is called blood loss resulting from damage to blood vessels. The integrity of the vessels can be broken by trauma, purulent fusion, an increase, and the action of toxins. Changes in blood chemistry can also cause bleeding. It provokes a wide range of diseases: hemophilia, scurvy, and so on.

When bleeding occurs in the body cavity (abdominal, pleural), it is called internal. Bleeding in the tissue is called. If any tissue is diffusely saturated with blood, they speak of a hemorrhage (into the subcutaneous tissue, brain tissue, etc.)

There are several general classifications of bleeding.

According to the time of bleeding can be:

primary (occur immediately after injury or tissue damage);

early secondary (occur after a few hours or after injury, before infection enters the wound);

late secondary (begin after the development of infection in the wound).

Depending on the severity and loss of blood, bleeding can be:

the first degree (loss of circulating blood is not more than 5%);

second degree (loss of circulating blood about 15%);

third degree (loss of circulating blood about 30%);

the fourth degree (loss of circulating blood more than 30%).

Symptoms of bleeding

Symptoms of bleeding depend on its type and the type of damaged vessels.

It occurs when the arteries (carotid, femoral, axillary, etc.) are damaged. It is the most dangerous, since blood is ejected very quickly, in a pulsating stream. Rapidly comes acute anemia; the color of blood is bright scarlet. The victim becomes pale, his pulse is quickened, blood pressure drops rapidly, nausea and, appears. Death can occur due to oxygen starvation or cardiac arrest.

Occurs when the integrity of the veins is violated. The blood flows in an even continuous stream and has a dark cherry color. If the intravenous pressure is not too high, the blood may spontaneously stop: a fixed clot forms. But bleeding leads to the occurrence of shock phenomena in the body, which often leads to death.

capillary bleeding is the least dangerous and stops on its own. Blood oozes from the wound, damaged vessels are not visible. The danger of capillary bleeding is only in diseases that affect blood clotting (hemophilia, sepsis,).

Parenchymal bleeding occurs when all the blood vessels in the area of ​​injury are damaged. It is dangerous, usually very strong and prolonged.

Also, bleeding symptoms may depend on the location of the injury. If bleeding occurs inside the skull, the brain is compressed, a pressing sensation appears in the head, especially in the temporal part. Pleural bleeding () leads to compression of the lung, the appearance of shortness of breath. Ruptures in the abdominal cavity cause an accumulation of blood in it (hemoperitoneum): a person has abdominal pain, nausea and vomiting. Bleeding into the cavity of the cardiac membrane causes a decrease in the activity of the heart, cyanosis; venous pressure is increased.

When bleeding occurs within a joint, its volume increases. When palpation of the joint or movements, the person feels severe pain. Interstitial hematoma is characterized by swelling, pain on palpation, and a sharp pallor of the skin. If timely treatment is not carried out, the hematoma will squeeze the veins, which can lead to the development of gangrene of the limb.

Arterial bleeding and first aid

Arterial bleeding is one of the most dangerous bleeding that poses a direct threat to human life. This is primarily due to the fact that blood loss is high and intense. Therefore, it is important to know its main signs and first aid rules.

Arteries are blood vessels, blood circulates through them and is delivered to all vital organs. If the artery is damaged as a result of any traumatic factor, then the blood from it begins to flow outward. It is not difficult to understand that arterial bleeding is not difficult, it is characterized by such signs as: the bright scarlet color of the blood, it is liquid in consistency, does not flow out of the wound, but beats with a powerful stream, similar to a jet in a fountain. There is always a pulsation that occurs in time with the contraction of the heart muscle. Since the blood is expelled very quickly, the person may experience vasospasm and loss of consciousness.

First aid algorithm for arterial bleeding

The rules for first aid will vary, depending on where the injury is located and which artery has been damaged:

First of all, it is necessary to apply a tourniquet, which will prevent blood loss. Before fixing it, it is important to press the injured artery against the bone, above the place where the blood flows from. If the shoulder is wounded, the fist is inserted into the armpit, and the arm is pressed against the body; if the forearm is wounded, place any suitable object in the elbow bend and bend the arm as much as possible in this joint. If the thigh is wounded, the artery is clamped with a fist in the inguinal region, if the shin is wounded, the corresponding object is placed in the popliteal zone and the leg is bent at the joint.

The limb should be raised, a tissue should be placed under the tourniquet. When there is no rubber band at hand, it can be replaced with an ordinary bandage or a strip of cloth. For a tighter fixation, you can use a regular stick.

It is important not to overexpose the tourniquet on the limb, it must be removed after 1 - 1.5 hours, depending on the time of year. It is best to record the time of its application on paper and put it under the bandage. This must be done so that tissue death does not occur, and amputation of the limb is not required.

When the time for wearing the tourniquet has expired, and the victim is not hospitalized, it is necessary to loosen it for a few minutes. In this case, the wound should be clamped with hands, using a clean cloth.

As soon as possible, deliver the victim to a medical facility where he will be provided with qualified assistance.

The rules for helping with the occurrence of arterial bleeding from the feet, as well as the hands, differ. In this case, there is no need to apply a tourniquet. It is enough to bandage the injured place and lift it higher.

When such arteries as the subclavian, iliac, carotid or temporal are injured, the blood is stopped with a tight tamponade. To do this, either sterile cotton wool or sterile wipes are put into the damaged area, then a layer of bandage is applied on top and wrapped tightly.

Venous bleeding and first aid

Venous bleeding is characterized by the outpouring of blood from the veins, as a result of their damage. Through the veins, blood enters the heart from the capillaries that lower the organs and tissues.

To understand that a person has venous bleeding, it is necessary to focus on the following signs: the blood is colored dark red or cherry. It does not pour out in a fountain, but flows out of the wound slowly and fairly evenly. Even if large veins were injured and the bleeding is profuse, there is still no pulsation. If it does, it will be slightly perceptible, which is explained by the irradiation of impulses from a nearby artery.

Venous bleeding is no less dangerous than arterial bleeding. In this case, a person can die not only because of the profuse loss of blood, but also because of the absorption of air through the veins and its delivery to the heart muscle. Air trapping occurs when inhaling during an injury to a large vein, especially in the neck, and is called an air embolism.

First aid algorithm for venous bleeding

In this case, there is no need to apply a tourniquet and the first aid rules are as follows:

If the vein of the limb is injured, then it must be raised up. This is done in order to reduce the flow of blood to the damaged area.

Then you should start applying a pressure bandage. For this purpose, there is an individual dressing package. If this is not at hand, then a clean napkin or cloth folded several times is applied to the wound, after which it is wrapped with a bandage on top. Put a handkerchief over the bandage.

