What is a Hematoma and How is it Treated?

The world is a bumpy place, full of opportunities to bang your head, your arm, your leg, or any other part of your body. Indeed, every kid in America has probably gotten a big enough whack to cause their skin to bruise. These bruises, while usually not a major health concern, can be painful and long-lasting. Sometimes what seems like a normal bruise can become larger and even develop into a sizable lump. This phenomenon is actually slightly different than a bruise, and it is called a hematoma.

What is a Hematoma?

Generally speaking, a hematoma is defined as a localized collection of blood outside of the blood vessels. Though it can happen anywhere in the body, a hematoma is usually most noticeable when it happens just under the skin. This is what most people call a bruise (otherwise known as a contusion in medical terminology), though in actuality a bruise is just a simple form of hematoma. Both hematomas and bruises involve the breakage of blood vessels and capillaries, but a hematoma involves pooling of blood, whereas a bruise has only limited leakage of blood—just enough to cause discoloration in the skin.

A hematoma can be caused by injury to blood vessels during surgery, but the most common causes of hematoma are a result of trauma. For example, if you tripped while running up some stairs and hit your shin really hard on the edge of a stair, the impact would cause blood vessels all around the area to rupture and hemorrhage. With significant enough force, those ruptures could cause a substantial amount of blood to leak into the surrounding soft tissue. In some injuries, the bleeding happens so rapidly that a large lump can form at the site of the injury within minutes.

In most hematomas (including bruises that result in discoloration), any blood that leaks into surrounding tissues will be reabsorbed into blood vessels relatively quickly. Sometimes, though, the bleeding happens fast enough that blood clots appear before that reabsorption can happen. This blood clotting process, known as coagulation, involves the blood thickening into a gel through the aggregation of blood platelets, components of blood that exist solely in order to stop the free flow of blood after an injury.

The kinds of trauma that can create a visible subcutaneous hematoma can also do the same thing anywhere in the body that might not be visible. Healthcare professionals categorize these types of hematoma by their location, though they all share the same basic characteristics. Below are some of the most common types:

• Subdermal: As described above, this type is the most noticeable and occurs just under the surface of the skin.
• Intramuscular: A hematoma inside layers of muscle tissue that is usually the result of direct trauma to a particular muscle.
• Subdural: A subdural hematoma type is typically caused by a traumatic head injury, and it is located between different layers (meninges) of the brain and the brain tissue itself.
• Intracranial epidural: Also the result of head trauma, this type occurs between the skull and the dura mater, the outermost membrane that surrounds the brain.
• Spinal epidural: In incidents of spinal trauma, an epidural hematoma develops between the vertebrae and the outer covering of the spinal cord.
• Subungual: Another type that is visually apparent, a subungual hematoma occurs underneath fingernails or toenails.
• Intra-abdominal: There are many subtypes, but this generally refers to any hematoma inside the abdominal cavity.
• Splenic: Direct trauma to the spleen is dangerous and can result in a splenic hematoma, in addition to other concerning complications.
• Hepatic: Similarly dangerous, this type occurs after trauma to the liver.

Hematoma Treatment

In many cases—particularly those that are subdermal—a hematoma will heal naturally and without any specific treatment. Over time, the blood vessel walls that were ruptured during the trauma will begin to heal and return to a normal state. As this happens, blood debris from the coagulated area will be carried away by normal blood flow to the spleen and liver where it is disposed of like any other damaged blood cells (this also highlights the danger of trauma to the spleen and liver).

There are other times when the hematoma is either too large or it is having a negative effect on a sensitive, vital organ or body system. In these cases surgery may be necessary to remove the coagulated blood and potentially repair other damaged tissue in the area. Depending on the type of hematoma, this surgery can be either fairly routine or incredibly delicate. In a subdural or intracranial hematoma, for instance, a surgeon may need to create a temporary “flap” of skin and skull bone before being able to remove it; this kind of surgery (known as a craniotomy) is naturally risky because of proximity to the brain tissue.

At-Home Remedies for a Hematoma

As noted above, however, most hematomas will resolve on their own and without the need for direct medical intervention. Nevertheless, there are a variety of at-home remedies that can bring pain relief as well as serve to speed up the healing process. These remedies are primarily meant for the most common subdermal hematomas that happen after the kind of everyday trauma that can occur when playing sports, slipping, or any other activity that can lead to injury. One of the most useful remedies is best remembered through the acronym R.I.C.E.:

• Rest: Avoid using the body part in question and just generally try to get rest.
• Ice: Apply an ice pack to the injured area for 20 minutes at a time, 4-8 times a day.
• Compress: Wrap the area (if possible) in gauze or elastic bandage.
• Elevate: Elevate the affected area above the heart whenever possible.

Apart from using the R.I.C.E. method for 24-48 hours after the injury, you can also turn to over-the-counter pain medications like acetaminophen (Tylenol) or ibuprofen. People who take blood thinners or anticoagulants like warfarin (Coumadin) or clopidogrel should be especially careful with a large hematoma and plan to seek medical attention; in addition to these drugs potentially slowing down the healing process, they can also cause a series of complications.

TrustCare is Here for You

As with any injury or medical condition, there are few hard and fast rules about when you should seek medical care. In the case of a hematoma, most of the time they represent minor injuries that will resolve themselves. But if you’re ever in doubt, TrustCare is available to provide speedy treatment or even just the peace of mind to know that the injury isn’t problematic. If you have experienced a traumatic injury that isn’t immediately life-threatening, we invite you to stop by one of our urgent care locations.