A hematoma refers to a collection of blood outside of a blood vessel. It occurs because of an injury to the wall of a blood vessel, allowing blood to seep out into surrounding tissues. Hematomas can occur anywhere in the body and vary in severity. Small bruises are a common minor form of hematoma. Larger hematomas may require medical treatment. Knowing what not to do with a hematoma can help prevent further complications.
Do Not Apply Heat
Applying heat to a hematoma should be avoided. Heat causes blood vessels to dilate, which can increase bleeding into the hematoma and cause it to grow larger. Sources of heat that should not be used on a hematoma include:
- Heating pads
- Hot compresses
- Warm baths or showers
- Saunas
- Hot tubs
The increased blood flow to the area that occurs with heat can prolong bleeding and inflammation. Swelling and pain may also increase if heat is applied. Even a warm shower or bath should be avoided if the hematoma is large or in a sensitive area.
Do Not Massage the Area
Massaging a hematoma may cause further damage and is not recommended. Massage increases blood flow to the area, which can increase swelling and inflammation. It may also break up clotting and prolonged bleeding into the tissue. Firm pressure from massage may also damage the tissues surrounding the hematoma more.
The only exception is that light massage may be done by a medical professional in later stages of healing to help reabsorb blood from the tissues. However, this should not be done in the acute stages immediately after injury.
Do Not Use Cold Therapy Constantly
While cold therapy can be used initially for some hematomas, constant cold should not be applied for too long. Cold works by constricting blood vessels to reduce blood flow. This can help limit the initial bleeding into tissues from a minor injury. However, extended cold therapy can also impair the healing process.
Cold should not be applied directly to a hematoma for more than 20 minutes at a time. It also should not be reapplied constantly throughout the day. This can damage skin and underlying tissues. Brief intermittent use of cold packs is recommended instead. Make sure to wrap ice packs in a towel before applying to the skin.
Do Not Use Pain Relievers Before Talking to a Doctor
Over-the-counter pain medications like NSAIDs (aspirin, ibuprofen, naproxen) and acetaminophen should not be used before speaking with a doctor about a hematoma. These drugs can increase bleeding and worsen the hematoma. They also affect clotting, which can prolong bleeding into the surrounding tissues.
Pain control should be discussed with a doctor to determine safe options. They may recommend a safer alternative that will not exacerbate bleeding and swelling. Avoid taking any non-prescription pain relievers until getting approval.
Do Not Bandage Too Tightly
Tight bandages or compression wraps should not be applied to a hematoma, particularly in the acute stage. This can increase bleeding and swelling in the area. Restrictive bandaging can damage the tissues surrounding the hematoma. It can also cut off proper circulation needed for healing.
Light wraps may be used to protect a hematoma and limit motion when needed. However, these should not be tied or secured too tightly. Signs a wrap is too tight include:
- Tingling or numbness in the extremity
- Increased pain
- Swelling above or below the bandage site
- Pale or blue color of skin
- Difficulty moving the extremity
The bandage should be loosened or removed if any of these warning signs occur. Care should be taken to bandage hematomas appropriately.
Do Not Ignore Changes in Symptoms
It’s important not to ignore worsening symptoms associated with a hematoma. This may indicate complications that require medical treatment. Signs to watch out for include:
- Increased swelling or bruising
- Signs of infection like redness, warmth, pus or foul odor
- Difficulty moving or sensation changes in the extremity
- Dizziness, fainting, or increased heart rate
- Difficulty breathing or swallowing
- Increased pain that is not relieved by over-the-counter pain medications
- Fever over 101 F (38.3 C)
If any of these warning signs develop, prompt medical care should be sought. Internal bleeding, compartment syndrome, infections, and blood clots are possible complications of hematomas that need treatment. Catching changes early can prevent long-term damage.
Do Not Remove Scabs or Crusting
It can be tempting to pick off scabs or crusting that develop over a hematoma as it starts to heal. However, this should be avoided. Removing or picking at scabs can remove clots that have formed and restart bleeding. It also increases the risk of infection by exposing the raw tissues underneath before they have fully closed.
Allow any scabbing or crusts to fall off naturally as the hematoma heals. Keep the area clean and protected with a light bandage if needed. Regular wound care should be done according to doctor’s instructions. However, scabs should not be scrubbed or intentionally removed before the tissues have properly closed.