The place of application of such a bandage is below the injury site. It is important to apply a bandage tightly and in a circle, otherwise it will only provoke an increase in blood output.

The criterion for assessing the correctness of the actions performed is the absence of bleeding and the presence of pulsation below the injury site.

When there is no clean tissue at hand, you should clamp the injured limb in the joint as hard as possible, or squeeze the place just below the blood outlet with your fingers.

In any case, the victim should be hospitalized.

Sometimes, with heavy bleeding, it is not possible to stop it with the help of a bandage alone. In this case, it is advisable to use a tourniquet. It is applied below the wound, which is due to the way blood is delivered to the heart muscle through the veins.

Capillary bleeding and first aid

Capillary bleeding is the most common bleeding. It does not pose a threat to human life, since capillaries are the smallest vessels that penetrate all tissues and organs. It has its own distinctive features. The blood flowing from the capillaries has a bright scarlet color, the discharge is not intense, since the pressure in this case will be minimal, the pulsation is completely absent.

First aid algorithm for capillary bleeding

The rule of first aid for capillary bleeding is simple.

In this case, the application of a tourniquet is not required, it is enough to confine ourselves to the following actions:

Wash and disinfect the wound.

The injured place should be pulled tightly, but in such a way as not to disturb the flow of arterial and venous blood, that is, not too much.

Apply cold to the wound site, which will constrict the blood vessels.

If a person has a superficial wound and no other injuries, then hospitalization is not required.

Parenchymal bleeding and first aid

Parenchymal bleeding is bleeding that occurs in the internal organs, which is characterized by profuse blood loss. The only way to stop it is through surgery. The parenchyma organs include the lungs, liver, kidneys, and spleen. Since their tissue is extremely delicate, even a slight injury to it leads to profuse bleeding.

To determine parenchymal bleeding, you need to focus on the following signs: general weakness, dizziness, fainting, blanching of the skin, low pulsation with a rapid heartbeat, a drop in blood pressure. Depending on which organ was injured or sick, it will be possible to suspect parenchymal bleeding of the lungs, liver, kidneys, etc.

First aid algorithm for parenchymal bleeding

Since this type of blood loss is dangerous to human life, it is necessary to act quickly:

The victim should be sent to a medical facility as soon as possible. If it is not possible to call an ambulance, then you need to go on your own.

Neither pressure bandages nor the application of tourniquets in this case will affect the amount of blood lost.

Before the arrival of the medical team, a person needs rest. To do this, lay it in a horizontal position, and slightly raise your legs.

Ice should be applied to the area where bleeding is suspected. If the transportation of the patient to the medical facility is delayed, then you can use such means as: Vikasol, Etamzilat, Aminocaproic acid.

Only a surgeon is able to stop parenchymal bleeding. Depending on the nature of the damage, complex sutures will be applied, vessels will be emmobilized and electrocoagulated, the omentum will be sutured, and other surgical methods will be applied. In some cases, it requires parallel blood transfusion and the use of saline solutions.

Gastrointestinal bleeding and first aid

Gastrointestinal bleeding deserves special attention, as they are life-threatening conditions. It is important not to miss the first signs of such blood loss and seek help from a specialist in time. Among them, the following can be distinguished: hematemesis with brown impurities, the presence of liquid bloody stools, pallor of the skin, increased heart rate with, general weakness accompanied by dizziness, sometimes loss of consciousness.

First aid algorithm for gastrointestinal bleeding

In order to stop gastrointestinal bleeding, a person must be taken to a hospital.

However, first aid will be as follows:

A person needs complete rest. For this, it is best to put him to bed.

A cold heating pad or ice pack should be placed on the abdomen.

You can prick some ice and give it to the person in small portions so that he swallows it.

Take the victim to the hospital.

First aid for bleeding

The provision of first aid for any type of bleeding is either a complete stop or a slowdown in blood loss until the victim is in the hands of a specialist. It is important to be able to distinguish between types of bleeding and be able to properly use improvised means to stop them. Although it is better to always have bandages, cotton wool, a tourniquet, an individual dressing bag and disinfectants in the first-aid kit and in personal vehicles. Two important rules for providing first aid are not to harm a person and act quickly, because in some cases every minute is important.

In order to properly provide first aid for bleeding, you need:

Apply a tourniquet above the wound if the bleeding is arterial.

Apply tampons and dressings below the wound if bleeding is venous.

Disinfect and bandage the wound if the bleeding is capillary.

Lay the person in a horizontal position, apply cold to the injured area and take him to the hospital as soon as possible if the bleeding is parenchymal or gastrointestinal.

It is important to properly clamp a vein or vessel in order to gain time and have time to deliver a person to a hospital, or transfer it to an ambulance team. The doctors who came to the call, if everything is done correctly, will not bandage the tourniquet or bandage. They can give a person an intravenous injection of solutions of Vikasol, or Calcium Chloride, or another hemostatic agent, measure blood pressure, and, if necessary, administer drugs to normalize cardiac activity. Then the person will be handed over to the surgeon.

Knowing the basic rules, you can one day save the life of not only another person, but also yourself.

About the doctor: From 2010 to 2016 practicing physician of the therapeutic hospital of the central medical unit No. 21, the city of Elektrostal. Since 2016, she has been working at the diagnostic center No. 3.

As a rule, people keep silent about diseases that affect the genitals and anus. For some reason, most are ashamed of such ailments. They turn to doctors already in very difficult and neglected situations, or do not resort to their services at all. Was no exception and such a problem as blood from the anus during bowel movements.

At the same time, it is worth knowing that anal bleeding can manifest serious diseases of the gastrointestinal tract, which pose a threat to the health, and sometimes the life of the patient. Therefore, neither the patient nor the doctor can ignore such a formidable symptom in order to prevent the further development of the disease and its complications.

If we turn to statistics, then most often bleeding from the anus is observed in women and men with hemorrhoids. In this disease, blood is released from the anus, as a rule, without pain, during or at the end of the act of defecation, more often drip, sometimes in a stream, and in advanced cases - in the form of "splashes". The color is scarlet.

Causes of bleeding from the anus

Why is blood coming from the anus, and what to do in this case? In adults, this symptom is primarily associated with damage to the mucous membrane of the rectum and colon.

Rectal bleeding can not be compared with a petty banality, which you can give up on. If it appears during or after defecation, accompanied by pain or without it, it is imperative to contact a proctologist so that adequate treatment can be carried out with timely diagnosis.

