Bleeding symptoms

Nosebleeds are common. Anyone can experience them, but nosebleeds are more frequent in children, the elderly and during pregnancy. Bleeding can occur from one or both nostrils, be light or heavy, and usually stops within a few minutes. Nosebleeds aren’t usually serious, but if your nosebleeds last for several minutes, they may be a sign of an underlying medical condition.

Nosebleeds originate from the many tiny, delicate blood vessels in your nose. These are easily damaged by picking your nose, blowing your nose too hard, or by minor nose injuries. Changing temperature and humidity may dry out the inside of your nose and this can also lead to bleeding. These nosebleeds are more common in children than adults and can often be treated at home.

Bleeding can also start from deeper inside the nose. These nosebleeds can be more serious and may require medical attention. Causes for this type of nosebleeds are surgery, injuries to the nose or to the head, or medicines that prevent blood clots. Heavy nosebleeds can also occur if blood clotting doesn’t work properly due to a bleeding disorder such as haemophilia or von Willebrand disease (VWD). In fact, frequent and long-lasting nosebleeds are one of the typical symptoms of VWD.¹

Oral bleeding usually occurs from the gums around the teeth. You may also experience bleeding from the tongue, lips or inside of the cheek, often caused by accidents. Gum bleeding may also arise due to gum inflammation, or gingivitis, a common and mild form of gum disease. If you have gingivitis, your gums may be swollen, red and sore. Your gums may bleed after teeth brushing, flossing or eating hard foods. Persistent gingivitis affects your eating habits, social life and intimacy and thus has a strong impact on your quality of life. In healthy people, bleeding after brushing or flossing should stop after seconds. However, if you have VWD, your gums may bleed frequently and the bleeding may last for 5 minutes or more.

To avoid gum bleeding, we recommend that you brush your teeth for two minutes, twice a day. A fluoride-containing toothpaste helps to keep your gums and teeth healthy. Together with regular check-ups, this will reduce the need for surgery or a tooth extraction. Thus, we recommend that you see a dentist at least twice per year.¹

Bruising is the skin’s reaction to minor trauma, like an accident, fall, or a medical procedure. The trauma damages blood vessels under the skin and blood leaks into the surrounding tissue. The blood pools under the skin, and forms a black, purple, or blue bruise. As the bruise heals, the colour changes to brown or yellow before eventually disappearing.^1,2

Most bruises are harmless and heal without treatment. If necessary, bruises can often be treated using simple first aid, such as applying a cool pack to reduce swelling, elevating the bruised area above heart level, or taking non-prescription pain relief like paracetamol.^2,3

Although everyone experiences bruising, some people bruise more easily and often. Easy bruising may be caused by medications, for instance by certain pain killers or blood thinners, or a lack of vitamins such as vitamin C or vitamin K. Some medical conditions can also make you more prone to bruising, including bleeding disorders like von Willebrand disease (VWD).² People with VWD may experience bruising from minor bumps or injuries on a weekly or daily basis, and they commonly experience other bleeding symptoms such as nose or gum bleeds.⁴

Please consult your doctor if you develop bruises that develop for no apparent reason, experience regular nose or gum bleeds, or have family members who also bruise easily.

A wound is an injury to living tissue that breaks the skin. Minor wounds, such as scratches, scrapes and cuts, are very common and usually not serious. These wounds often stop bleeding on their own or after applying a bit of pressure and will start to heal in a few days. Minor wounds can generally be treated at home. When treating a wound, it’s important to keep it clean and cover it with an adhesive bandage or dressing to prevent infections.^1-3

Some wounds may need more care, in particular wounds that are deep, don’t stop bleeding or are still dirty after cleaning. These wounds should be examined by a doctor or a nurse. You should also see your doctor if the wound doesn’t heal, or if there are signs of infection such as swelling, pain, redness, or leaking pus from the wound.^1,2

Prolonged bleeding from minor wounds can also occur if blood clotting doesn’t work properly due to a bleeding disorder such as haemophilia or von Willebrand disease (VWD). In fact, bleeding longer than 10 minutes after getting a minor cut is one of the typical symptoms of VWD. Other common symptoms of this disease are frequent nosebleeds, easy bruising and heavy menstrual bleeding.^4-6

About 1 in 4 women experience signs of heavy menstrual bleeding. Untreated heavy menstrual bleeding can lead to iron deficiency, anaemia, and fatigue. Studies have shown that heavy menstrual bleeding can also cause anxiety and depression, and affect your social interactions and sexual functioning.^1-3

At certain times, your periods may be heavier naturally, for instance at the start of your period, after pregnancy, or during the menopause. However, if your bleeding lasts for more than 7 days, or you need to change your pad or tampon every 1 or 2 hours and during the night, you may have heavy menstrual bleeding. Other signs of heavy menstrual bleeding are the need to use two types of sanitary products together, bleeding through your clothes or bedding, and passing large blood clots.²

If you worry about your periods being too heavy or lasting too long, please use this simple tool to help you assess your periods.

