Nearly everyone has gotten bruises at some point in their lives, but you may not know much about them. What causes a bruise? How can you prevent getting a bruise in the first place? If you do end up getting a bruise, can you make it go away? When should you see a doctor?

Bruises appear when blood vessels beneath the skin are broken and cause blood and hemoglobin to seep into the surrounding area. They are typically caused by bumping into or hitting something, but bruises can also be caused by:

• strenuous exercise such as weightlifting

• malnutrition

• vitamin C deficiency (also known as scurvy)

• certain medical conditions such as a bleeding disorder, leukemia, liver disease, or anemia

• alcohol abuse

• use of medications that thin the blood, such as aspirin or steroids, and some medications used to treat heart disease

• some medications used in cancer treatments

While bruises are common and don’t usually indicate any serious health problems, they are unsightly and uncomfortable. Fortunately there are ways to prevent bruises and ways to speed healing if you do get a bruise. Most bruises can be treated at home without a doctor’s care.

What is a bruise?

A bruise is a type of minor skin injury in which blood vessels under the surface of the skin are damaged and broken. Blood and hemoglobin then leak out into the skin surrounding the injury, causing a visible mark on the skin. Bruises do not bleed openly.

Bruises can appear anywhere on the body, but they can be typically bothersome when they happen on your face or head. Bumping your forehead or nose can sometimes create a bruise around your eye, commonly referred to as a black eye.

Bruises do not typically cause complications for a healthy person and are usually accompanied by only mild pain and discomfort when the bruise is touched. Most bruises are not painful unless pressure is applied.

What causes a bruise?

Most bruises are caused by bumping into something forcefully. Dropping something heavy onto your foot can cause a bruise, as can hitting your shin on the edge of a coffee table or falling down and landing on something hard. Any kind of blunt force can cause a bruise.

Some bruises can happen without experiencing an injury. This type of bruising is called ecchymosis, and usually does not feel sore or tender. Older people and anyone with bleeding disorders or other medical conditions can be prone to ecchymosis, but it can happen to anyone.

Excessive or unexplained bruising can be caused by vitamin C deficiency, also known as scurvy. Vitamin C contributes to the building and maintenance of connective tissues, skin, and blood vessels, among other things, and thin skin and weak blood vessels lead to bruising.

Frequent unexplained bruising can also be a symptom of liver disease. The liver makes clotting factors to stop bleeding, so people with liver disease often have a bleeding disorder as a result. Alcohol abuse, certain inherited diseases, and some forms of hepatitis can lead to liver disease.

Symptoms of a bruise

The most easily identifiable symptom of a bruise is the telltale “black and blue” mark, but bruises usually start out more reddish. Over time, the bruise will gradually darken to a purple or blue color which can sometimes look black.

The initial red color is caused by inflammation and blood under the skin’s surface. The purplish color is caused by the blood that has leaked out into the skin and has begun to collect in the area. Most bruises will then fade to a greenish or yellowish hue within a week or two before fading away.

As a bruise heals, the leaked blood and hemoglobin gets broken down by the skin and its components are either reused or excreted. After the iron is removed, the rest of the hemoglobin is converted into biliverdin and bilirubin, producing the green and yellow tint.

A bruise will generally feel tender to the touch for a few days, and you may notice some swelling around the area. Bruises are not prone to infection since they are not an open wound, so you don’t need to keep them bandaged or clean them with antiseptic.

How to prevent bruises

• Keep your home free of tripping hazards such as electrical cords and clutter on the floor.

• Secure area rugs and throw rugs to prevent them from curling at the edges, bunching and rippling, or slipping on the floor.

• Wear shoes with rubber soles to keep from slipping and falling. Avoid walking on icy sidewalks or wet floors, and use handrails wherever they are available.

• Use night lights in hallways, bathrooms, and other areas to prevent tripping accidents at night.

• Close doors, cabinets, and drawers completely so that you don’t run into them.

• Avoid texting, reading, playing games on your phone, and other activities that keep you from watching where you are going while you walk.

• Wear protective gear such as a helmet and elbow pads when bicycling, roller skating, or playing contact sports.

• Make sure to eat a healthy diet with plenty of fruits and vegetables. If your doctor says your vitamin C levels are low, take an over-the-counter supplement. You can also take a collagen supplement to promote skin and vein health.

• Avoid taking over-the-counter NSAIDs unless absolutely necessary. Only use steroids when prescribed by a doctor.

• Keep your liver healthy by drinking plenty of water and avoiding excessive alcohol use.

• Exercise regularly to keep your veins and heart healthy.

• Use compression hose when lifting weights or performing other strenuous exercise to prevent spontaneous bruises from appearing on your legs and feet.

How to get rid of bruises

Even with our best efforts, sometimes bruises happen. Most bruises will go away on their own within two to four weeks without treatment, but sometimes you want to get rid of the pain and visible mark a little more quickly, especially if the bruise is on your face.

You usually will not need to see a doctor to treat a bruise. Most bruises can be treated effectively at home with some simple home remedies to relieve pain and swelling and to make the mark less noticeable.

1. Apply a cold compress to the bruise. The cold will help to constrict blood vessels and minimize the bleeding, as well as preventing swelling and numbing the pain. Apply the compress for 15 to 30 minutes at a time once per hour for best results.

