Let's learn exactly what hemorrhage is, whether it's internal or external.

Have you ever noticed that even a small wound does not stop bleeding? Or have you sometimes felt like bleeding from somewhere inside your body, or have you experienced similar symptoms? Actually, this bleeding, that is, the condition called `(Hemorrhage)`, can sometimes be a little more serious than you think. So, let's talk about this in detail today, in Sinhala that you can understand.

What is bleeding or ``Hemorrhage''?

Simply put, a blood vessel (blood vessel) in our body is damaged and blood leaks out of it, which is what we call `(Hemorrhage)`. This bleeding can also occur inside the body, in which case we call it ``internal hemorrhage``. On the other hand, if the blood is visible outside, either from a wound or an opening in the body, it is ``external hemorrhage``. This bleeding can be small or it can be large enough to affect life.

Most of the time, we consider these conditions called ``Hemorrhage'' as medical emergencies that require urgent medical treatment .

What are the types of bleeding?

Since there are blood vessels throughout our bodies, this `(Hemorrhage)` can occur in a variety of ways. Here are some examples:

• Blood in the chest (`Hemothorax`): Imagine that the space between your lungs and rib cage (`pleural space`) in your chest fills with blood. What happens then? Your lungs become compressed , making it difficult to breathe, and you may experience chest pain. This condition is called `(Hemothorax)`.
• Intracranial hemorrhage (or brain bleed): This is a slightly more dangerous condition. It is caused by uncontrolled bleeding inside your brain or between the delicate membranes that surround it. If the bleeding occurs inside the brain, it is called a hemorrhagic stroke. This type of stroke is very serious and can quickly become life-threatening. The other type of stroke, an ischemic stroke, is when the blood supply to the brain is blocked, but this is different. The bleeding occurs here.
• Postpartum hemorrhage (PPH): This is a very important issue for mothers. Postpartum hemorrhage, or PPH for short, is the excessive bleeding from the vagina after giving birth. This is a very serious condition that can be life-threatening. This condition can occur within a few hours of giving birth or up to 12 weeks after delivery.
• Subarachnoid hemorrhage (SAH): Bleeding between the meninges of the brain and the protective membranes that surround it is called a subarachnoid hemorrhage (SAH). This is also a medical emergency.
• Subconjunctival hemorrhage: You may have seen some people have a red blood spot under the white of their eyes . That's what's called a subconjunctival hemorrhage. This is when blood collects in the thin membrane around the eye called the conjunctiva. This is usually not as serious as other types of hemorrhage.

Bruises , which are the accumulation of blood under the skin that we all experience, are actually a small example of ``hemorrhage.`` Another related word is ``hematoma.`` It refers to the accumulation of blood within the tissue.

What are the symptoms of bleeding?

The feelings you have when you bleed can vary, depending on where the bleeding is and how bad it is.

According to doctors, no major symptoms usually appear until about 15% of the body's total blood volume is lost (Class I hemorrhage).

However, if your body loses 15% to 30% of its blood volume (Class II hemorrhage) , then these symptoms start to appear:

• Dizziness or lightheadedness (this is caused by low blood pressure).
• Fatigue and lethargy.
• Nausea and vomiting.
• Difficulty breathing (dyspnea) and increased respiratory rate.
• Increased heart rate (tachycardia).

If you or someone close to you has these symptoms, you should immediately call 1990 or go to the emergency department of the nearest hospital.

If you lose more than 30% of your total blood volume, the condition can become more serious. In such cases, the following can occur:

• Confusion.
• Seizures.
• Loss of consciousness.
• Hypovolemic shock (shock caused by a severe drop in blood pressure).

Specific symptoms of internal bleeding

Internal bleeding in certain parts of the body can cause specific symptoms:

• Headache: Sudden , severe headache , vision changes, confusion, and a feeling of numbness on one side of the body.
• Chest: Difficulty breathing , chest pain, and coughing up blood.
• Stomach (abdomen): Abdominal bloating or feeling full, abdominal distension, vomiting blood, blood in urine or stool.
• Bones, joints, and muscles: Bruising, swelling, and pain. But the most important thing to remember is that blood pooling in a closed space (e.g., between the muscles of an arm or leg) and increasing pressure on the tissues is a medical emergency. This can cause pressure on nerves and blood vessels, potentially causing permanent loss of function in that area.

If you have symptoms like these, as mentioned earlier, it is very important to seek medical advice immediately.

How do you know for sure if you are bleeding?

In fact, sometimes it's hard for us to understand how serious it is to bleed. For example, nosebleeds. Most of the time, they're normal and not a big deal. However, if the bleeding comes from a large blood vessel or artery, it can be severe and difficult to stop. As mentioned earlier, vaginal bleeding after childbirth is also common. It's normal and expected. However, if it's excessive, it can be a dangerous condition called postpartum hemorrhage.

The best thing to do is to pay attention to your body and your symptoms. Also, if you have any concerns about the amount of bleeding, be sure to seek medical advice. Be aware of the symptoms of heavy bleeding (such as dizziness, fatigue, and shortness of breath). If you have even the slightest concern about bleeding, don't hesitate to seek medical help.

Why is there bleeding like this? What are the reasons?

This type of bleeding occurs when one or more blood vessels are damaged. The severity of the bleeding often depends on where in the body it is and how large the damaged blood vessel is.

