What Causes a Hematoma? Signs and Treatments
Learn what causes a hematoma, the common signs and symptoms to watch for, and effective treatments. Understand when it’s safe to manage at home and when urgent medical care is needed.
Written by Dr. Vasanthasree Nair
Reviewed by Dr. Rohinipriyanka Pondugula MBBS
Last updated on 12th Sep, 2025
Introduction
A sudden, painful lump under the skin after a bump or fall is a common experience. This collection of blood outside the blood vessels is known as a hematoma. While often confused with a simple bruise, a hematoma is typically more significant, involving larger amounts of blood that can cause pronounced swelling and firmness. Understanding what leads to the signs of a hematoma is crucial for proper care and knowing when to seek medical attention. This article will delve into the various causes, from everyday injuries to underlying medical conditions, explain the key symptoms, and guide you through effective treatment options and important warning signs. Whether you're dealing with a minor subcutaneous bleed or are concerned about a more serious internal hematoma, we've got you covered.
What Exactly is a Hematoma?
A hematoma is defined as a pocket of blood that accumulates in a body tissue, organ, or space. It occurs when a wall of a blood vessel—be it an artery, vein, or small capillary—sustains damage that causes blood to leak out into areas where it does not belong. Unlike a bruise (contusion), which is a minor seepage of blood into tissues close to the skin's surface, a hematoma often involves a larger volume of blood that can create a palpable lump or mass. The body's natural response is to wall off this collection, and over time, special cells work to break down and reabsorb the blood.
Primary Causes: What Leads to Hematoma Formation
The formation of a hematoma fundamentally requires an injury to a blood vessel. This injury can be obvious and traumatic or subtle and spontaneous.
Traumatic Injury
This is the most common cause of hematomas. Any significant impact or force can rupture blood vessels.
Examples: Falls, car accidents, sports collisions, direct blows from an object, and sprains or strains.
Surgical Procedures
Surgery, by its nature, involves cutting through tissues and blood vessels. Despite a surgeon's best efforts to achieve hemostasis (stop bleeding), some oozing can occur post-operatively, leading to a post-surgical hematoma. This is a known risk of any operation.
Spontaneous and Medical Causes
Sometimes, hematomas appear with minimal or no trauma, pointing to an underlying issue.
Blood Thinners (Anticoagulants): Medications like warfarin (Coumadin), heparin, clopidogrel (Plavix), aspirin, and novel oral anticoagulants (NOACs like apixaban) reduce the blood's ability to clot. This makes a person more prone to bleeding from even minor bumps.
Bleeding Disorders: Conditions like hemophilia and von Willebrand disease impair the body's clotting mechanisms.
Thrombocytopenia: A low platelet count, which can be caused by various illnesses or chemotherapy, prevents proper clot formation.
Aneurysms: A weakened, bulging spot in a vessel wall can rupture spontaneously.
Recognizing the Signs and Symptoms of a Hematoma
The symptoms of a hematoma depend heavily on its location, size, and whether it's causing pressure on adjacent structures like nerves or organs.
Localized Symptoms (Superficial Hematomas)
These are the signs you can see and feel on the skin's surface.
Skin Discoloration: The area may appear red, purple, dark blue, or black initially. As it heals, it will change color to greenish and yellowish.
Swelling and Inflammation: The area will often be puffy and raised.
Pain and Tenderness: The site is typically painful to the touch and may ache or throb.
Warmth: The skin over the hematoma may feel warm due to inflammation.
Systemic and Severe Symptoms (Internal Hematomas)
These signs indicate a more serious problem requiring urgent medical evaluation.
Headache, Confusion, or Drowsiness: Key signs of an intracranial hematoma (e.g., subdural or epidural hematoma).
Loss of Consciousness: Even for a brief moment, this is a major red flag after a head injury.
Nausea and Vomiting: Particularly concerning when associated with a head injury.
Severe Abdominal or Back Pain: Can indicate a hematoma within an organ or the abdominal wall.
Vision or Speech Changes: Suggests neurological involvement.
Different Types of Hematomas and Their Locations
Hematomas are classified based on their specific location in the body, which determines their severity.
Subcutaneous Hematoma
This is the most common type, occurring just beneath the skin. It's what most people think of when they get a "goose egg" on their shin or arm.
Intramuscular Hematoma
This occurs deep within a muscle tissue. It's common in athletes and can be very painful, limiting range of motion. A classic example is a quadriceps contusion.
Subungual Hematoma
A collection of blood under a fingernail or toenail, often caused by a crushing injury or impact. It is extremely painful due to the pressure buildup in a confined space.
