Ouch! Why Do I Bruise So Easily?

One moment you’re bumping into the edge of a desk, the next you’re sporting a mysterious purple blotch like a badge of fragility. 

If your skin seems to bruise at the slightest touch, you’re not alone — and the reasons might be more revealing than you think.

Skin contact can cause bruising, even when the incident itself isn’t painful. “Most mild bruising, especially if it occurs with trauma, does not necessarily indicate a medical issue and will heal without intervention. An extensive workup is not always indicated,” says Diana Byrnes, M.D., M.P.H., a hematologist at the University of Miami Health System.

Common causes of bruises include:

• Aging: Thinner skin and fragile blood vessels make skin more vulnerable to injury.
• Chronic sun exposure: Sun damage makes the connective tissue and blood vessels beneath the skin more fragile, which can cause them to rupture with minor trauma.
• Side effects of medications, including blood thinners, nonsteroidal anti-inflammatory drugs, corticosteroids, certain antibiotics, and antidepressants
• Certain supplements including ginkgo biloba and omega-3 fatty acids/fish oil have anti-clotting properties
• Nutritional deficiencies, including low levels of vitamin C, B vitamins, or iron

If your bruising isn’t from any of these triggers, “it should be investigated further for rarer causes, including coagulation disorders, blood cancer, and some autoimmune conditions,” Dr. Byrnes says.

Additional causes of excessive bruising include:

• Bleeding disorders
• Platelet function disorders
• Connective tissue disorders (such as Ehlers Danlos syndrome)
• Congenital/inherited and acquired coagulation/blood clotting disorders (such as hemophilia and Von Willebrand disease)
• Liver disease, which affects blood clotting
• Leukemia and other blood cancers
• Autoimmune conditions including immune thrombocytopenia, systemic lupus erythematosus, and autoimmune hemolytic anemia
• Excessive alcohol use

Why do women bruise more easily than men?

Females tend to find more bruises on their legs and arms than males. But, this isn’t because women and girls are clumsier.

“Women have a greater tendency to bruise compared to men,” says Dr. Byrnes. “This may be due to gender differences in skin and fat distribution. Women have thinner skin and less muscle mass, so blood vessels are less cushioned.” Also, the hormone estrogen, which women naturally have at higher levels than men, “can make blood vessel walls more fragile and influence clotting.”

Simple lifestyle choices can help you avoid banging up your arms and legs.

• Wear protective clothing. “Clothing can protect against skin tears and soft tissue injury from contact with abrasive objects,” Dr. Byrnes says. “This is particularly useful for individuals with thin, frail skin.”
• Consistently wear SPF sunscreen or sun-protective clothing to avoid sun damaged skin, which can worsen bruising, especially in older people.
• Avoid contact with sharp edges and blunt surfaces. With mindfulness practices (like yoga and meditation), you can aim to become more conscious of your surroundings and improve your bodily awareness and mental focus.
• Avoid excessive alcohol use (for many health reasons).
• Enjoy a balanced, diverse, and nutritious diet to help avoid vitamin and mineral deficiencies.

If you’re always black and blue, should you see a doctor?

Your doctor may refer you to a hematologist, a specialist who focuses on blood and bone marrow disorders. This referral relies on your medical history and bloodwork.

Speak to your primary care physician if you experience any of the following.

• Frequent, large bruises
• Sudden changes in how easily or frequently you experience bruising
• Bruising on areas of the body that rarely bump into surfaces (such as your chest, abdomen, and back)
• Bruising without any injury or trauma to the body

Tell your doctor if you experience frequent bruising in combination with any of the following:

• Mucosal bleeding from the nose, gums, vagina, or rectum
• Blood in urine or stool
• Family history of bleeding disorders
• Petechiae (tiny, flat, red dots on the skin or mouth)
• Heavy, long-lasting menstrual periods (more than 7 days or having to change sanitary products every hour or two)
• Minor cuts and wounds that bleed for a long time
• Excessive bleeding during surgery or dental extractions
• Associated symptoms, such as fever, chills, fatigue, and unintentional weight loss

With your physician’s guidance, you can better manage medications that may be causing you to bruise easily. He or she may recommend a different dosage or type of medication, if significant bruising remains an issue.

Bloodwork can help identify any vitamin or mineral deficiencies that may be contributing to your bruising. With this knowledge, your doctor can recommend specific supplements or dietary changes to fill those nutritional gaps. You should also speak to your physician before making changes to your medications or supplements.

Written by Dana Kantrowitz for UHealth.

Tags: bleeding and bruising, blood issues, Dr. Diana Byrnes, easy bruising, type of bruising