Hematoma

Overview

A hematoma is a pool of blood that collects outside your blood vessels. It happens when a blood vessel is damaged — often by a bump, a knock, a fall, or an injury — and blood leaks into the tissue around it. The blood gets trapped there and forms a swelling or a lump. A common bruise is a small hematoma. Hematomas can sit just under the skin, deep inside a muscle, under a fingernail, or, less often, deeper inside the body near an organ.

Yes, very common. Almost everyone gets small hematomas (bruises) from time to time, and they are one of the most frequent reasons people ask for advice about a lump or a bruise.

Anyone can get a hematoma. They are more likely if you play contact sports, take medicines that make your blood slower to clot, have a bleeding disorder, or are an older adult, whose skin and blood vessels are thinner and more fragile. Children get them often from everyday play and falls.

Symptoms

Common symptoms

• A swelling or a soft or firm lump under the skin
• Skin colour change — red, purple, blue, green, or yellow as it heals
• Pain or tenderness when you touch the area
• The skin over the area feeling warm
• Stiffness or aching in the nearby muscle
• Less movement than usual in a nearby joint, if the hematoma is deep

Symptoms in children

• Bruises on the shins, knees, and forehead are very common in children who run, climb, and play sport
• A lump that appears soon after a bump and is sore to touch
• Crying or guarding the area when it is touched
• Seek advice if a child has bruises with no clear cause, bruises in unusual places (such as the back, tummy, or ears), or if a baby who is not yet crawling or walking has bruises

Symptoms in older adults

• Bruises can appear with very little force, because skin and blood vessels become more fragile with age
• Bruises may be larger and take longer to fade
• Blood-thinning medicines make bleeding more likely and can make a hematoma bigger
• A hard lump may remain for several weeks after the bruise has faded
• Any bang to the head should be taken seriously, especially if you take a blood thinner — get medical advice even if you feel fine

Causes

Main causes

• A bump, knock, fall, or blow to the body — the most common cause
• Sports injuries and strains, where muscle fibres and small blood vessels tear
• A needle or injection, especially blood tests, vaccinations, or blood donation
• Squeezing or trapping of skin, such as a finger caught in a door, which causes a blood blister under the nail
• Repeated rubbing or pressure on the ear, which can cause a collection of blood in the ear (sometimes called cauliflower ear)
• Medical procedures or surgery
• In rare cases, bleeding inside the body with no obvious injury — for example in the brain or the tummy

Risk factors

• Taking medicines that slow blood clotting, such as blood thinners
• A bleeding disorder, or a low number of platelets (the cells that help blood clot)
• Older age, because skin and blood vessels become more fragile
• Liver disease or heavy alcohol use, which can affect clotting
• Contact sports such as rugby, football, boxing, or martial arts
• Not wearing protective equipment at work or during sport
• Conditions that cause easy bruising, and some treatments such as steroids or chemotherapy
• Problems with balance or eyesight that make falls more likely

When to see a doctor

See a doctor urgently if:

• Any head injury where you feel unwell, drowsy, confused, or are vomiting — call your local emergency number if symptoms are severe
• A hematoma that keeps growing or becomes very painful
• A limb that feels numb, cold, or weak, or looks pale
• Fever, spreading redness, or pus around the area
• A very painful collection of blood under a nail
• You take a blood thinner and have had a bang to the head or a large swelling

Book a routine appointment if:

• A hematoma that has not started to improve after about two weeks
• A firm lump that stays after the bruise colour has faded
• Bruises that appear without a clear cause, or come back often
• You are bruising much more easily than before
• You have questions about whether a medicine you take could be making bruising worse

Diagnosis

Most hematomas are diagnosed with a simple conversation and a physical examination. Your doctor will ask how the injury happened, how long the swelling has been there, whether it is painful, and about any medicines you take. They will look at the area and gently feel it, and they may measure it so they can tell whether it is changing.

Tests that may be done

• Usually no tests are needed for a small hematoma under the skin
• An ultrasound scan, which uses sound waves to show what is inside a swelling — it is quick and painless
• A CT scan or MRI scan if the hematoma is deep inside the body or near the head
• Blood tests to check your blood count and how well your blood clots, if you bruise easily or take a blood thinner
• Sometimes a small sample of the fluid is taken with a needle to check for infection

What to expect at your appointment

The appointment is usually short and gentle. Your doctor may press lightly around the area and ask you to move the nearby joint. If a scan is needed, it is painless and you can usually go home the same day. You should get a clear explanation of what was found and what to do next.

