Why is my hematoma not going down? Understanding persistent blood clots

October 3, 2025 •

2 min read

While most minor bruises resolve on their own, a hematoma—a more significant collection of pooled blood—can sometimes linger for weeks or even months. If you are asking 'Why is my hematoma not going down?', you may need to consider several factors, from the initial injury's severity to underlying health conditions that affect the body's natural healing process.

Quick Summary

A hematoma that isn't resolving may indicate it is larger, deeper, or still bleeding internally, or it could be a sign of complications like infection, calcification, or an underlying blood-clotting issue. The healing time depends heavily on its size, location, and the individual’s overall health.

Key Points

Size and Location Matter: Larger or deeper hematomas take significantly longer for the body to absorb, potentially lasting months.
Continued Bleeding is a Risk: A hematoma that is still actively bleeding internally will not decrease in size and requires immediate medical evaluation.
Underlying Conditions Can Interfere: Certain medical issues, including blood disorders and liver disease, can impair the body's natural healing and clotting processes.
Medications Can Affect Healing: If you are taking blood thinners or other medications that affect clotting, your hematoma is likely to heal more slowly.
Watch for Complications: Infection and calcification are possible complications that prevent a hematoma from resolving and may require medical intervention.
When in Doubt, Seek Medical Advice: Persistent pain, swelling, or signs of infection warrant a visit to a healthcare provider to rule out serious issues.

Understanding the difference: Bruise vs. Hematoma

Many people use the terms bruise and hematoma interchangeably, but they are medically distinct. A bruise, or contusion, involves minor damage to small blood vessels, resulting in a flat, discolored area on the skin. A hematoma, however, occurs when larger blood vessels are ruptured, causing a more significant, localized collection of blood that pools and often forms a firm, painful lump. This larger volume of blood takes longer for the body to reabsorb, which is a primary reason for its persistence.

Factors contributing to a persistent hematoma

Size and Location of the Hematoma

The size and location are common reasons a hematoma persists. Larger hematomas contain more blood and take longer to reabsorb. Deep-tissue hematomas may heal slower than those under the skin. Intracranial or spinal hematomas are serious and require immediate medical attention.

Continued Internal Bleeding

Ongoing bleeding at the injury site can prevent a hematoma from shrinking. This is a concern that needs prompt medical evaluation.

Underlying Medical Conditions

Certain health issues can impair healing, including bleeding disorders, liver disease, thrombocytopenia (low platelet count), and some blood cancers.

Medications

Medications like anticoagulants, antiplatelets, and corticosteroids can thin the blood and slow down the healing process of a hematoma.

Complications during the healing process

Complications such as infection, calcification (hardening of the blood clot), and compartment syndrome can prevent a hematoma from resolving naturally and may require medical intervention.

Monitoring and comparing hematoma vs. bruise


Characteristic	Hematoma	Bruise (Contusion)
Appearance	Raised, firm, or lumpy mass	Flat, discolored patch
Pain	Often more painful and tender	Mild pain or tenderness
Size	Larger, more significant collection of blood	Smaller, surface-level discoloration
Feeling	Spongy or rubbery initially, then firm	Skin is typically soft
Healing Time	Can take weeks to months	Typically heals within 1-2 weeks
Underlying Cause	Larger blood vessels ruptured	Small capillaries damaged

When to see a doctor

Seek medical advice if you experience increasing size or pain, signs of infection, numbness, or if the hematoma lasts over four weeks. Also, consult a doctor if you are on blood thinners, the hematoma is on your head or neck with concerning symptoms, or it appeared without injury.

Conclusion: Navigating a slow-healing hematoma

A persistent hematoma may simply need more time to heal or could signal an underlying issue or complication. Monitoring symptoms and understanding the difference between a bruise and hematoma is key to knowing when to consult a healthcare professional.

For a more comprehensive resource on types and treatments, you can visit the Cleveland Clinic website.

Frequently Asked Questions

Most small, superficial hematomas may fade within a few weeks, similar to a bruise. However, larger or deeper hematomas can take several weeks to several months to fully resolve. The healing timeline depends on the size and location of the blood pool.

A firm or hard hematoma is often a normal part of the healing process as the pooled blood clots. However, if it remains hard for a long time or becomes extremely firm, it could indicate calcification, a condition where the blood clot hardens into a calcium deposit.

Yes, a hematoma can become infected. The pooled blood can become a breeding ground for bacteria, especially if the overlying skin is broken. Signs of infection include increasing redness, warmth, severe pain, and pus. If you suspect an infection, seek medical attention immediately.

A doctor may need to drain a hematoma if it is very large, causing significant pain or pressure on surrounding tissues, or if it shows signs of infection. Surgical or needle drainage helps to remove the accumulated blood and relieve pressure, especially in cases where it isn't healing on its own.

Yes. Medications such as anticoagulants and antiplatelets reduce your blood's ability to clot, which can cause a hematoma to form more easily and take much longer to resolve. If you are on these medications, it is crucial to follow your doctor's guidance regarding any injury.

For a minor hematoma, the R.I.C.E. method (Rest, Ice, Compression, and Elevation) is often recommended. Rest the area, apply a cold compress to reduce swelling, use a bandage for compression, and elevate the limb if possible. Consult a doctor for more serious or persistent cases.

A hematoma is considered an emergency if it occurs after a head injury and causes neurological symptoms like severe headache, confusion, or nausea. In the limbs, a rapidly growing hematoma or extreme pain, numbness, and tightness could indicate compartment syndrome, a serious medical condition.