In the elderly (age ≥65 years), hemorrhoids and colorectal cancer are the most common causes of minor bleeding. Peptic ulcer, diverticular disease, and angiodysplasia are the most common causes of major bleeding. Approximately 35% to 45% of all cases of acute upper GI hemorrhage occur in elderly persons.
Signs and symptoms of internal bleeding
It can cause fatigue, weakness, and shortness of breath. Some people with internal bleeding will also have low blood pressure because of the constant blood loss. This is known as orthostatic hypotension. Common symptoms include feeling dizzy or light-headed when you stand.
Pain is a common symptom of internal bleeding, as blood is very irritating to tissues. Symptoms such as severe abdominal pain or a severe headache should always be evaluated by a medical professional.
Drugs that can lead to gastrointestinal bleeding include non-steroidal anti-inflammatory drugs (NSAIDs) like diclofenac and ibuprofen, platelet inhibitors such as acetylsalicylic acid (ASS), clopidogrel and prasugrel, as well as anticoagulants like vitamin-K antagonists, heparin or direct oral anticoagulants (DOAKs).
In severe cases, internal bleeding can cause death within 6 hours of hospital admission. It is critical to go to a hospital or call emergency service as soon as internal bleeding is suspected.
Blood tests may be performed to check for a low red blood cell count, or anemia. However, if the bleeding occurs rapidly, the initial hemoglobin reading or red blood cell count may be normal. The suspicion of internal bleeding will often require an imaging test to look for the bleeding source.
There are three main types of bleeding: arterial, venous, and capillary bleeding. Arterial bleeding occurs in the arteries, which transport blood from the heart to the body. Venous bleeding happens in the veins, which carry blood back to the heart.
Gastrointestinal bleeding due to stress ulcerations range from 1.5% to 15%, depending on whether stress ulcer prophylaxis has been provided. If stress gastritis is left untreated, life-threatening intestinal hemorrhage may occur, followed by perforation, with ensuing septic shock and, potentially, death.
Often, GI bleeding stops on its own. If it doesn’t, treatment depends on where the bleed is from. In many cases, medication or a procedure to control the bleeding can be given during some tests.
Acetaminophen is generally considered safer than other nonopioid pain relievers because it doesn’t cause side effects such as stomach pain and bleeding.
However, blood thinners can cause dangerous bleeding that requires immediate medical attention, says Gomes. Major bleeding complications include internal bleeding in the stomach, bowel, or brain, he says. “This could be life-threatening,” he adds.