Cephalohematoma
This occurs in newborns, between a baby’s skull and the skin covering it, often as a result of the pressure experienced during a vaginal delivery.
Intracranial Hematoma (Head Hematoma)
This is a serious collection of blood within the skull.
Epidural Hematoma: Between the skull and the brain's protective lining (dura). Often caused by a skull fracture and is a medical emergency.
Subdural Hematoma: Between the dura and the brain. Common in the elderly after a fall, even a minor one.
Intracerebral Hematoma: Bleeding directly into the brain tissue itself.
Septal Hematoma
A collection of blood within the septum of the nose, usually following a nasal fracture. It can lead to cartilage damage if not drained promptly.
Effective Hematoma Treatment and Management
Treatment is dictated by the hematoma's size, location, and symptoms.
Immediate First Aid (The RICE Protocol)
For most minor, fresh hematomas, start with RICE:
Rest: Avoid using the injured area to prevent further bleeding.
Ice: Apply an ice pack wrapped in a cloth for 15-20 minutes every 1-2 hours for the first 48 hours to reduce swelling and pain.
Compression: Lightly wrap the area with an elastic bandage to provide support and limit swelling. Ensure it's not too tight.
Elevation: Raise the injured area above the level of your heart to help drain fluid and reduce swelling.
Medical Interventions
Drainage (Aspiration): For large, painful, or persistent hematomas, a doctor may use a needle and syringe to drain the collected blood. This is common for subungual hematomas (where a small hole is burned through the nail) or large intramuscular hematomas.
Surgical Evacuation: In cases of recurrent or organized hematomas (where the blood has clotted and hardened), a minor surgical procedure may be needed to open the site and remove the clot.
Addressing Underlying Causes: If a medication like a blood thinner is the cause, a doctor may adjust the dosage.
If a bleeding disorder is suspected, consulting a doctor online with Apollo24|7 can be a good first step to discuss symptoms and necessary blood tests, which Apollo24|7 offers via convenient home collection.
When to See a Doctor: Warning Signs
While many hematomas are harmless, certain symptoms demand immediate medical evaluation. Seek urgent care if you experience:
The hematoma is very large, extremely painful, or continues to expand.
It is located on your head and you have any associated symptoms like a headache, dizziness, vomiting, or confusion.
You develop signs of infection, such as fever, redness, warmth, or pus draining from the area.
You experience numbness, tingling, or loss of function in the limb or area below the hematoma (e.g., foot or hand).
The hematoma occurred spontaneously without any known cause or injury.
You are on blood-thinning medication.
If your hematoma shows any of these red flags, book a physical visit to a doctor with Apollo24|7 for an in-person evaluation and imaging if needed.
Conclusion
A hematoma is a common but often unsettling result of blood vessel injury. While most are minor and resolve with simple home care, understanding the causes—from trauma and surgery to medication side effects—is key to prevention and management. Recognizing the signs, from the classic skin discoloration to the more sinister symptoms of an internal bleed, empowers you to take the right action. Always listen to your body. When in doubt, or if warning signs like rapid expansion, severe pain, or neurological symptoms appear, err on the side of caution and seek professional medical advice. Proper diagnosis and timely treatment are essential for preventing complications and ensuring a smooth recovery.
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(50+ Patients)
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Frequently Asked Questions
How long does it take for a deep tissue hematoma to heal?
A deep tissue or intramuscular hematoma can take several weeks to a few months to fully resolve. The initial pain and swelling should subside within a week or two, but the body needs time to completely reabsorb the collected blood.
Can a hematoma cause a blood clot?
A hematoma is itself a localized clot of blood outside the vessels. However, a very large hematoma can theoretically increase pressure and affect blood flow, potentially contributing to a deep vein thrombosis (DVT) in rare cases. The bigger risk is mistaking a DVT for a simple hematoma.
What is the difference between a bruise and a hematoma?
A bruise is a minor, superficial seepage of blood that causes skin discoloration but doesn't form a significant lump. A hematoma involves a larger volume of blood that pools and creates a raised, often painful swelling.
Why does a hematoma change color?
The color change is part of the healing process. The body breaks down the hemoglobin in the trapped red blood cells. The chemical changes during this process cause the colors to shift from purple/blue to green and finally to yellow before fading.
Is it safe to drain a hematoma at home?
No, it is not safe to attempt to drain a hematoma at home. Using unsterile instruments can introduce a serious infection. Incision and drainage should only be performed by a healthcare professional under sterile conditions.