Common causes of blood from the anus in women and men:

1. The leader of such a symptom is. Usually blood appears after a bowel movement. The color of blood is scarlet, blood is not mixed with feces.
2. . With this disease, inflammation and ulceration occurs in any part of the gastrointestinal tract, most often in the large intestine.
3. . Blood from the rectum comes in small portions, is observed after a stool, accompanied by pain burning sensations immediately after a bowel movement.
4. Blood may appear with constipation. The human body is built in such a way that a network of blood vessels is quite densely developed inside the anus.
5. Polyps. The amount of bleeding depends on the location and size of the polyp, and can be both weak and heavy.
6. Proctitis. Ulceration of the rectal mucosa, followed by inflammation. Blood is accompanied by mucus, mixed with feces.
7. . There is profuse bleeding. Chair decorated.
8. And . Accompanied by profuse bleeding simultaneously with the release of tar-like stools (the so-called merena). The first sign of such a disease is vomiting of blood.
9. Diverticulosis - the formation of diverticula (pockets and protrusions on the intestinal mucosa). When they are injured during bowel movements, feces mixed with blood are released.
10. Rectal cancer. Bleeding in this case is similar to bleeding from the rectum during the formation of polyps.
11. Bleeding in people with The reason is not the disease itself, but reduced immunity, which contributes to the rapid progression of any of the diseases, including those with symptoms of bleeding from the anus.
12. Other systemic diseases.

In some cases, such a phenomenon as scarlet blood from the anus may be the result (side effect) of taking certain medications (antibiotics, drugs that contain potassium).

blood color

By the nature of the released blood, one can judge the possible diseases in women and men:

1. The cherry color of the blood is characteristic of the pathologies of the colon.
2. Red rectal bleeding indicates the development of cancer, as well as the presence of polyps. The appearance of a polyp in the rectum is not an incurable disease, since polyps are classified as benign tumors.
3. Scarlet blood from the anus, which you find on your underwear or when using toilet paper, may indicate an anal fissure or hemorrhoids.
4. Dark blood clots from the anus indicate the presence of diseases such as diverticulosis and a tumor of the colon.
5. Black discharge and tarry stools is evidence of the presence of diseases of the stomach, small intestine and duodenum.

Scarlet blood from the anus during bowel movements

Anal bleeding of varying intensity may indicate serious problems in the digestive system. By the color of the liquid, you can determine the part of the intestine that has undergone damage.

So, the scarlet blood released from the anus without pain indicates a violation of the integrity of the tissues of the rectum, colon or diseases of the anus. Most often it is hemorrhoids or anal fissure.

Haemorrhoids

Hemorrhoids can be accompanied by the release of blood both after a bowel movement and during stool. Bleeding is manifested in the form of blood drops on paper or linen. In this case, the blood will be scarlet.

Discharge usually appears after passing bulky or hard stools, sometimes occurs after heavy physical exertion. With hemorrhoids, as well as with anal fissures, blood clots can remain in the stool. A characteristic symptom of hemorrhoids are red nodular formations falling out of the rectum, possibly with a bluish tinge.

The main drugs for the treatment of hemorrhoids are anti-varicose drugs that normalize blood circulation and venous outflow from the pelvic organs. Representatives of this group of drugs are troxevasin, aescusan, reparil, tribenoside, anavenol, aspirin, detralex. However, the range of their use is limited by contraindications and side effects.

If conservative methods do not help, surgical treatment of hemorrhoids is prescribed:

1. Latex ligation: a ring is put on the leg of the expanded hemorrhoid, as a result of which blood circulation is disturbed and the hemorrhoid tissues die;
2. Sclerotherapy: the doctor injects an agent into the expanded hemorrhoid, which leads to the collapse of its walls, which makes it possible to eliminate I-III degree hemorrhoids;
3. Hemorrhoidectomy: during the operation, the doctor removes the hemorrhoidal dilated vessels, after which the wound is usually sutured;
4. Electrocoagulation: during anoscopy, the hemorrhoid is coagulated with an electrode, after which its tissues die and eventually fall off.

anal fissure

The delicate problem of anal fissures is found mainly in constipated people. Stool retention, hard stools, combined with irritation of the anorectal region with soap and hygiene products, is fraught with microtears in the skin and mucous membranes.

As a result, every trip to the toilet turns into torture. Fear of defecation causes psychological constipation, a vicious circle closes. The main symptoms of anal fissure are blood in the stool and pronounced pain during bowel movements. The doctor makes a diagnosis after finding a crack at the junction of the rectal mucosa into the skin.

Intestinal polyps

These are benign neoplasms that grow on a stalk or are located on a wide base. For a long time, polyps do not manifest themselves in any way, less often patients experience constipation or diarrhea associated with impaired intestinal motility.

The danger of the disease lies in the fact that polyps often degenerate into a cancerous tumor. The surface of polyps can bleed, and the larger the size of the formation, the easier its surface is damaged.

Malignant tumors of the intestine

Polyps are counterweighted by malignant tumors. They can also bleed at any stage of their development. Most often, they initially make themselves felt either by the appearance of blood from the anus, or by intestinal obstruction. It is much easier to diagnose them if they are localized in the rectum. Then any doctor, having carried out her digital examination, will be able to detect the problem in a timely manner and refer the patient for treatment.

By themselves, bleeding from malignant tumors of the intestine can manifest itself in different ways. Sometimes there is blood of a bright color or mixed with feces after a bowel movement. As for the intensity of bleeding, it can also be different. If a tumor bleeds, which disintegrates, then very strong bleeding is noted, since large vessels are involved in the process.

Crohn's disease and ulcerative colitis

Characterized by damage to the intestinal wall of an ulcerative nature due to autoimmune pathological processes in the body.

Emerging ulcerative defects of the intestinal wall lead to frequent bleeding, in addition, patients are concerned about intense pain in the abdomen, loss of appetite, and elevated body temperature. The nature of the stool in these diseases varies from melena (black stool) to profuse bleeding.

Intestinal diverticulosis

This is a protrusion of the intestinal mucosa through its outer layer. The disease can be complicated by bleeding, germination of the intestine and peritonitis.

Signs of early diverticulitis:

• pain in the abdomen, especially on the lower left;
• bleeding from the anus;
• sometimes - an increase in temperature.

The main thing in this case is to establish bowel movement in order to prevent the appearance of new diverticula. And treatment depends on the severity and neglect of the disease. It can be carried out using only medications or by the surgical method with the removal of tissues affected by diverticula.

Acute intestinal infection

The disease is accompanied by severe bleeding from the anus, high fever, diarrhea, nausea, vomiting, severe pain in the abdomen. Examples of acute intestinal infections are dysentery, salmonellosis, amoebiasis.

What to do if there is blood from the anus?

If you find yourself with blood from the anus, the treatment of such a problem should be started after establishing the cause, since this is just a symptom, and not an independent disease.

