Bruising and bleeding both occur because of damage to blood vessels. When a vein, artery, or capillary is torn or cut, blood flows out into the vessel's surroundings; if the escaped blood is contained within the tissues directly under the skin, we see a bruise.
While all of us bruise from time to time, some people bruise particularly easily. A number of factors, besides being accident-prone, can make this occur.
One factor contributing to easy bruising is thinning skin, caused by aging or by medications such as corticosteroids. Easy bruising can also be due to fragile blood vessel walls. Finally, difficulties with blood clotting, including problems with platelets or clotting factors, can also increase bruising. For this reason, strong blood-thinning drugs such as heparin and warfarin (Coumadin) can lead to excessive bruising. Warning: If you’re taking these or other anticoagulant drugs and notice increased bruising, contact your doctor, as this situation could be dangerous.
Aspirin or natural remedies, such as policosanol, ginkgo, garlic, and high-dose vitamin E, may also thin the blood, possibly raising the risk of bruising and other bleeding problems; and if you combine two blood-thinning substances, these effects might multiply.
Rarely, severe bruising from minor or unnoticed injuries can be a sign of leukemia or another serious health problem. Especially if this is a new development, discuss your symptoms with a doctor.
However, in most cases, there is no identifiable medical cause for easy bruising, and no conventional treatment. Furthermore, once you have a bruise, there is no conventional therapy to help speed its resolution.
A number of natural substances might be helpful for easy bruising, including citrus bioflavonoids, the related substances OPCs and bilberry, and vitamin C. In addition, if you already are bruised, you may find some help with a combination of two proteolytic enzymes, trypsin and chymotrypsin or a topical preparation, of escin (an extract of horse chestnut).
Citrus Bioflavonoids and Related Substances
Bioflavonoids (or flavonoids) are plant substances that bring color to many fruits and vegetables. Citrus fruits are a rich source of bioflavonoids, including diosmin, hesperidin, rutin, and naringen; studies have found these bioflavonoids may help decrease bruising. Two types of natural compounds related to bioflavonoids—OPCs (oligomeric proanthocyanidins) and anthocyanosides—have also shown promise for decreasing the tendency to bruise.
For example, a double-blind, placebo-controlled study of 96 people with fragile capillaries found that a combination of the bioflavonoids diosmin and hesperidin decreased the tendency to bruise.1 Participants took 2 tablets daily of these bioflavonoids or placebo for 6 weeks, while researchers used a suction cup to measure their capillaries' tendency to rupture and also looked for spontaneous bruising and other symptoms of fragile capillaries. Those individuals who received bioflavonoids had significantly greater improvements in both capillary strength and symptoms compared to those taking placebo.
Two rather poorly designed studies from the 1960s found benefits with a combination of vitamin C and citrus bioflavonoids for decreasing bruising in collegiate athletes. In a single-blind study of 27 wrestlers, 71% of those taking placebo were injured, with bruises making up more than half their injuries; in contrast, only 38% of those taking the supplement were injured, none of whom sustained bruises.2 In a follow-up double-blind study of 40 football players, the treated group received fewer severe bruises than the group taking placebo.3
Test tube studies have found that OPCs protect collagen, partly by inhibiting an enzyme that breaks it down.4 One rather poorly designed double-blind study of 37 people—most of whom had fragile capillaries—found that OPCs were more effective than placebo in decreasing capillary fragility 5 ; however, the authors of this study left many questions unanswered in their report, making it hard to determine how seriously to take their results.
Anthocyanosides, which are present in high concentrations in bilberry, may also strengthen capillaries through their effects on collagen. Some European physicians believe that these vessel-stabilizing properties make bilberry useful as a treatment for easy bruising, but the evidence as yet is only suggestive.
Vitamin C is essential for healthy collagen; severe vitamin C deficiency, called scurvy, can lead to easy bruising. Fortunately, scurvy is extremely rare in Western countries today—but marginal vitamin C deficiency is not rare, and might lead to increased risk of bruising.
A 2-month, double-blind study of 94 elderly people with marginal vitamin C deficiency found that vitamin C supplements decreased their tendency to bruise.10
If your diet is low in fresh fruits and vegetables, you may wish to supplement it with vitamin C. In the study mentioned above, bruising in elderly people decreased significantly with 1 g of oral vitamin C given daily for 2 months.
For more information, including dosage and safety issues, see the full Vitamin C article.