Treatment

Most hematomas need time rather than treatment. Your body slowly breaks down the trapped blood and carries it away, which is why the colour fades over days and weeks. The aim of treatment is to ease pain and swelling, protect the area while it heals, and check for anything that needs more attention.

Self-care at home

• Rest the area and avoid using it heavily for the first day or two
• Hold a cold pack — a bag of frozen peas wrapped in a cloth works well — against the area for up to 15 to 20 minutes at a time, with a break in between. Never put ice directly on bare skin
• Raise the area, if you can, to help reduce swelling
• A gentle compression bandage may help if a healthcare professional advises it — it should feel snug, not tight, and you should not feel numbness or tingling
• Avoid heat, hot baths, saunas, and alcohol for the first couple of days, as these can increase bleeding
• Avoid massaging or deep-rubbing the area early on, as this can make bleeding worse
• Ask your pharmacist or doctor which pain relief is suitable for you, especially if you take other medicines
• Once the pain is easing, gentle movement helps — start slowly and build up

Medical treatments

If the hematoma is large, painful, or not settling, your doctor may discuss options with you. These can include reviewing any medicines that affect bleeding, draining the trapped blood with a needle or a small procedure, treating an infection if one is present, or referring you to a specialist. Physiotherapy may be suggested afterwards to help a muscle or joint get back to normal. Your doctor will explain the benefits and risks of each option so you can decide together.

When is surgery considered?

Surgery is only needed in some situations — for example if a hematoma is very large, is pressing on a nerve or blood vessel, has become infected, is inside the skull, or is a very painful blood blister under a nail. Most hematomas never need an operation, and your doctor will explain clearly if they think you do.

Living with this condition

In the first few days, you may notice the swelling is firm and the colour changes a lot. That is normal. Keep the area comfortable, follow the self-care steps, and check it once a day to see whether the swelling is shrinking and the pain is easing. Most people are back to normal activities within one to two weeks, though a hard lump can linger for longer.

Lifestyle tips

• Wear proper protective gear for sport and for any physical work
• Make your home safer to reduce falls — good lighting, no loose rugs, and grab rails if you need them
• Keep physically active in general, as stronger muscles help protect joints
• Go easy on alcohol, which can affect clotting and make falls more likely
• If you smoke, ask for help to stop — smoking slows healing
• Tell any healthcare professional you see that you bruise easily, and mention all medicines and supplements you take

Diet and exercise

There is no special diet for a hematoma. Eating well and drinking enough fluids supports healing. Iron-rich foods — such as beans, lentils, leafy greens, and lean meat — help your body rebuild healthy blood, and vitamin C helps you absorb iron. If you have lost a lot of blood or bruise very easily, ask your doctor whether your iron levels should be checked. Gentle movement is good once the pain settles; start with easy activity and build up. Avoid heavy lifting or contact sport until the area feels comfortable again.

Mental health and emotional wellbeing

It is common to feel worried, especially after a bang to the head or if the hematoma is on a child. Seeing a large bruise or lump can be unsettling even when it is harmless. Most of the time the worry fades as the swelling goes down. If anxious thoughts are stopping you sleeping, eating, or getting on with your day, please talk to your doctor — that is a normal thing to ask for help with. If you ever feel unable to cope or have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away, or reach out to someone you trust.

Prevention

Many hematomas can be prevented, though not all. Wear the right protective equipment for your sport or job, warm up before exercise, and take care to reduce falls at home. If you take a medicine that slows clotting, keep regular reviews with your doctor and ask about safety steps. Some causes — such as a bleeding disorder — cannot be prevented, but they can be managed well with the right care.

Screening programmes

There is no routine screening programme for hematomas. However, if you bruise easily or without a clear cause, your doctor may suggest a blood test to check how well your blood clots. That is a sensible precaution, not a reason to worry.

Complications

If left untreated

• The hematoma may keep growing and cause more swelling and pain
• A large hematoma can press on nerves or blood vessels, causing numbness, weakness, or poor circulation
• Trapped blood can occasionally become infected
• Some hematomas leave a firm lump or scar tissue that takes months to soften
• A very large hematoma can cause a drop in red blood cells (anaemia), leading to tiredness and breathlessness
• A hematoma inside the skull can press on the brain and is a medical emergency
• A hematoma in a limb can, rarely, raise the pressure inside the muscle — this needs urgent care

Long-term outlook

For most people, the outlook is very good. Small hematomas heal completely with time and simple self-care, and the skin usually returns to normal. Larger or deeper hematomas can take several weeks, and a firm lump may be felt for a while, but this usually softens. If you have an underlying condition or take a blood thinner, your doctor can help you manage it so that bruising causes fewer problems. The important thing is to get checked if something is not settling or if you are worried.

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