Accordingly, in order to accurately determine the cause of bloody discharge from the anus, and reliably make sure that they are not associated with cancer or other dangerous bowel disease, you should contact a proctologist for examination. He will tell you what to do, and what examinations should be done to clarify the diagnosis.

Diagnosis and treatment

In proctology, various methods are used to help determine what caused bleeding from the anus:

1. Analysis of feces, which allows you to identify blood, even if it is not visible visually - is prescribed in cases where the doctor suspects a patient has a disease whose symptom is rectal bleeding.
2. Irrigoscopy - for its implementation, a special substance is introduced into the intestine, which is necessary to obtain a clear picture on the x-ray.
3. Gastroduodenoscopy- examination of the patient using an endoscope, which allows to assess the condition of the mucous membrane of the digestive organs. Sometimes with the help of this method, treatment is also carried out - cauterization - ulcers.
4. Rectoscopy - with its help, the human digestive system is examined, and more specifically, its lower sections. Using this method, doctors can identify hemorrhoids, anal fissures, various formations in the sigmoid and / or rectum.
5. Colonoscopy - is nothing more than a more detailed rectoscopy. It is carried out by the endoscopic method and allows you to detect all the changes that have occurred in the structure of the colon.

There can be many reasons for the discharge of blood from the anus in men and women. Only a specialist can install and remove them. And if after some time the excretion of blood during a bowel movement stops, this does not mean that the cause of its occurrence has disappeared.

You need to take this problem very seriously, even if you assume what caused the disorder. There are a number of diseases that can cause blood to appear after a bowel movement.

- this is an outpouring of blood into the external environment, natural body cavities, organs and tissues. The clinical significance of the pathology depends on the magnitude and rate of blood loss. Symptoms - weakness, dizziness, pallor, tachycardia, decreased blood pressure, fainting. Identification of external bleeding is not difficult, since the source is visible to the naked eye. For the diagnosis of internal bleeding, depending on the localization, various instrumental techniques can be used: puncture, laparoscopy, radiopaque examination, endoscopy, etc. Treatment is usually surgical.

ICD-10

R58 Bleeding, not elsewhere classified

General information

Bleeding is a pathological condition in which blood from the vessels is poured into the external environment or into internal organs, tissues and natural cavities of the body. It is a condition that requires emergency medical attention. The loss of a significant volume of blood, especially within a short time, poses an immediate threat to the life of the patient and can cause death. Orthopedic traumatologists, abdominal surgeons, thoracic surgeons, neurosurgeons, urologists, hematologists and some other specialists can treat bleeding, depending on the cause of their occurrence.

Classification

Taking into account the place in which the blood is poured, the following types of bleeding are distinguished:

• External bleeding - into the external environment. There is a visible source in the form of a wound, an open fracture or crushed soft tissues.
• Internal bleeding - into one of the natural cavities of the body that communicates with the external environment: the bladder, lung, stomach, intestines.
• Hidden bleeding- in tissues or cavities of the body that do not communicate with the external environment: in the interfascial space, ventricles of the brain, joint cavity, abdominal, pericardial or pleural cavities.

As a rule, in clinical practice, occult bleeding is also called internal, however, taking into account the characteristics of pathogenesis, symptoms, diagnosis and treatment, they are distinguished into a separate subgroup.

Depending on the type of damaged vessel, the following types of bleeding are distinguished:

• arterial bleeding. Occurs when the wall of an artery is damaged. It is characterized by a high rate of blood loss, is a danger to life. The blood is bright scarlet, pouring out in a tense pulsating stream.
• Venous bleeding. It develops when the wall of the vein is damaged. The rate of blood loss is lower than when an artery of the same diameter is damaged. The blood is dark, with a cherry hue, flows in an even stream, and there is usually no pulsation. If large venous trunks are damaged, pulsation in the rhythm of breathing can be observed.
• capillary bleeding. Occurs when capillaries are damaged. Blood is released in separate drops, resembling dew or condensate (a symptom of "bloody dew").
• Parenchymal bleeding. It develops with damage to parenchymal organs (spleen, liver, kidneys, lungs, pancreas), cavernous tissue and cancellous bone. Due to the peculiarities of the structure of these organs and tissues, damaged vessels are not compressed by the surrounding tissue and do not contract, which causes significant difficulties in stopping bleeding.
• mixed bleeding. Occurs with simultaneous damage to the veins and arteries. The cause, as a rule, is the injury of parenchymal organs with a developed arterial-venous network.

Depending on the severity of bleeding can be:

• Lungs (loss of no more than 500 ml of blood or 10-15% of BCC).
• Medium (loss of 500-1000 ml or 16-20% of BCC).
• Severe (loss of 1-1.5 liters or 21-30% of BCC).
• Massive (loss of more than 1.5 liters or more than 30% of the BCC).
• Fatal (loss of 2.5-3 liters or 50-60% of BCC).
• Absolutely fatal (loss of 3-3.5 liters or more than 60% of BCC).

Taking into account the origin, traumatic bleeding is distinguished, which develops as a result of trauma to unchanged organs and tissues, and pathological bleeding that occurs as a result of a pathological process in any organ or is a consequence of increased permeability of the vascular wall.

Depending on the time of occurrence, specialists in the field of traumatology and orthopedics distinguish between primary, early secondary and late secondary bleeding. Primary bleeding develops immediately after injury, early secondary - during or after surgery (for example, as a result of slipping of the ligature from the vessel wall), late secondary - after a few days or weeks. The cause of late secondary bleeding is suppuration with subsequent melting of the vessel wall.

bleeding symptoms

Common signs of pathology include dizziness, weakness, shortness of breath, severe thirst, pale skin and mucous membranes, low blood pressure, increased heart rate (tachycardia), fainting and fainting. The severity and rate of development of these symptoms is determined by the rate of blood flow. Acute blood loss is more difficult to tolerate than chronic, since in the latter case the body has time to partially “adapt” to the ongoing changes.

Local changes depend on the characteristics of the injury or pathological process and the type of bleeding. With external bleeding, there is a violation of the integrity of the skin. When bleeding from the stomach occurs melena (tarry black loose stools) and vomiting of altered dark blood. With esophageal bleeding, hematemesis is also possible, but the blood is brighter, red, rather than dark. Bleeding from the intestine is accompanied by chalky, but there is no characteristic dark vomiting. If the lung is damaged, bright scarlet, light foaming blood is expectorated. Haematuria is characteristic of bleeding from the renal pelvis or bladder.

