Bruises, appearing as black and blue marks under the skin, occur when small blood vessels break due to impact. While often harmless, a tendency to bruise easily can sometimes signal underlying issues.
Age and Medications Contribute to Bruising
As individuals age, skin and blood vessels naturally become more fragile, leading to more frequent bruising from minor bumps. Dr. Bethany Samuelson Bannow, director of classical hematology at the Cleveland Clinic Cancer Institute, identifies increased skin fragility with aging as a common cause. Medications also play a significant role. Steroids, especially with long-term use, can increase bruising. Additionally, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen can affect the blood's clotting ability, making bruising more likely.
"Sometimes bruising is actually a sign that the medication is doing exactly what it's supposed to do in reducing the blood's ability to clot," said Dr. Bimal Ashar, clinical director of general internal medicine at Johns Hopkins Medicine. He emphasizes that patients should consult their doctor before stopping any prescribed medication, as the benefits of reduced clotting may need to be balanced against the risk of bleeding.
Diet and Bruising
For most people with a varied diet, vitamin deficiency is unlikely to be the cause of easy bruising. However, individuals with very restrictive diets, malabsorption issues, or a history of poor nutrition may be exceptions. Vitamin C deficiency, for instance, can contribute to bruising by impairing collagen production in the skin. "Patients with underlying medical problems that impair absorption of nutrients, such as intestinal diseases, or people with highly restricted diets, alcohol use disorder, or other causes of malnutrition are the exception to that and can develop severe nutritional deficiencies that can contribute to bruising and bleeding," Ashar explained.
When to Seek Medical Advice
While most bruises resolve on their own, certain circumstances warrant a doctor's attention. If bruises appear frequently, are unusually large, develop in unexpected locations such as the chest or abdomen, or are accompanied by other bleeding symptoms, it is advisable to consult a healthcare professional.
"Newly developed bruising is particularly concerning when it occurs over a very large area and/or occurs on 'protected' parts of the body, like the chest, abdomen or inner arms and legs as opposed to parts of our body we commonly hit when we bump into things," noted Samuelson Bannow. Other warning signs include persistent nosebleeds, bleeding gums, blood in the stool or urine, unusually heavy menstrual periods, or jaundice (yellowing of the skin or eyes).
Medical Evaluation
When consulting a doctor about bruising, patients can expect to be asked about the onset, location, and frequency of the bruising, as well as current medications, supplements, and any other bleeding symptoms. Blood tests may be ordered to assess blood counts, platelet levels, clotting function, and liver and kidney function. "The history often provides as much information as the laboratory tests," Ashar stated. Further testing or a referral to a hematologist may be recommended if initial evaluations reveal abnormalities or a high level of suspicion for a bleeding disorder.
Maintaining Health and Safety
Staying active is encouraged for overall health and can improve balance and coordination, thereby reducing the risk of serious injury. "The goal isn't to stop moving, it's to move safely," Ashar advised. For individuals without underlying health issues and a balanced diet, bruising is a normal aspect of life. However, for those experiencing new, unexplained, or concerning bruising, seeking professional medical advice is the recommended course of action.