Steroids are powerful medications prescribed for various inflammatory and autoimmune conditions. While beneficial, concerns exist about potential side effects, including internal bleeding. Understanding the different types of steroids and their associated risks is important for anyone using or considering these medications.
The Link Between Steroids and Internal Bleeding
It is important to distinguish between two main types of steroids: corticosteroids and anabolic-androgenic steroids. Corticosteroids, such as prednisone or dexamethasone, are anti-inflammatory medications used to treat conditions like asthma, arthritis, and autoimmune disorders. Anabolic steroids are synthetic variations of the male hormone testosterone, sometimes misused for muscle growth and performance enhancement.
Corticosteroids are associated with an increased risk of internal bleeding, primarily affecting the gastrointestinal (GI) tract. This risk is particularly noted with long-term use, higher doses, or when combined with nonsteroidal anti-inflammatory drugs (NSAIDs). A systematic review found that corticosteroids increased the risk of gastrointestinal bleeding or perforation by 40%. This heightened risk is more pronounced in hospitalized patients.
Anabolic steroids are not typically linked to direct internal bleeding, especially gastrointestinal bleeding. Their primary risks involve cardiovascular issues like increased blood pressure and cholesterol changes, liver damage, and hormonal imbalances. While anabolic steroids can lead to blood thickening, increasing the risk of blood clots, this is distinct from causing internal bleeding.
Mechanisms Behind Increased Bleeding Risk
Corticosteroids contribute to gastrointestinal bleeding by affecting the protective lining of the stomach and intestines. They inhibit the production of prostaglandins, compounds that help maintain GI lining integrity and regulate blood flow. Without adequate prostaglandins, the stomach and intestinal lining become more vulnerable to damage from gastric acid.
Corticosteroids may also increase gastric acid secretion, further contributing to mucosal damage. This combination of reduced protection and increased acid can lead to the formation of ulcers, which may erode into blood vessels, causing bleeding. Corticosteroids also impair the healing of existing ulcers or mucosal injuries by inhibiting growth factors and reducing the inflammatory response necessary for tissue repair.
Recognizing Signs of Internal Bleeding
Internal bleeding can manifest in various ways, and its signs often depend on the location. For gastrointestinal bleeding, common with corticosteroids, symptoms include black, tarry stools (melena) from digested blood in the upper GI tract. Vomiting blood, which can appear bright red or resemble coffee grounds, is another clear indication of upper GI bleeding.
Other signs of internal bleeding include severe abdominal pain, unexplained dizziness or lightheadedness, and general weakness or fatigue. Pale skin, shortness of breath, or a rapid heart rate can also indicate blood loss. Obvious symptoms like blood in stool or vomit should not be ignored.
When to Seek Medical Attention
Internal bleeding is a medical emergency requiring immediate attention. If any signs are observed, seek medical help without delay. Symptoms such as severe pain, dizziness, or blood in vomit or stool warrant prompt evaluation by a healthcare professional.
Delaying medical attention can lead to serious complications, including shock, organ damage, or death. It is advisable to go to the nearest emergency room if you suspect internal bleeding. Healthcare providers can quickly diagnose the source and severity of the bleeding and provide necessary interventions, such as fluid replacement or blood transfusions.