Latent bleeding is the most dangerous and most difficult in terms of diagnosis, they can only be detected by indirect signs. At the same time, the blood accumulating in the cavities compresses the internal organs, disrupting their work, which in some cases can cause the development of dangerous complications and death of the patient. Hemothorax is accompanied by shortness of breath, shortness of breath and weakening of percussion sound in the lower parts of the chest (with adhesions in the pleural cavity, dullness in the upper or middle parts is possible). With hemopericardium, due to compression of the myocardium, cardiac activity is disturbed, cardiac arrest is possible. Bleeding into the abdominal cavity is manifested by bloating and dullness of percussion sound in its sloping sections. With bleeding into the cranial cavity, neurological disorders occur.

The outflow of blood outside the vascular bed has a pronounced negative effect on the entire body. BCC decreases due to bleeding. As a result, cardiac activity worsens, organs and tissues receive less oxygen. With prolonged or extensive blood loss, anemia develops. The loss of a significant volume of BCC within a short period of time causes traumatic and hypovolemic shock. A shock lung develops, the volume of renal filtration decreases, oliguria or anuria occurs. Foci of necrosis are formed in the liver, parenchymal jaundice is possible.

Types of bleeding

Bleeding from wounds

First aid consists of anesthesia and immobilization with a splint. For open fractures, a sterile bandage is applied to the wound. The patient is taken to the emergency room or trauma department. To clarify the diagnosis, an x-ray of the damaged segment is prescribed. With open fractures, PXO is performed; otherwise, the treatment tactics depend on the type and location of the injury. In case of intra-articular fractures accompanied by hemarthrosis, a joint puncture is performed. In case of traumatic shock, appropriate anti-shock measures are taken.

Bleeding from other injuries

TBI can be complicated by occult bleeding and hematoma formation in the cranial cavity. At the same time, a fracture of the skull bones is not always observed, and patients in the first hours after the injury may feel satisfactory, which complicates the diagnosis. With closed fractures of the ribs, damage to the pleura is sometimes observed, accompanied by internal bleeding and the formation of a hemothorax. With a blunt injury to the abdominal cavity, bleeding from a damaged liver, spleen, or hollow organs (stomach, intestines) is possible. Bleeding from parenchymal organs is especially dangerous due to massive blood loss. Such injuries are characterized by the rapid development of shock, without immediate qualified assistance, a fatal outcome usually occurs.

With injuries of the lumbar region, a bruise or rupture of the kidney is possible. In the first case, the blood loss is insignificant, evidence of bleeding is the appearance of blood in the urine, in the second, there is a picture of rapidly increasing blood loss, accompanied by pain in the lumbar region. With bruises in the lower abdomen, a rupture of the urethra and bladder may occur.

First aid for all internal bleeding of a traumatic nature consists in anesthesia, rest and immediate delivery of the patient to a specialized medical facility. institution. The patient is placed in a horizontal position with raised legs. Cold is applied to the area of ​​suspected bleeding (a bladder or heating pad with ice or cold water). If esophageal or gastric bleeding is suspected, the patient is not allowed to eat or drink.

At the prehospital stage, if possible, anti-shock measures are carried out, the BCC is replenished. Upon admission to medical institution continue infusion therapy. The list of diagnostic measures depends on the nature of the injury. For TBI, a consultation with a neurosurgeon, x-ray of the skull and EchoEG are prescribed, with hemothorax - chest x-ray, with

A) ANATOMICAL CLASSIFICATION

According to the type of bleeding vessel, bleeding is divided into arterial, venous, arteriovenous, capillary and parenchymal.

arterial bleeding. Bleeding from an injured artery. Blood expires quickly, under pressure, often in a pulsating stream, sometimes gushing. The blood is bright scarlet. Quite high is the rate of blood loss. The volume of blood loss is determined by the diameter of the vessel and the nature of the damage (lateral, complete, etc.).

With profuse (abundant) arterial bleeding, the wound is in the projection of a large artery; the outflowing blood is bright red (scarlet), beats with a strong pulsating stream. Due to the high blood pressure, usually the bleeding does not stop on its own. Damage to the main artery is dangerous, both by rapidly progressive blood loss and by ischemia of the tissues that it should supply blood to. The rate of blood loss is high, which often prevents the development of compensatory mechanisms and can quickly lead to death.

Venous bleeding. Bleeding from an injured vein. Uniform flow of dark cherry color of blood. The rate of blood loss is less than with arterial bleeding, but with a large diameter of the damaged vein, it can be very significant. Only when the damaged vein is located next to a large artery, can a pulsating jet be observed due to transmission pulsation. When bleeding from the veins of the neck, you need to remember the danger of an air embolism. If the large veins of the upper half of the body are damaged, blood can flow out in an intermittent stream, synchronously with breathing (due to the suction action of the chest), and not with the pulse.

There are significant clinical differences in bleeding when deep (large, main) and superficial (subcutaneous) veins are damaged. Bleeding in case of damage to the main veins is no less, and sometimes more dangerous, than arterial ones, since they quickly lead to a drop in pressure at the mouths of the vena cava, which is accompanied by a decrease in the strength of heart contractions. Such bleeding can lead to air embolism, which especially often develops with damage to the veins of the neck, intraoperative damage to the vena cava. Veins, unlike arteries, have an underdeveloped muscular membrane, and the rate of blood loss almost does not decrease due to vessel spasm.

Bleeding from damaged saphenous veins is generally less dangerous because the rate of blood loss is much lower and there is little or no risk of air embolism.

capillary bleeding. Bleeding from capillaries, in which blood oozes evenly from the entire surface of damaged tissues. This bleeding is due to damage to capillaries and other microvessels. In this case, as a rule, the entire wound surface bleeds, which, after drying, is again covered with blood. Such bleeding is observed when any vascularized tissue is damaged (only a few tissues do not have their own vessels: cartilage, cornea, dura mater). Capillary bleeding usually stops on its own.

Capillary bleeding is of clinical importance in case of a large area of ​​the wound surface, disorders of the blood coagulation system and damage to well-perfused tissues.

Arteriovenous bleeding. In the presence of both arterial and venous bleeding. Combined damage to an artery and a vein located nearby, as part of one neurovascular bundle, is especially common. The clinical picture consists of a combination of symptoms of various types of bleeding, and, at the stage of first aid, it is not always possible to reliably determine the source and nature of bleeding.

Parenchymal bleeding. Bleeding from the parenchyma of any internal organ. It is observed with damage to parenchymal organs: liver, spleen, kidneys, lungs, pancreas. Such bleeding, as a rule, does not stop on its own. Since the listed organs mainly consist of parenchyma, they are called parenchymal. Bleeding when they are damaged is called parenchymal .

B) BY THE MECHANISM OF APPEARANCE

Depending on the cause that led to the release of blood from the vascular bed, there are two types of bleeding:

Physiological bleeding among women.

