When blood comes out of the wrong places, people get upset. And really, why shouldn’t they? Blood belongs on the inside. Not all bleeding needs to be investigated, but some does. Here is a brief guide for the evaluation of dripping, seeping, oozing, leaking, flowing, spurting, gushing red stuff.

Vessels are everywhere in your body and they leak, especially the tiny capillaries. The typical person has multiple capillary leaks every day. We’re sieves. Most of the leaks are very small and go unnoticed. They become noticeable only when they cause pain, interfere with our function, or look dramatic.

A drop of blood lost into your skin would hardly be noticed, but a drop of blood inside your eye can dramatically blur vision. Even a few tablespoons of blood into your gut may not be obvious, but bleeding that much into a knee joint can cause a lot of pain. Generally speaking large bleeds, internal bleeds, and the peeing, pooping, and barfing of blood all need further investigation, but here are more details.

Bleeding on the outside can be stopped by applying direct pressure, but not internal bleeding. Not only is it hidden, but how do you apply pressure? Even my grade school buddy, who could fit his entire hand into his mouth, would fall short. Bleeds into the stomach can be large and dangerous. Because of our love affair with anti-inflammatory pain killers (NSAIDS such as ibuprofen, naproxen, etc.) such bleeds are common. The longer one uses NSAIDS, the greater the risk of a catastrophic bleed. Things like aspirin, fish oil, garlic, vitamin E, and ginko biloba, can increase the risk further. Symptoms may be abdominal pain or nothing at all. If you notice a black tarry stool, a frankly bloody stool, or if you throw up blood or something that looks like coffee grounds, it is time to see your doctor, right now, unless you are routinely eating coffee grounds, in which case you need to see a psychiatrist, right now.

Then there are the bleeds that can damage you. The most notorious are hemorrhagic strokes. While most strokes are caused by a clot in a vessel, hemorrhagic strokes result from a burst vessel. This causes direct damage to the brain. The so-called “thunder clap headache” is the classic presentation of a brain hemorrhage. It is a sudden, severe headache, followed by an actual miniature lightening bolt from your nose. If you experience such a headache, get checked out immediately. Okay, the lightening bolt part doesn’t actually happen.

Then there are the bleeds that are informational, such as invisible blood in the stool, which of course really isn’t invisible, it’s just hidden in all of that poop. It can, however, be found with the “Hemocult Test” and may indicate the development of colon cancer, infection, or inflammatory bowel disease. Blood in the urine, whether visible or not, may be due to something as benign as a leaky vessel or something as ominous as bladder cancer. Nose bleeds or easy skin bruising may be a problem with platelets, medications, your liver, or other clotting problems.

More likely than not, any bleeding that you will ever experience will be subtle and will be an indicator of a problem more than a problem in itself. Screening the urine and stool for blood, colonoscopy at age 50 or older, and a variety of blood tests can discover bleeding problems early before things get ugly. I will tell you, however, that ugly is a lot more fun to treat. There just isn’t anything like spurting blood to brighten your day. Officially, however, I am supposed to advise that you get the screening tests.