Do Not Use Alcohol on Open Wounds
Alcohol should not be used to clean an open or bleeding hematoma. While alcohol can disinfect skin, it kills healthy tissues and delays wound healing if used on open wounds or bleeding. It can cause significant pain and damage.
Using alcohol on an open hematoma can damage blood clots and protective tissues forming in the wound bed. This restarts bleeding and increases swelling, pain, and inflammation. The numbness caused by alcohol can also disguise symptoms of worsening injury.
Clean an open or bleeding hematoma with cool water and a mild soap to remove debris. Avoid alcohol, hydrogen peroxide, iodine, and any other disinfectants until the wound has closed unless instructed by a doctor. Keep the area protected with a sterile bandage.
Do Not Reinjure the Area
Reinjury should be avoided after a hematoma develops. This can cause additional bleeding and damage. Sports, physically demanding work, and activities that increase strain on the injured area should be avoided. Protect the injured area from further trauma.
Change your activities and motions to avoid putting pressure on areas with a hematoma. Use bracing, taping or assistive devices as needed. Alter your sleeping positions and movements to prevent reinjury as well. Allow your body adequate rest to heal.
Do Not Apply Creams or Ointments Before Talking to a Doctor
Medicated creams, ointments, or home remedies should not be applied to a hematoma without approval from your doctor. Substances like arnica, vitamin K, turmeric, and others may interact with medications or exacerbate inflammation and bleeding.
Discuss any topical treatments with your doctor to ensure they are safe for your specific type of hematoma and medical history. Avoid using any new creams or home remedies on broken skin without talking to your physician first. Proper wound care is essential.
Do Not Take Blood Thinners Without Medical Consultation
Blood thinners and anticoagulant medications help prevent clot formation. However, they can also lead to increased bleeding from a hematoma. Common blood thinners include:
- Aspirin
- Heparin
- Warfarin (Coumadin)
- Enoxaparin (Lovenox)
- Rivaroxaban (Xarelto)
- Dabigatran (Pradaxa)
- Apixaban (Eliquis)
- Edoxaban (Savaysa)
Do not start taking any new blood thinner without medical guidance. Those already on blood thinners should consult their doctor for special precautions needed after a hematoma. They may advise temporarily stopping usage under medical supervision.
Do Not Ignore Hematomas after Surgery
Hematomas occurring after surgery require prompt medical attention. Post-surgical hematomas usually develop from bleeding underneath the skin at the incision site. However, they can also arise internally and may not be visible.
Signs of a post-surgical hematoma include:
- Increasing swelling and bruising around the incision
- Increased drainage of bloody fluid from the incision
- Extreme pain or tenderness at the surgery site
- Visible pooling of blood under the incision or skin
- Large bruising away from the surgical wound may indicate internal bleeding
- Dizziness, lightheadedness, confusion, fast heart rate signal blood loss
Notify your surgeon immediately if you have any symptoms of a hematoma after surgery. You may require hospitalization or additional procedures to drain the blood and control bleeding. Ignoring post-surgical hematomas can lead to serious complications.
Do Not Delay Treatment of Groin, Retroperitoneal, or Abdominal Hematomas
Certain areas where hematomas develop can be life-threatening emergencies. These include:
- Retroperitoneal hematomas – bleeding into the retroperitoneal space behind the abdominal lining
- Pelvic or groin hematomas – may compress vital structures like major blood vessels
- Intra-abdominal hematomas – bleeding inside the abdominal cavity
These types of deep body hematomas are considered true medical emergencies. They can cause severe pain, nerve damage, significant blood loss into the abdomen, shock, and death in some cases.
Prompt emergency medical care is needed for rapid diagnosis and treatment of high-risk hematomas. Surgery may be required to stop bleeding and drain the hematoma. Even with treatment, some retroperitoneal and intra-abdominal hematomas can be fatal.
Conclusion
Hematomas vary widely in severity but share some common do’s and don’ts in treatment. Applying heat, massaging the area, using non-steroidal anti-inflammatory drugs, and removing scabs are actions that should be avoided. Caution is needed with use of cold therapy, bandaging, and activity modifications as well. Any worsening symptoms should be evaluated promptly to avoid complications. High-risk hematomas in the abdomen, pelvis or retroperitoneal space constitute medical emergencies requiring rapid treatment. Following appropriate guidelines for care can improve outcomes from hematomas of all types.