hemorrhage. Preventing falls can often prevent serious bruising and bleeding. 
• Children also are prone to accidents and bumps. Child-proofing the home may decrease hematoma or hemorrhage in young children.