Trypsin and Chymotrypsin
Trypsin and chymotrypsin, naturally produced in the body to help digest protein, are often called proteolytic enzymes. (Bromelain, discussed below, is a proteolytic enzyme from a plant source.) It is theorized that trypsin and chymotrypsin reduce swelling by breaking down protein fibers that trap fluids in the tissues after an injury, thereby restoring normal circulation in the area.17 Three, small, double-blind studies, involving a total of about 80 athletes, found that treatment with proteolytic enzymes significantly speeded healing of bruises and other mild athletic injuries as compared to placebo.18,19,20
For more information, including dosage and safety issues, see the full Proteolytic Enzymes article.
An extract of horse chestnut called escin may also help with bruising. Horse chestnut has been traditionally used to treat varicose veins and other problems involving blood vessels and swelling. One double-blind study of 70 people found that about 10 g of 2% escin gel, applied externally to bruises in a single dose 5 minutes after they were induced, reduced bruise tenderness.22
For more information, including dosage and safety issues, see the full Horse Chestnut article.
Like trypsin and chymotrypsin, bromelain is thought to decrease bruising by breaking down proteins that trap fluids in the tissues after an injury,24 and it is sometimes used in Europe to speed recovery from injuries. However, better-quality studies are needed before bromelain can be said to be effective.
In one controlled study, 74 boxers with bruises on their faces and upper bodies were given bromelain until all signs of bruising had disappeared;25 another 72 boxers were given placebo. Fifty-eight of the group taking bromelain had lost all signs of bruising within 4 days, compared to only 10 taking placebo. Unfortunately, this study was apparently not double-blind, meaning that some of its results may have been due to the power of suggestion.
Another study—this one without any type of control group—found that bromelain reduced swelling, pain at rest, and tenderness among 59 patients with blunt injuries, including bruising.26
For more information, including dosage and safety issues, see the full Bromelain article.
Other Herbs Used for Bruising
The herbs comfrey, arnica, and sweet clover are widely used externally on bruises and other minor injuries, but despite this traditional use, there is no real scientific evidence that they work.
Note: There are various safety concerns involved in using comfrey, arnica, and sweet clover internally. For the treatment of bruising, they are used as topical ointments and salves.
For a discussion of homeopathic approaches to easy bruising, see the chapter on bruises in the Homeopathy Database
1. Galley P, Thiollet M. A double-blind, placebo-controlled trial of a new veno-active flavonoid fraction (S 5682) in the treatment of symptomatic capillary fragility. Int Angiol. 1993;12:69-72.
2. Miller MJ. Injuries to athletes. Evaluation of ascorbic acid and water soluble citrus bioflavonoids in the prophylaxis of injuries in athletes. Med Times. 1960;88:313-316.
3. Miller MJ. Injuries to athletes. Evaluation of ascorbic acid and water soluble citrus bioflavonoids in the prophylaxis of injuries in athletes. Med Times. 1960;88:313-316.
4. Maffei Facino R, Carini M, Aldini G, et al. Free radicals scavenging action and anti-enzyme activities of procyanidines from Vitis vinifera: a mechanism for their capillary protective action. Arzneimittelforschung. 1994;44:592-601.
5. Dartenuc J-Y, Marache P, Choussat H. Capillary resistance in geriatry: a study of microangioprotector = endotelon [translated from French]. Bord Med. 1980;13:903-907.
10. Schorah CJ, Tormey WP, Brooks GH, et al. The effect of vitamin C supplements on body weight, serum proteins, and general health of an elderly population. Am J Clin Nutr. 1981;34:871-876.
17. Rathgeber WF. The use of proteolytic enzymes (Chymoral) in sporting injuries. S Afr Med J. 1971;45:181-183.
18. Rathgeber WF. The use of proteolytic enzymes (Chymoral) in sporting injuries. S Afr Med J. 1971;45:181-183.
19. Zuschlag JM. Double-blind clinical study using certain proteolytic enzyme mixtures in karate fighters. Working paper. Mucos Pharma GmbH (Germany). 1988;1-5. 16.
20. Deitrick RE. Oral proteolytic enzymes in the treatment of athletic injuries: a double-blind study. Pa Med. 1965;68:35-37.
22. Calabrese C, Preston P. Report of the results of a double-blind, randomized, single-dose trial of a topical 2% escin gel versus placebo in the acute treatment of experimentally-induced hematoma in volunteers. Planta Med. 1993;59:394-397.
24. Blonstein, JL. Control of swelling in boxing injuries. Practitioner. 1969;203:206.
25. Blonstein, JL. Control of swelling in boxing injuries. Practitioner. 1969;203:206.
26. Masson M. Bromelain in blunt injuries of the locomotor system. A study of observed applications in general practice [in German; English abstract]. Fortschr Med. 1995;113:303-306.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 12/15/2015
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