Horse Supplements

It’s well-known that equine athletes require special diets to sustain their body’s energy demands during training and competition. They also require extra nutrients to support their muscle health before, during and after vigorous exercise. Most commercial horse feeds do not have ingredients that focus on relieving lactic acid build-up and muscle soreness. You can speed up your performance horse’s recovery time by feeding a high-quality muscle supplement.

What Is Lactic Acid?

If you’ve ever been a runner or played high-intensity sports, then you’ve experienced Lactic Acidosis. This is a build-up of lactate (lactic acid) that causes muscles to feel tired, sore and achy. It’s the same for horses. When you work your horse, their body uses oxygen to break down glucose for energy. During intense training or competition, there may not be enough oxygen to facilitate this process and lactate is created. This metabolic byproduct can then build up in the bloodstream faster than your horse can burn it off resulting in uncomfortable muscle burning and tying-up.

Preventing Muscle Soreness Due to Lactic Acid

Accumulation of lactic acid is common in horses that race, jump, event or otherwise perform demanding work. The following are ways to prevent lactic acidosis in horses:

Begin exercise routines gradually
Offer plenty of fresh water
Allow recovery time between workouts
Provide a healthy fat source for energy
Replenish electrolytes lost from sweating
Feed an antioxidant supplement to support healthy muscle performance

Supplemental Nutrients That Support Muscle Health and Recovery

A blend of antioxidants and herbs can help alleviate muscle soreness and stiffness as well as aid horses prone to tying up. Inflammation and muscle pain can be improved with the following ingredients:

Siberian Ginseng
Panax Ginseng
Vitamin C
Licorice Root (Glycyrrhiza Glabra)
Magnolia Berry (Schisandra Chinensis)

Are Equine Muscle Recovery Supplements Only for Performance Horses?

Not, not at all. They are for any equine that requires support to maintain their muscle health such as the following:
Older, senior horses
Youngsters beginning their career
Horses with limit grazing access
Performance, show and competition equines
Horses with metabolic or musculoskeletal disorders

Best Supplement for Horse’s Muscles

Equine athletes need special care and consideration to keep them healthy and in top shape. Prevention is always better than treatment. Feed TWYDIL® M to elevate lactic acid buildup and maintain the elasticity of muscles, tendons and ligaments. Our unique musculoskeletal supplement can aid achy legs, sore toplines and relieve joint stiffness. It also prevents soft tissue inflammation and oxidative stress while speeding up recovery time. Our all-natural formula is drug-free as all TWYDIL® products observe international anti-doping rules.

As with any condition, it is advised that you seek proper diagnosis and treatment from a licensed veterinarian. From there, he or she can recommend proper dietary changes and equine management practices to relieve muscle pain and reduce the tying up episodes.

Most people think fat is bad but when feeding healthy fats, it can be beneficial. Some horses may need to gain weight while others have trouble keeping it on. Regardless of the reason your horse is currently a little leaner than you’d like, adding a fat source to his or her daily ration will help. Also, if you are increasing your horse’s workout, adding a supplement with fat will help increase his energy level and maintain his weight.

Digestible Energy for Horses

Energy is required to maintain a horse’s body at rest and especially during physical activity. It’s necessary for a healthy pregnancy and lactation. Young horses need it to fuel their growth. As an equine athlete’s workload increases, they require a diet that meets their energy needs along with protein, fiber and essential vitamins, and minerals.

There are actually four types of energy but to keep things simple, we’ll stick to discussing the energy that your horse’s body actually utilizes. That is referred to as Digestible Energy (DE). Simply put, DE means digestibility. There is a scientific formula for figuring out exactly what a horse’s energy needs are by calculating how much energy is fed, digested and then subtract what is lost in feces and urine. But, without a lab to examine the samples, you can safely assume that a diet higher in calories (fat) is necessary to sustain activity levels and body condition.

Why Are Healthy Fats Important in Equine Diets?

Not only do horses require fat (calories) to fuel their body, many vitamins are fat-soluble and depend on lipids (fat molecules) to carry them to the small intestine. Diets too low in fat can actually cause vitamin deficiencies creating health issues.

The equine diet is fairly simple: grains, grass and water. Domestic horses are fed commercial feeds that are high in fiber and are often designed for specific life stages (breeding, growing, performance, senior and maintenance). When a horse requires more fat calories to maintain their body condition or stamina, adding a fat source is an effective way to increase the calorie intake without increasing the volume of grain being fed.

Hard Keeper Solution

There’s one in every barn. You know the one. The horse with the feed bucket that is fuller than all the others yet he is always on the thin side. Horses like that are known as ‘hard-keepers’ and many owners struggle to find the right diet. Adding extra calories can help hard keepers maintain a healthy weight, body condition and slick coat. Because fat contains more than two times the calories as carbohydrates or protein, adding a weight gainer supplement increases their daily calorie intake. Feeding less grain and more calories with a supplement is important to note because it minimizes the risk of colic from overfeeding.

What Is A Good Source of Fat for Horses?