There are different causes and treatments for heavy menstrual bleeding. Causes include hormone imbalance, medicines that help to prevent blood clots, conditions affecting your womb or ovaries, and inherited bleeding disorders such as von Willebrand disease (VWD).³ To find the cause of your heavy menstrual bleeding, you should discuss with your doctor any bleeding you may have experienced. Your doctor will then help you choose the right treatment for you.

Researchers have found that bleeding disorders underlie heavy menstrual bleeding in about 1 in 5 adult women. Although VWD is the most common inherited bleeding disorder, it is often overlooked as a cause of heavy menstrual bleeding.⁴ Moreover, treatments that may control heavy menstrual bleeding in women with VWD, may not prevent bleeding after an accident or during surgery. Women with VWD may also suffer excessive bleeding during pregnancy as well as during and after childbirth. Therefore, proper diagnosis and treatment of VWD are very important to reduce the risk of bleeding.^4,5

A certain amount of blood loss during a surgical operation is expected, and some minor bleeding from an incision after an operation is also not unusual. The bleeding is normally confined to the surgical area and your doctor may apply pressure, stitches or cauterisation to stop the bleeding.¹

In some cases, the blood loss during or after the surgery is greater than expected. This kind of excessive bleeding can originate from the incision or from inside the body. Excessive bleeding during or after an operation may lead to complications and require intensive blood transfusions and extended hospital stays.^2-4

In most cases, bleeding during or after surgery is due to injuries to blood vessels or other organs, or stitches that come apart. Bleeding may also be caused by medicines such as aspirin or blood thinners (anticoagulants). Lastly, certain health conditions, such as liver or kidney disease, or bleeding disorders can lead to excessive or prolonged blood loss during or after an operation.^2,5 The most common hereditary bleeding disorder is von Willebrand disease (VWD), which is often undiagnosed. Without proper treatment, people with undiagnosed VWD are at risk of serious bleeding. Undiagnosed VWD frequently leads to prolonged bleeding after surgery, for example after a tooth extraction or a tonsillectomy. Together with frequent nosebleeds and gum bleeds, bleeding during and after such surgeries are hallmarks of VWD.^6,7

Postoperative bleeding may start immediately or several days after surgery and can become life-threatening. Signs of postoperative bleeding include feeling faint or short of breath, anxious, confused, having a faster heart rate than normal and urinating less than usual. The bleeding from the surgical area may also soak through the bandage covering your wound. If you experience any of the symptoms above, you should seek immediate medical care.²

Feeling overtired, overworked or exhausted from time to time is normal. Usually, the reasons are easily identified, for example lack of sleep or too much stress or exercise. Fatigue, on the other hand, means that you constantly feel too tired to manage daily activities for no obvious reason. There are many causes for fatigue. Fatigue can be caused by elements of your lifestyle, psychological conditions, a wide range of diseases, and by certain drugs.^1,2

One of the physical causes of fatigue is anaemia.¹ Anaemia is a very common condition.³ When you have anaemia, your blood does not contain enough healthy red blood cells to carry sufficient oxygen from your lungs to the rest of your body. Without enough oxygen, the cells in your body cannot work properly, making you feel tired, cold and weak.^4,5 In most cases, the anaemia is due to a lack of iron, which red blood cells need to carry oxygen. If you do not consume enough iron, or if you are losing too much blood, iron deficiency anaemia will develop. Initially, iron deficiency anaemia can be so mild that it goes unnoticed. But as the body becomes more deficient in iron and anaemia worsens, the signs and symptoms intensify.^5,6 Iron deficiency anaemia is very common in women with heavy menstrual bleeding. The repeated blood loss eventually depletes their bodies’ iron stores and results in anaemia and fatigue.⁷ Heavy menstrual bleeding and associated anaemia are particularly frequent symptoms in women with bleeding disorders, such as von Willebrand disease (VWD).⁸ If you experience heavy menstrual bleeding, or other bleeding symptoms such as frequent nose bleeds or gum bleeds, please take our bleeding test.

Most cases of anaemia are treatable. Often, a change in diet or taking iron supplements is sufficient to treat iron deficiency anaemia. However, if the cause of the anaemia is more serious, your doctor will advise you on the appropriate treatment.³