The sooner you can get apply the cold compress, the less blood will leak into the skin and the less visible your bruise will be. If you can apply an ice pack right away, you may be able to keep a bruise from appearing altogether if the injury is small enough.

Make sure that you never apply anything frozen directly to the skin, as this can cause frostbite or otherwise damage your skin. If you are using an ice pack or a bag of frozen vegetables, make sure to first wrap it in a hand towel before placing it on the skin.

If you don’t have an ice pack, you can also soak a wash cloth in very cold water and wring it out tightly. Then place the washcloth on the area. If it gets warm, simply wet it and wring it out again. Repeat the process for up to 30 minutes at a time, once per hour.

2. Elevate the injury. Keeping a bruised area raised above your heart can prevent swelling and help keep visible bruising to a minimum by working with gravity to keep blood and fluid away from the area.

It is especially important to elevate any injury on the legs or feet. Keep the injury elevated as much as possible during the first 24 hours. Depending on the severity of the bruise, you may need to elevate the leg for several days to keep swelling down.

3. Take an over-the-counter pain medication such as acetaminophen to reduce inflammation and relieve pain. Do not take NSAIDs such as aspirin or ibuprofen, as these can prevent clotting and make bruising worse.

If your doctor has prescribed NSAIDs or other medications that thin your blood, do not stop taking them without consulting your doctor first. But if you are taking these medications and you get a bad bruise, you should notify your doctor.

4. Use heat therapy. 24 to 48 hours after the injury, apply a warm compress to the bruise two to three times per day for 10 minutes at a time. This can increase blood flow to the area to help the skin break down the hemoglobin more quickly and make the bruise disappear faster.

A sock filled with rice makes a great moist heat compress. Simply microwave it for up to one minute and then place it on the bruise. Alternatively, you can soak a washcloth in very warm water and then wring it out before applying it to the area.

An electric heating pad can be used, but it is not recommended for bruises. Moist heat generally works better for healing the skin, and heating pads provide a dry heat. Use a heating pad only if there are no moist heat options available, and be sure not to let it get too hot.

5. Use arnica montana. Arnica montana is an herbal remedy known to soothe pain and speed healing. Arnica is typically available in cream or gel form and can be applied directly to the bruise to reduce inflammation and pain. You can also find oral arnica if you prefer.

6. Massage the bruise with apple cider vinegar. Apple cider vinegar can promote healing by increasing blood flow to the area and dissolving blood clots in the area. Soak a soft cloth in a mixture of apple cider and vinegar, and gently massage it into the bruised skin.

7. Apply witch hazel. Witch hazel is known for its purifying properties, making it ideal for removing old blood from a bruised area. Moisten a cotton ball with witch hazel and apply to the mark once or twice a day.

8. Make a tea compress. Black or green tea bags can be moistened and placed directly onto the bruise. The tannins in the tea constrict blood vessels, lightening the appearance of a bruise and preventing it from spreading further.

9. Eat some pineapple. Pineapples contain a combination of enzymes called bromelain. Bromelain is a natural anti-inflammatory that can reduce swelling. If you’re not a pineapple fan, bromelain is also available as an over-the-counter supplement.

10. Apply aloe vera. Aloe vera is well known for its healing and soothing properties. You can apply aloe directly to the bruise as often as you like to help heal the skin and diminish the mark.

11. Drink plenty of water. Dehydration will slow the healing process, so be sure to drink at least 8 cups of water each day, or more if you sweat or if you are ill.

12. Get lots of rest. If you are fatigued, your body won’t be able to heal as quickly. Doctors recommend that most people get between six and eight hours of sleep each night.

13. Take an Epsom salts bath. The magnesium in Epsom salts is known to help remove toxins from the body and provide nutrients vital for health, while the warm bath water encourages circulation and healing. After a hot bath, be sure to replenish your fluids by drinking water.

When to see a doctor?

If you have a condition that prevents clotting such as hemophilia or anemia, you should call your doctor right away if you get a bruise, especially if the bruise is severe. You may need medical treatment to stop the bleeding and prevent further injury.

A painful bruise under a toenail or fingernail should be checked out by a doctor as soon as possible. If too much blood collects under the nail, you could lose the nail. A doctor can create a small hole in the nail to drain the blood and relieve the pressure and pain.

If you are taking medication that thins the blood and notice an increase in bruising, especially if the bruises are unexplained, call your doctor right away. You may need different or additional treatment to keep the bruises at bay and prevent complications.

A bruise that is accompanied by sharp or unbearable pain should be seen by a doctor immediately. You could have a broken bone or other deep wound that requires medical treatment. Home treatment is not recommended in this case.

While most bruises go away within two to four weeks, any bruise that is not greatly improved within two weeks or which refuses to go away could be a symptom of a serious health issue. If you have a bruise that will not go away within three to four weeks, see a doctor right away.

Bruises are a common injury, and medical treatment is usually not necessary for most people. The skin can heal rather quickly on its own, given enough time. But these simple home remedies can help to speed healing and improve the look of the skin after a bruise.

Again, you should see your doctor right away if you have frequent unexplained bruising, or if a bruise does not heal on its own or heals more slowly than expected. A bruise that will not heal can be an indicator of a serious health problem and should not be ignored.

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