Corn oil used to be the go to fat source for many horse owners. Over the years, other fat sources, such as fatty acids, have proven to be healthier and more effective. Fatty acids or Omega-3 and Omega-6, can be added to the daily rations in oil form. Most oils like flaxseed, soybean, rice bran and camelina are highly palatable and high in fat calories. Fish oil is a great option as it is high in Omega-6 but the odor may not be appetizing to some horses.

Feeding Fat for Energy and Performance

An easier, less messy solution to feeding oils is purchasing a proven high-fat horse supplement. This concentrated source of calories can be top-dressed and fed to most horses without refusal. This is a great option for all horses needing additional calories to gain more energy like hard working athletes, hard-keepers, seniors and young, growing horses. Also, for horses that chronically tie-up, feeding a high-fat, low-carb diet can reduce episodes. As always, provide plenty of forage (hay) and free access to fresh water to facilitate healthy digestion and maintain overall wellness.

Our recommendations are not a substitute for proper veterinarian care. If you suspect your horse’s weight loss or inability to maintain a healthy weight is due to an underlying condition, please contact your large animal vet for evaluation as soon as possible.

TWYDIL USA is a proud partner of TWYDIL® Switzerland and their performance horse products. Currently, we are the sole American distributor of these top-quality, globally renowned equine dietary supplements.  Each supplement we carry has been carefully created to meet specific scientific criteria and only the highest-quality ingredients are found in every batch.

Why Choose TWYDIL USA Products?

We offer a selection of the finest supplements in the world to support the health, recovery, performance and digestion of your sport horse. Designed to improve commercially available horse feeds, they fill the nutritional gaps of hardworking equine athletes and horses with specific dietary needs.

Not only has each product been subjected to rigorous testing, each individual batch is tested again prior to being sold. Triple certified testing is carried out by LCH, the FEI-approved laboratory in France. TWYDIL products have been certified to be safe to use up to and during the day of competition without violating anti-doping rules.

 Where Can I Buy TWYDIL Performance Horse Supplements?

Currently, we have six products from the TWYDIL line FDA approved and available for purchase in the United States. Interested parties may purchase equine supplements directly through the TWYDILUSA.com website or for faster service, contact our equine nutritional specialists. Regardless of your discipline or breed of horse, our team is here, ready to help you choose the right product for your horse.

Benefits of Buying From TWYDIL USA

Since we maintain a well-stocked inventory stateside, we are able to offer fast shipping directly to your home or barn.  Occasionally, you’ll see our friendly faces at horse shows, events and racetracks throughout the country including Florida, Kentucky, Michigan, New York and California. We believe in getting to know our clients and their horses in their own environment and we always appreciate the feedback we receive about TWYDIL products.

Where It All Started

In 1966, Daniel Stofer founded TWYDIL® in Basel, Switzerland, part of PAVESCO AG. After a successful banking career, he wanted to bring high-quality nutritional supplements to the equine industry. With the help of Valère Henry, current TWYDIL President, they introduced a full line of scientifically backed feed additives made available to the international horse world. TWYDIL® has become synonymous with superior quality. All TWYDIL products meet strict international anti-doping regulations and are guaranteed until its expiration date. Each formula contains the best micro-nutrients using the latest and most innovative production and packaging techniques. TWYDIL® products are used with great success by equine professionals in over 70 countries around the globe. Visit their website to learn more about Swiss TWYDIL® or the extensive research behind each of the products.

All-Natural European Supplements for Equine Athletes Now Available in America

When equestrians select nutritional supplements for their horses, they look for quality ingredients that they can feed safely and confidently. TWYDIL® offers trainers, breeders and competitors world-class products that they can trust. No other brand strives to provide the horse world with natural supplements that can be fed without risk during show season and even on the day of competition.  Our clients are from every discipline including dressage, show jumping, eventing, barrel racing, thoroughbred racing and more. Trust TWYDIL USA and TWYDIL®, the globally-known equine supplement line, to deliver scientifically proven nutrition whether you have one horse or an entire barn full.

Why Is My Horse Coughing?

When your horse coughs once or twice, it’s not typically a cause for panic. Like humans, they do cough to clear their airways occasionally of dust, mucus or foreign matter. However, if you notice your horse coughing frequently, during exercise or seasonally, it is time to have your veterinarian evaluate his lung function. Coughing could mean the start of an illness or an inflammatory condition such as heaves.

What Is Heaves?

Heaves is the common term that vets and equestrians use to refer to equine asthma or Recurrent Airway Obstruction (RAO). The coughing is usually triggered by an inhaled allergen like dust, mold, pollen or dust mites. Poor ventilation can cause this condition or further aggravate an existing case. When an allergen enters the airways, it causes them to tighten and produce more mucus. Once the tissues in the respiratory tract become irritated and inflamed, the airways are obstructed making it difficult for your horse to breathe.

Symptoms To Look For If Your Suspect Your Has Heaves

Knowing what to look for can help you describe your horse’s current condition to your vet and help get the diagnosis and treatment underway.

