A hemorrhage is any escape of blood from a blood vessel, and its appearance depends entirely on where it happens and how much blood is involved. On the skin’s surface, it can range from tiny red dots smaller than a pinhead to deep, swollen pools of blood that form a visible lump. Inside the body, you may never see the bleeding directly, but it leaves telltale signs in your stool, vomit, eyes, or the color patterns on your skin.
External Bleeding: Color and Flow
When a blood vessel breaks through the skin, the appearance of the bleeding itself tells you which type of vessel is damaged. Arterial bleeding is bright red because the blood is oxygen-rich, and it comes out in spurts that match your heartbeat. Venous bleeding is dark red, almost maroon, and flows steadily without pulsing. Capillary bleeding, the most common and least dangerous type, simply oozes from the wound rather than spurting or flowing.
Fresh blood on a bandage or wound dressing is typically bright red and may soak through in an expanding circle. As it slows, the color shifts to a darker red or brownish-pink. If you’re monitoring a surgical wound or injury, a sudden increase in bright red saturation on a dressing is more concerning than a slow, brownish seepage.
Bleeding Under the Skin
Not all hemorrhages break the surface. When blood leaks from damaged vessels and stays trapped beneath the skin, it creates distinct patterns based on how much blood escapes and from how large a vessel.
- Petechiae are tiny spots smaller than 2 millimeters, roughly the size of a pinpoint. They appear as flat red, pink, or purple dots, often in clusters that resemble a rash.
- Purpura are larger than 2 millimeters and look like flat, discolored patches ranging from red to deep purple. Like petechiae, they can appear in rash-like clusters.
- Ecchymosis is what most people call a bruise: a broader area of discoloration caused by blood spreading through tissue under the skin.
One reliable test for all three: press a glass or your finger against the spot. Petechiae and purpura do not fade or change color under pressure. A simple red rash or skin irritation will briefly blanch white when pressed. This non-blanching quality is the hallmark of blood that has already leaked out of its vessel and is sitting in the tissue.
How a Bruise Changes Color Over Time
A bruise is a visible timeline of your body breaking down trapped blood. When red blood cells rupture in the tissue, they release hemoglobin, the oxygen-carrying protein that gives blood its red color. Your body then processes that hemoglobin through a series of chemical steps, each producing a different pigment.
Fresh bruises start red or dark purple. Over the next day or two, hemoglobin begins converting into a green pigment, giving the bruise a bluish-green tint. That green pigment then breaks down further into a yellow one, which is why older bruises turn yellow or yellowish-brown. Iron left over from the hemoglobin gets stored as a brown pigment, which accounts for the brownish edges that linger longest before the bruise fully fades. The whole cycle typically takes one to three weeks, depending on the severity.
Hematoma vs. Bruise
A bruise is flat. The blood spreads thinly through damaged muscle fibers and small surface-level vessels, creating discoloration without much swelling. A hematoma is different: it involves a larger vessel, and the blood pools into a defined pocket under the skin, forming a raised lump. That lump is often tender or painful to touch and feels firm or slightly spongy. Visually, a hematoma looks like a bruise with a swollen mound beneath it. Small hematomas resolve on their own, but large ones sometimes need to be drained.
Signs of Internal Bleeding on the Skin
When bleeding occurs deep inside the abdomen, it can sometimes be visible on the outside as unusual bruising in specific locations. Bruising and swelling around the belly button, sometimes called Cullen sign, suggests bleeding inside the abdominal cavity. The color varies with severity: mild internal bleeding may produce yellowish bruising, while more serious bleeding causes dark blue, purple, brown, or even black discoloration around the navel. These bruises are often painful to touch.
Bruising along the side of the body between the ribs and hip, known as Grey Turner sign, points to bleeding in the back of the abdominal cavity. Neither of these patterns appears immediately. They typically develop hours to days after the internal bleeding begins, as blood tracks through tissue layers to reach the skin’s surface.
What Hemorrhage Looks Like in Stool and Vomit
Gastrointestinal bleeding often announces itself through changes in what comes out of your body, and the appearance tells you roughly where the bleeding is happening.
Vomiting bright red blood points to active bleeding in the upper digestive tract, typically the esophagus, stomach, or the first part of the small intestine. If the bleeding has slowed or stopped before you vomit, the stomach acid converts the blood into a dark brown, granular material that looks remarkably like coffee grounds. This “coffee ground” vomit is a classic indicator that bleeding occurred but may no longer be active.
Black, tarry stool with a distinctly sticky texture indicates that blood has traveled through most of the digestive tract, getting broken down along the way. It takes roughly 100 to 200 milliliters of blood in the upper GI tract to produce this kind of stool, and the black color can persist for several days after the bleeding has actually stopped. One important caveat: iron supplements and bismuth (the active ingredient in some antacids) can also turn stool black, so color alone does not always mean bleeding.
Bright red or maroon blood passed from the rectum typically indicates bleeding lower in the digestive tract, such as the colon. However, a very brisk bleed higher up can also produce red blood if it moves through the intestines quickly enough.
Hemorrhage in the Eye
A subconjunctival hemorrhage, the kind caused by a burst blood vessel on the surface of the eye, is one of the most visually dramatic yet least dangerous types. It appears as a vivid bright red patch on the white of the eye, sometimes covering a large portion of the sclera. Despite looking alarming, it typically causes no pain, no discharge, and no change in vision. You might feel mild itching or a scratchy sensation, but nothing more. The red patch gradually fades over one to two weeks as the blood is reabsorbed, often turning yellow before disappearing entirely.
What Hemorrhage Looks Like on a CT Scan
If you or someone you know has a brain scan after a suspected bleed, acute hemorrhage shows up as a bright white area on a standard CT scan. Fresh blood is denser than the surrounding brain tissue and cerebrospinal fluid, which makes it stand out clearly. Radiologists measure this density in standardized units: cerebrospinal fluid registers between 0 and 24 on the scale, while fresh blood clocks in around 52 to 75, depending on whether it has clotted. A clot is denser than liquid blood, so it appears even brighter. Over time, as the body reabsorbs the blood, the bright white area gradually darkens on follow-up scans, eventually blending with the surrounding tissue.