Internal bleeding is bleeding inside the body, and it can be fatal precisely because it is often invisible. It may follow a blow, a fall, a car crash, a broken bone or a penetrating wound, or arise from a medical condition such as a stomach ulcer. No first aid can stop internal bleeding, which usually needs surgery, so the job of the first aider is to recognise it early, treat the signs of shock and get the person to hospital quickly.
Revealed and Concealed Internal Bleeding
Internal bleeding is either revealed, when blood escapes through a body opening, or concealed, when it collects inside a cavity such as the abdomen or skull.
- Coughing up bright red frothy blood suggests the lungs
- Dark brown, “coffee ground” vomit suggests the stomach
- Blood-stained or dark brown urine suggests the kidneys or bladder
- Black, foul-smelling stools suggest bleeding in the bowel
- Bruising, or blood from the ear, nose or mouth after injury
Bleeding from the liver, spleen or brain is concealed and may show no outward sign at all.
How to Suspect Internal Bleeding
The history of the incident is the key. A fall from a height, a heavy blow to the abdomen or chest, a crush or a car crash, in a person who becomes pale and unwell with no obvious wound, should make you suspect internal bleeding until a doctor says otherwise. Look for:
- Pain, swelling or tenderness over the injured area
- A rigid, swollen or bruised abdomen
- Cold, pale, sweaty skin and a fast, weak pulse
- Rapid, shallow breathing, anxiety and restlessness
- Thirst, nausea or vomiting
- Drowsiness and eventual unconsciousness
Internal Bleeding First Aid for a Conscious Person
- Call the emergency number straight away and say you suspect internal bleeding.
- Reassure the person and help them into the position of greatest comfort. Sit them up if breathing is difficult.
- If breathing is comfortable and there is no leg, pelvic or spinal injury, raise the legs gently to support circulation.
- Loosen tight clothing and cover with a blanket without overheating.
- Check for and treat obvious injuries and control any external bleeding.
- Give nothing by mouth, because they may need urgent surgery.
- Check pulse, breathing and alertness every five to ten minutes and write the times and findings down for the ambulance crew.
See our shock first aid guide for the full circulation care routine.
If the Person Is Unconscious
Open and protect the airway, check breathing and follow the DRABC primary survey. Place a breathing, unresponsive person in the recovery position, lying on the uninjured side where possible, and keep monitoring until the ambulance arrives.
Why Speed Matters With Internal Bleeding
Internal bleeding cannot be controlled without surgery, so every minute of delay in reaching hospital counts. Never wait for symptoms to “declare themselves” after a significant impact. Even a person who looks well can have a slowly bleeding organ and deteriorate suddenly.
Frequently Asked Questions
Can you stop internal bleeding at home?
No. First aid supports the person and treats shock, but hospital treatment, often surgery, is needed to stop the source.
Is a bruise internal bleeding?
Yes, a bruise is minor bleeding under the skin. Large, rapidly spreading or painful bruising after major injury should be assessed.
References and Further Reading
- American Heart Association and American Red Cross, Guidelines for First Aid
- NHS, Internal bleeding and trauma overview
- St John Ambulance, Internal bleeding
Last updated: October 2026
Prepared by: EHS Guidelines Editorial Team
This article is general educational information and is not a substitute for accredited first aid training or professional medical care. In an emergency, call your local emergency number immediately. Emergency numbers, medicines and protocols differ between countries, so follow local guidance.
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