We all experience bruising occasionally, usually as the result of a bump or fall. By the time the contusion is noticeable, however, it has already started to heal, according to the Wyoming Valley Health Care System. A bruise occurs when impact causes blood vessels to break and blood leaks into the soft tissue under the skin. If the skin is not broken, the blood has nowhere else to go. During the healing process, which normally lasts from two to four weeks, bruises go through a sequence of color changes. Spectrum of Bruise Colors The changing colors happen while white blood cells remove the decayed blood products bit by bit. For the first two days, bruises appear red because of the iron in the leaked blood. At that point, the area around the bruise may be swollen and tender. Because the age of bruises is so important in determination of child abuse, the National Criminal Justice Reference Service has published a guide to identifying the stage of a bruise's healing by color. The contusion will appear blue or purple through the fifth day. Following that, the bruise becomes green, as the blood's biliverdin gains prominence, through the seventh day. Yellow, on days seven to 10, represents the bilirubin. Finally, the bruise usually appears brown until it goes away. When blood vessels are broken very close to the skin's surface, the colors will be more intense. Those Most Likely to Bruise Generally, women bruise more easily than men, according to WebMD. Genetics may also play a part; some families seem to have a greater tendency to bruise than others. Taking aspirin or anticoagulant drugs can increase the likelihood of bruising, because when the blood is thin, more of it leaks under the skin whenever trauma occurs. The elderly are both more apt to bruise from minor injuries and slower to heal, since the removal of decaying blood components is hampered by restricted circulation. This is especially true with bruises on the lower extremities. Bruise Age-Dating in Child Abuse Investigations Often when child abuse is going on, bruising is the first sign. If authorities can identify this possibility early, further abuse may be prevented. The National Criminal Justice Reference Service says that determining the age of bruises is valuable to see if they are consistent with the caregiver's explanation of when the injury occurred. If more than one bruise is present, the investigator determines if they match. If they do not, multiple injuries are indicated. Signs of Trouble in Bruise Healing Although most bruises heal on schedule, going through the gamut of colors, in a few instances, delayed healing may signify a more serious problem. If the pain is out of proportion to what you would expect from a bruise and does not lessen quickly, the area should be X-rayed to see if a bone has been fractured. Another cause of pain could be the formation of a hematoma. This happens when a large pool of blood accumulates under the skin or in a muscle, and rather than gradually removing the deposit, the body walls it off. According to Medicine Net, a hematoma may need to be drained by a medical practitioner. Source
