Steroid injections, often called cortisone shots, deliver powerful anti-inflammatory medication directly into areas of localized pain, such as a joint, tendon, or bursa. This targeted approach reduces inflammation and provides pain relief for various musculoskeletal conditions. While patients often worry about bleeding, a small amount of spotting or minor oozing immediately afterward is a common and expected part of the healing process.
The Expected Reaction at the Injection Site
Minor bleeding occurs because the needle must penetrate the skin and underlying tissues to reach the target area. This physical breach can nick tiny, superficial blood vessels called capillaries, leading to light spotting. This slight seepage is usually negligible and stops almost immediately with gentle pressure.
Normal bleeding is minimal, consisting of a few beads of blood or a light ooze that ceases within a minute or two. This is distinct from bruising, which happens when blood leaks into the surrounding tissue and appears as a discolored patch hours or days later. Patients taking blood-thinning medications, such as aspirin or anticoagulants, may experience slightly more bleeding or prominent bruising, but it should still resolve quickly.
Immediate Care Following the Procedure
Immediate care following the procedure minimizes bleeding and reduces the chance of bruising. The first step involves applying firm, direct pressure to the injection site, usually with a sterile gauze pad, for several minutes as instructed by your provider. This pressure helps compress the blood vessels, encouraging clot formation and stopping minor bleeding.
Once bleeding stops, cover the site with a small, sterile bandage to keep the area clean and protected. For the next 24 to 48 hours, avoid strenuous activity or heavy lifting involving the treated area. Applying ice can help reduce swelling and localized pain after the numbing agent wears off. Avoid soaking the area in a bathtub, hot tub, or pool for at least one to two days to prevent introducing bacteria to the puncture wound.
Signs That Require Medical Attention
While minor bleeding is normal, excessive bleeding or developing complications require prompt medical evaluation. The most immediate concern is bleeding that does not stop despite applying firm, continuous pressure for 10 to 15 minutes. This level of persistent bleeding suggests a larger vessel may have been affected and warrants contacting the injecting physician or seeking urgent care.
Another concern is the rapid formation of a hematoma, which is a collection of blood outside the blood vessels that presents as a firm, rapidly expanding lump under the skin, often accompanied by severe, sudden pain. If the injection was performed near the spine, such as an epidural, severe or new neurological symptoms, including sudden numbness or extreme weakness, could signal a rare but serious complication like a spinal hematoma.
Monitor the injection site for signs of infection, which typically appear days after the procedure. These signs include increased redness and warmth that spreads out from the site, swelling that worsens after 48 hours, or the appearance of pus or cloudy drainage. A fever of 100.4°F or higher is a sign of systemic infection that necessitates immediate medical attention.
Finally, some women may experience abnormal vaginal bleeding or spotting in the days or weeks following a steroid injection. This is a recognized, though uncommon, systemic side effect of the corticosteroid medication affecting hormonal balance. While this is often temporary, it should be reported to a healthcare provider so they can rule out other potential underlying causes.