Pathological bleeding- other.

By origin, pathological bleeding is divided into

- traumatic caused by mechanical damage to the vascular wall (including during surgery), and

- non-traumatic associated with pathological changes in the vascular (with neoplasm, inflammation, increased permeability of the vascular wall, damage by ionizing radiation, etc.).

Causes of bleeding may be different:

mechanical damage to the vessel wall : injury of the vessel with an open injury or rupture of the vessel with a closed injury;

destruction (destruction) of the vessel wall during the pathological process : ulceration of an atherosclerotic plaque, a destructive process in tissues (a focus of purulent inflammation, a stomach ulcer, a decaying tumor);

increased permeability of the vascular wall (with intoxication of the body, sepsis, beriberi C), leading to leakage of blood through the walls of blood vessels.

Blood clotting disorder ( with hemophilia, thrombocytopenia, disseminated intravascular coagulation, overdose of anticoagulants, cholemia) in itself is not a cause of bleeding. But, it prevents bleeding from stopping and contributes to the development of prolonged bleeding, massive blood loss.

Learn more about causes of bleeding

Traumatic bleeding - bleeding caused by a violation of the integrity of the vessels in case of injury (wound, rupture of the wall of the vessel or heart), includingsurgical bleeding (during surgery).

These damages (traumas) can be open, in which the outflow of blood occurs through the wound channel to the outside, or closed. For example, with closed fractures, vascular rupture by bone fragments can occur. Also, traumatic ruptures of internal organs, muscles and other anatomical formations lead to the development of internal bleeding with closed injuries.

Closed vascular injuries pose a great danger, since difficulties in recognizing them often lead to diagnostic errors and untimely assistance. At the same time, hemorrhages in the body cavity, as well as retroperitoneal and intermuscular hematomas, can be very significant in terms of blood loss, leading to severe acute hypovolemia and hemorrhagic shock.

Non-traumatic bleeding - this is bleeding due to pathological changes in the walls of blood vessels or the heart.

According to the mechanism of occurrence, they are distinguished

- bleeding from a rupture(haemorrhagia per rhexin),

- bleeding from eating(haemorrhagia per diabrosin - arrosive bleeding,

- bleeding from seepage(haemorrhagia per diapedesin) with increased permeability of the vascular wall.

Rupture of a pathologically altered wall of a vessel or heart.

With an aneurysm of a vessel or heart, hemorrhoids, varicose veins, myocardial infarction, sclerotic changes in the arteries, tubal ectopic pregnancy, etc. An increase in blood pressure contributes to the rupture of the wall of a vessel or heart.

In this regard, one can single out vicarious bleeding- bleeding from small vessels of the mucous membrane of the walls of the nose, caused by excessive blood pressure, for example, in a hypertensive crisis. Or bleeding from secondary hemorrhoids caused by increased pressure in the portal vein (portal hypertension), most often with cirrhosis of the liver.

Corrosion (arrosion) of the vessel wall .

- bleeding through a defect in the vascular wall, formed as a result of a pathological process (purulent-necrotic, tumor, etc.).

Arrosive (arrosive) bleeding arises

When corroding (destruction) of the vascular wall (with the germination of the vascular wall by a malignant tumor and decay - destruction of the tumor;

With necrosis, including with an ulcerative process;

With caseous necrosis in the wall of the tuberculous cavity;

With destructive inflammation, including purulent inflammation, when the vessel wall can melt in the focus of inflammation;

With enzymatic melting of the vascular wall with pancreatic juice containing proteases, lipases, amylases in pancreatic necrosis, etc.).

Increased permeability of the walls of microvessels.

diapedetic hemorrhage ( due to an increase in the permeability of the walls of blood vessels) occurs due to leakage of blood from microvessels (arterioles, capillaries and venules). An increase in the permeability of the vascular wall is observed with hemorrhagic diathesis, including systemic vasculitis, beriberi (especially avitaminosis C), uremia, sepsis, scarlet fever, other infectious and infectious-allergic diseases, as well as poisoning with benzene, phosphorus.

A certain role in the development of bleeding is played by the state of the blood coagulation system. Violation of the thrombus formation process in itself does not lead to bleeding and is not its cause, but significantly aggravates the situation. Damage to a small vein, for example, usually does not lead to visible bleeding, since the system of spontaneous hemostasis is triggered, but if the state of the coagulation system is disturbed, then any, even the most minor injury, can lead to fatal bleeding. The most well-known diseases with a violation of the blood coagulation process are hemophilia, Werlhof's disease. DIC, cholemia also leads to a decrease in blood coagulation. Often there are decreases in blood coagulation of medicinal origin, which occur when using indirect anticoagulants that disrupt the synthesis in the liver of VII, IX, X coagulation factors; direct anticoagulants (eg, heparin); thrombolytic drugs (for example, streptase, streptokinase, urokinase, streptolyase, etc.), as well as non-steroidal anti-inflammatory drugs (for example, acetylsalicylic acid, butadione, etc.), which disrupt platelet function.

bleedingAndvost- propensity to prolonged, low-intensity bleeding; observed in violation of the mechanism of blood coagulation and (or) an increase in the permeability of the vascular wall.

Hemorrhagic diathesis- this is a condition characterized by increased bleeding, a tendency to prolonged bleeding, which is observed in violations of blood coagulation and (or) an increase in the permeability of the vascular wall.

The Greek word "diathesis" (diatesis) means a tendency, a predisposition to something, such as certain diseases or inadequate reactions to common stimuli.

C) IN RELATION TO THE EXTERNAL ENVIRONMENT

All bleeding is divided into three main types: external, internal and mixed. There are also various combinations of these types of bleeding in one patient.

I. external bleeding comes from a wound (or from a trophic ulcer of the skin) directly into the external environment, outward, onto the surface of the body.

IIMixed bleeding e - this is bleeding into the lumen of a hollow organ that communicates with the external environment through the natural openings of the body. With mixed bleeding, blood first accumulates in cavities that communicate (normally) with the external environment, and then, through the natural openings of the body, it is released outside, unchanged or altered. A typical example is bleeding into the lumen of the organs of the gastrointestinal tract: with gastric bleeding, blood first accumulates in the stomach, and then is released in the form of hematemesis, vomiting of “coffee grounds” is possible (hemoglobin turns into black hydrochloric hematin under the action of hydrochloric acid) and ( or) bloody stools, often black (melena). In addition to bleeding into the lumen of the gastrointestinal tract, bleeding into the lumen of the tracheobronchial tree and into the urinary tract - hematuria can be considered mixed.