There are many causes and conditions that can cause or increase the risk of a hemorrhage. Here are a few examples:

• Alcohol use disorder: This is a major risk factor, especially for subarachnoid hemorrhage.
• Blood clotting disorders: For example, conditions like antiphospholipid syndrome.
• Blood disorders: Congenital diseases such as hemophilia and Von Willebrand disease.
• Cancer.
• Certain medications: Examples include blood thinners such as `warfarin (Coumadin®), `aspirin` (including baby aspirin), `clopidogrel (Plavix®)` and `apixaban (Eliquis®).
• Some vascular diseases: conditions such as hereditary hemorrhagic telangiectasia and aneurysms (where blood vessels become weak and bulge like balloons).
• Complications of medical treatment: Complications that can occur after things like surgery.
• Damage to an internal organ: For example, prolonged use of painkillers such as ibuprofen (Advil®) can cause an ulcer in the intestine to develop and bleed.
• Injuries: Cuts, major fractures, traumatic brain injury.
• Trauma: Things like gunshot wounds, stabbings, etc.
• Viral hemorrhagic fevers: These are diseases caused by a group of viruses. These viruses can damage blood vessels and cause severe bleeding. Examples include Ebola, dengue fever, Marburg, and yellow fever.

How do doctors diagnose a `(Hemorrhage)`?

Doctors will diagnose a hemorrhage based on your symptoms (e.g., dizziness) and physical examination findings (e.g., increased heart rate, decreased blood pressure). The next step is to find out exactly where the bleeding is coming from and what is causing it. External bleeding is often obvious. However, internal bleeding can be a bit more challenging.

The doctor will perform a physical exam, ask about your symptoms and medical history, and may also order imaging tests (such as scans) and laboratory tests.

What are the treatments for bleeding?

The treatment for a hemorrhage depends on several factors:

• Where does the blood go and whether it is inside or outside the body.
• The severity of it.
• The original cause of the bleeding.
• Do you have any other illnesses or injuries?

If the cause is not known and/or the bleeding is severe, you may need to be hospitalized for treatment. Your medical team will find the cause and treat it appropriately. You may need things like:

• Surgery.
• Vitamin K injections: (Especially if you are taking medication like warfarin, to help stop bleeding).
• Intravenous fluids (`IV fluids`).
• Blood transfusions.

First aid for someone who is bleeding

You can also provide first aid to someone who is bleeding heavily – whether it's you or someone else. Follow these steps:

1. Immediately call 1990 or your local emergency number.

2. Lay the injured person down. If there is a wound on their arm or leg, elevate the injured part above the level of the heart if possible.

3. If you have medical supplies, cover the wound with sterile gauze or a clean cloth.

4. Ask the injured person to hold the wound with his/her hand(s). If he/she cannot do it, you should do it.

5. If something (e.g. a piece of glass, a piece of wood) is stuck in the wound, do not pull it out. Tighten the bandage around it.

6. If you are using a `Tourniquet` (a band that is tied tightly over a wound to stop bleeding), do so only if you are familiar with it, and only as a last resort in cases of severe bleeding. (This is a method of stopping bleeding by using something like a piece of wood or cloth to apply pressure over a wound. However, this should only be done by someone who is familiar with it, as it can be harmful if done incorrectly.)

What is the recovery outlook for someone who has had a hemorrhage?

If you have a hemorrhage, your prognosis (outlook) depends on several factors:

• What kind of `(Hemorrhage)` is that?
• The severity of it.
• How quickly you received treatment.
• Your age and overall health.

Early medical attention is the key to a better recovery. Once you receive treatment, your medical team will give you a good idea of ​​what to expect going forward.

Complications that may occur due to `(Hemorrhage)`

Complications from hemorrhage are mainly caused by a decrease in the amount of blood reaching your organs. This can eventually cause tissue and cells to die, leading to complications such as:

• Organ failure.
• Seizures.
• Coma.
• Death.

Bleeding is a leading cause of potentially preventable death, especially among those who suffer severe trauma injuries.

Some specific types of hemorrhage can have specific complications. For example, a brain hemorrhage can cause permanent brain damage and neurological issues. Postpartum hemorrhage can cause a condition called Sheehan syndrome, which is when your pituitary gland is damaged by excessive bleeding.

Other common complications include rebleeding and complications associated with hospitalization (e.g., deep venous thrombosis, and infection).

Our bodies need blood to stay in our blood vessels. When it leaks, especially if it's a lot, it can cause serious problems. When it comes to hemorrhage, getting immediate medical attention is the most important thing. If you or a loved one is bleeding uncontrollably, or if you suspect that you're bleeding internally, don't delay getting to the hospital.

Finally, things for you to remember

Okay, I think you now have a good understanding of what we've been talking about, ``Hemorrhage,'' which means bleeding. The most important thing is that if you're bleeding in an unusual way, don't just ignore it, thinking, "Oh, it's just a little thing," and seek medical advice immediately. Also, if you have symptoms that make you think you're bleeding somewhere inside your body (e.g., a sudden severe headache, vomiting blood, black stools), that's also the case, and you need to see a doctor right away.

Remember, if we get treatment early, we can prevent many serious conditions. Therefore, always pay attention to your body. If you have any problems or doubts, do not be afraid or hesitate to see a doctor and get advice. Stay healthy!

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