1. Esophageal, gastric, intestinal bleeding (in the lumen of the esophagus, gastrointestinal tract);

2. Pulmonary bleeding (in the respiratory tract);

3. Bleeding into the urinary tract (hematuria); urethral bleeding (into the lumen of the urethra, which is manifested by urethrorrhagia - the release of blood from the urethra outside the act of urination); hemospermia (the presence of blood in the seminal fluid).

4. Uterine bleeding (metrorrhagia).

5. Nosebleeds (epistaxis).

6. Bleeding in the bile ducts (hemobilia).

Gastrointestinal, pulmonary bleeding, bleeding into the urinary tract, etc. are explicit And hidden.

Explicit (manifest) bleeding presents with clear clinical signs.

Covert (occult) bleeding determined only by special research methods.

Explicit bleeding- these are bleedings in which blood, even in an altered form, appears outside after a certain period of time, which is visible to the naked eye. For example, hematemesis of unchanged blood or coffee grounds; bloody stools of red, dark or even black color (melena); hematuria in the form of bloody urine; hemoptysis or secretion of scarlet frothy blood during coughing shocks.

Hidden bleeding - these are such small bleedings in which the naked eye (macroscopically) cannot see the blood that is released outward from the natural openings of the body, since there is only a small amount of blood (occult blood) in the test material (feces, urine). It is detected only by special laboratory studies (with hidden gastrointestinal bleeding and microhematuria) and (or) instrumental (endoscopic) research methods.

III. internal bleeding takes place inside the body:

In body cavities that do not normally communicate with the external environment,

In tissues, organs.

With internal bleeding, blood can be poured out in the body cavity, not communicating (normally) with the external environment: cranial cavity, joint cavity (hemarthrosis), pleural cavity (hemothorax), abdominal cavity (hemoperitoneum), into the pericardial cavity (hemopericardium), and blood can also flow from the vessels in tissue, in the form of a hematoma(formed as a result of stratification of tissues, with the formation of a cavity in them filled with liquid or clotted blood), or ashemorrhages with impregnation of the tissue with blood (appearance of petechiae, ecchymosis). With interstitial bleeding (hemorrhage), blood flowing from the vessels can impregnate the tissues surrounding the damaged vessel. Hemorrhages in the integument of the body (skin, mucous membranes), with their impregnation with blood (which leads to the formation of petechiae and ecchymosis), are also a type of internal bleeding. There are petechiae - pinpoint hemorrhages; ecchymosis (bruising, bruising) - larger than petechiae, hemorrhages in these tissues. petechiae- point, small spotted hemorrhages in the skin, as well as in the mucous or serous membranes, the size of which, on average, is from a pinhead to a pea. ecchymosis(other Greek ἐκχύμωσις- “outpouring” from ἐκ- “from-” and χέω- “pour”) - more extensive hemorrhages in the skin or mucous membrane, the diameter of which usually exceeds 2 cm. Ecchymosis is also called a bruise (in everyday life), a bruise (in medicine) - an area of ​​superficial tissue (skin, mucosa) soaked in blood that has leaked from a damaged vessel (s).

Hematomas usually formed in denser tissues (brain tissue, liver) or delimited by fascia (on the limbs). More loose tissues (adipose tissue, muscles), more often, are simply saturated with blood.

As the pressure in the hematoma cavity increases, the bleeding stops, however, in the future, a rupture of the tissue delimiting the hematoma may occur, and the bleeding recurs. This mechanism of early secondary bleeding is typical for subcapsular ruptures of the parenchyma of the liver and spleen (two-stage ruptures of the organ with the development of intra-abdominal bleeding).

Small hematomas may resolve over time.

Larger hematomas are usually organized, ie. are replaced by fibrous connective tissue and become a scar.

If a large hematoma exists long enough, the surrounding tissues turn into a scar, and the hematoma is surrounded by a fibrous connective tissue capsule. This forms a pseudocyst. In addition, hematomas can suppurate, turning into phlegmon, and in the presence of a strong capsule, into abscesses.

Learn more about internal bleeding.

1. Intracavitary (cavitary) bleeding , when blood flows into any large serous body cavity that does not normally communicate with the external environment:

but) hemorrhage with accumulation of blood in the abdominal cavity- hemoperitoneum (in case of injury or rupture of blood vessels, abdominal organs or abdominal wall);

b) hemorrhage with accumulation of blood in the pleural cavity- hemothorax;

in) hemorrhage with accumulation of blood in the pericardial cavity- hemopericardium.

G) hemorrhage with accumulation of blood in the joint cavity - hemarthrosis.

Open cavity (intra-abdominal, intrapleural) bleeding observed at hemoperitoneum, hemothorax with outflow of blood from the cavity to the outside, through a penetrating wound or through drainage. At the same time, the intensity of outflow of blood outward often does not correspond to the intensity of internal bleeding.

2. Interstitial (interstitial) bleeding (hemorrhage) is the outflow of blood into the thickness of the tissue.

Interstitial (interstitial) are bleeding in which blood or impregnates fabrics, or accumulates in interstitial spaces, forming a hematoma.

but) INintratissue hemorrhage with tissue impregnation (hemorrhagic infiltration, hemorrhagic tissue imbibition):

Small point (petechial) hemorrhages caused by capillary hemorrhage into the thickness of the skin, mucous membrane and serous membranes - hemorrhagic petechiae;

Multiple spontaneous hemorrhages in the skin, mucous membranes of purple color (red color with a purple tint) - thrombocytopenic purpura;

- spotted planar hemorrhage into the thickness of the skin or mucous membrane - bruise(bruise, suffusio, ecchymosis);

Hemorrhage into the substance of the brain in the form of a focus of hemorrhagic softening - intracerebral hemorrhage;

Bleeding into the subarachnoid space of the brain or spinal cord subarachnoid hemorrhage;

Outcome of hemorrhage may be different:

blood resorption,

The formation of a cyst at the site of hemorrhage,

Encapsulation and germination by connective tissue,

Attachment of infection and suppuration.

b) hemat about ma (haematoma; hemat- + -oma; blood tumor) - occurs with interstitial bleeding with tissue separation and the formation of a cavity in them containing liquid or clotted blood accumulated in it.

Varieties of hematomas according to their localization (by location):

subcutaneous hematoma,

intermuscular hematoma,

subperiosteal hematoma,

retroperitoneal (in the retroperitoneal tissue) hematoma,

perirenal (in the perirenal tissue) hematoma,

extrapleural hematoma (between the soft tissues of the chest wall and the parietal pleura),

paraurethral hematoma (in paraurethral tissue),

mediastinal hematoma (mediastinal hematoma),

intrawound hematoma (with intrawound bleeding, a hematoma in the wound channel, formed as a result of hemorrhage into the cavity of a gunshot or stab wound, without significant external bleeding from the wound),

subcapsular (subcapsular) hematoma of any parenchymal organ (spleen, kidney, liver),

intracranial hematoma (with hemorrhage in the cranial cavity),

suprathecal (epidural) hematoma (with hemorrhage between the dura mater and the bones of the skull or spine),

intrathecal (subdural) hematoma (with hemorrhage under the dura mater),

intracerebral (intracerebral) hematoma (with hemorrhage in the substance of the brain),

intraventricular hematoma (with hemorrhage in the ventricle of the brain),

hematocele (hemorrhage with accumulation of blood between the membranes of the testicle, in the tissues of the scrotum).

The blood poured into the tissues and cavities was a good breeding ground for microorganisms. Thus, any hematoma, any accumulation of blood in internal bleeding. are predisposing factors for the development of suppuration.

Outcomes of hematomas:

Suppuration of a hematoma (formation of an abscess) during infection

resorption of the hematoma;

Organization of a hematoma (germination of a hematoma by connective tissue) with the formation of a scar;

Hematoma encapsulation with pseudocyst formation;

Pulsatinghematoma- this is a hematoma formed as a result of interstitial arterial bleeding and retained communication with the lumen of the damaged artery.

Bursting hematoma- this is a pulsating hematoma associated with a damaged large main artery, rapidly increasing in volume and squeezing the surrounding tissues; in case of compression of the collateral vessels passing through them, ischemic gangrene of the limb may occur. From a pulsating hematoma, a false arterial aneurysm (post-traumatic or arrosive) can form.

Aneurysm(from Greek aneuryno - to expand) is a local (local) expansion of the lumen of a blood vessel or heart cavity due to pathological changes in their walls (usually atherosclerotic) or developmental anomalies.

True aneurysm - this is an aneurysm, the walls of which have layers inherent in a given blood vessel.

congenital aneurysm- an aneurysm resulting from an anomaly in the development of the vascular wall:

arterial aneurysm,

venous aneurysm,

An arteriovenous aneurysm characterized by a communication between an artery and an accompanying vein.

Dissecting aneurysm(usually aorta) is an aneurysm (aorta) in the form of an intramural canal, formed as a result of tearing of the inner shell of the vessel and separation of the vessel wall with blood entering through the tear.

False aneurysm is a pathological cavity communicating with the lumen of the vessel. It is formed by the formation of a connective tissue capsule around a pulsating hematoma formed during an injury to the vascular wall (post-traumatic aneurysm); less often, when the vessel wall is destroyed by a pathological (inflammatory or tumor) process that has spread to the vessel wall (arrosive aneurysm).

IVVarious combinations of the main types of bleeding in one patient. For example: with a chest injury, a combination of intrapleural bleeding (hemothorax) and bleeding into the respiratory tract (pulmonary bleeding) is possible, and if there is a chest injury, external bleeding from damaged vessels of the chest wall wound is also possible. The intensity of each of these bleedings can be different.

D) BY THE TIME OF APPEARANCE

By the time of occurrence of bleeding are primary and secondary.

Primary bleeding due to damage to the vessel at the time of injury. It appears immediately after damage to the vessel and continues after damage.

Secondary bleeding are early (usually from several hours to 4-5 days after damage) and late (more than 4-5 days after damage).

Early secondary bleeding develop in the first hours or days after injury due to the expulsion of a thrombus from the vessel or slipping of the ligature from the vessel (with an increase in blood pressure), as well as due to the end of the spasm of the vessel. Early secondary bleeding it can be caused by damage to the vessels by a bone fragment or separation of a blood clot, due to poor transport immobilization, careless shifting of the victim, etc. It is very important to remember the possibility of secondary early bleeding during antishock therapy, when the increase in blood pressure caused by it can contribute to the expulsion of a blood clot by current blood.

Late secondary (or arrosive) bleeding develop a few days after the injury due to the melting of a thrombus by a purulent process, erosion (destruction) of the vessel wall in the focus of purulent inflammation. Often, late secondary bleeding is a consequence of the destruction of the vessel wall as a result of prolonged pressure from a bone fragment or a foreign body (decubitus), purulent fusion of a thrombus, erosion of the vessel wall, and aneurysm rupture.

D) DOWN

All bleeding can be acute or chronic.

Acute bleeding the most dangerous, the outflow of blood is observed in a short period of time. A rapid loss of 30% of the volume of circulating blood (BCC) leads to acute anemia, cerebral hypoxia and may result in the death of the patient.

Chronic bleeding. In chronic bleeding, blood loss occurs slowly and gradually, in small portions, and therefore the body has time to adapt to a slight decrease in BCC. Sometimes for many days there is a slight, sometimes periodic bleeding. Chronic bleeding can be observed with gastric and duodenal ulcers, malignant tumors, hemorrhoids, uterine fibroids, etc.

By frequency of bleeding there are:

■ single;

repeated;

multiple.

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Dream Interpretation - Bed

Dreams about beds express our hopes for the best, our desire for a prosperous and dignified life, our desire for a good arrangement of our home. Sometimes such dreams predict changes in health or illness.

Buying or seeing how they bring it into the house is a sign of imminent marriage and acquiring their own household.

If you dream that someone offers you to buy a bed, then soon you will find out that you have a secret admirer who decided to open his feelings to you.

A large, solid, beautiful, richly furnished bed in a dream means a good arrangement, a prosperous and prosperous life, protection from troubles and the patronage of people in power.

A chic bed and a beautiful bedroom in a dream mean that a prosperous life awaits you, which you will be very pleased with.

Feeling pleasant smells in the bedroom in a dream is a sign of a dubious love adventure.

A broken bed in a dream predicts trouble, obstacles in business, failure of plans.

An empty bed means that your life will be unsettled and lonely.

A made bed, making a bed or seeing that it is being made for you, portends you a reciprocity of feelings, which can end in a big scandal. After such a dream, you should exercise maximum caution and prudence.

A hospital bed with dried blood stains is a sign of great worries due to an illness that you have recently successfully endured.

Such a dream warns you that your illness has traumatized your psyche and you should be more attentive to your health in the future.

A soiled bed in a dream means illness.

Lying in bed in a dream is a sign of a calm, arranged life; an empty bed (your) in a dream means loneliness, disorder of life;

Seeing someone else's bed empty in a dream is a sign of the imminent death of its owner or separation from a loved one.

If you dream that you are going to bed, then beware of illness.

Lying in bed with a friend or a person of the same gender is a loss that could have been avoided; with a stranger of the opposite sex - to the news;

A strange bed in a dream is a harbinger of an imminent unusual, amazing turn in your life.