• Flaring nostrils
• Increased respiratory rate
• Exercise intolerance
• Nasal discharge
• Wheezing
• Frequent coughing
• Heaves lines*

*These “lines” are often noticeable on your horse’s chest and belly. They are created when the abdominal muscles are working extra hard to breathe.

Note: Horses that are struggling to breathe may be huffing and puffing so hard that it appears they are rocking back and forth. If your horse is experiencing great difficulty getting enough oxygen, call your veterinarian immediately.

Managing Mild Equine Asthma and Other Related Respiratory Problems

If your horse is diagnosed with heaves, asthma, COPD or RAO, EQUUS magazine reviews some of the preventive measures you can take to decrease the respiratory triggers.

• Avoid dusty places and dry footing
• Keep horse turned out as much as possible
• Wet his food and hay to cut down on dust
• Dampen his bedding (or turn him out!)
• Improve the barn ventilation
• Keep his stall clean and free of dust and cobwebs
• Don’t sweep or blow out aisle-ways when your horse is inside
• Add a supplement with fatty acids

Can Respiratory Supplements Help My Heavey Horse?

Equine breathing supplements may help horses diagnosed with respiratory issues such as heaves or RAO. There is no cure for these conditions so any supportive measures offered may help open the airways or lessen future inflammatory responses. Look for supplements that are  all-natural, drug-free and safe for all horses to use. When reading supplement labels, you’ll want to choose one that has ingredients such as antioxidants and potassium. Adding vitamin c and Omega 3 and 6 fatty acids may also help horses prone to asthma, allergic reactions and fungal infections of the respiratory tract

Severe Cases of Heaves Require Treatment from Your Veterinarian

If you’ve made all the necessary changes and your horse is still exhibiting signs that he or she is having difficulty breathing, prescription medications may be needed. Horses with respiratory problems may be prescribed oral anti-inflammatory medications, inhaled medications or antibiotics. Your veterinarian will decide which treatment course best suits your horse’s condition.

Help Your Horse Breathe Easier

Any illness or chronic condition that affects your horses’ lung health can cause respiratory distress and compromise his quality of life. Taking the necessary steps to prevent or lessen future inflammatory flare-ups will only benefit the overall well-being of your equine athlete or companion. Natural remedies and any necessary medications may help provide cough relief and make breathing easier. Knowing the signs of heaves, COPD or RAO will allow you to begin treatment sooner ensuring your horse isn’t suffering unnecessarily.

Does your horse behave well at home but not at the showgrounds? He’s level-headed, focused and performing near perfect every time you’re in the saddle. Both of you are ready to compete. Then you arrive at the horse show grounds and suddenly, your quiet steed is a nervous wreck and he’s spooking at everything. In his stall, he’s walking in circles, hollering loudly and can’t seem to settle in. After tacking him up, he nervously jigs to the warm-up ring and is definitely not focused on you. What can you do?

Figure Out What Is Causing The Stress & Anxiety

Before you grab a calming product or ask your vet for a tranquilizer, first consider the reason why your horse may be acting nervous or flighty. Is this his first event, show or race? Is this his first time at this specific facility? Thoroughly evaluate his environment. Stressful situations can force even the most well-trained equines into their fight or flight instinct.

Since your horse is either stabled, under saddle or in hand, he can’t just flee to escape these new, scary surroundings. However, you can help him adjust by remaining calm, keeping your routine the same and making time for him to settle into his new surroundings. Some horses adjust quickly while others need to visit the show grounds a few times to desensitize them. Your horse may need extra time to relax before being expected to focus and perform.

Evaluate Your Horse’s Health

Before adding a calming supplement you may want to have your veterinarian check your horse’s blood work. An imbalance or nutritional deficiency can directly influence equine behavior. Once your vet has determined that your horse’s poor behavior is due to a lack of a specific vitamin or mineral, you can adjust his diet accordingly including using calming feed additives.

Effective Calming Ingredients

Once you’ve decided to add a quality equine calmer to your horse’s diet, there are a few key ingredients it should have. Look for equine calming products that contain L-Tryptophan, Magnesium and B Vitamins. Having prebiotics and probiotics on the ingredients list makes a supplement even better as it can also aid digestion, a great benefit for already stressed horses.

Taking The Edge Off Horses Legally

When choosing a calming product for your show horse, you should first verify that the ingredients are legal for use during competition. Each governing body that oversees the different breeds, disciplines or events will have their own list of banned substances. To remain in compliance, it is important to review the latest rule changes and prohibited ingredients updates so you and your horse do not violate competition policies. Keep in mind that the term ‘natural’ does not automatically make a substance show-legal.

Equine Calming Products That Are Show & Competition Approved

Despite your best efforts, some horses are just naturally high-strung and need a little help to relax. TWYDIL® C has been scientifically formulated with nutrients known to aid in calming, behavior management and stress-relief. Our show-safe horse calmer contains the following  essential vitamins and minerals:

• L-tryptophan (essential amino acid)
• Magnesium
• Vitamin E
• Selenium
• Vitamin C
• Vitamins B1, B6 & B12
• Prebiotics

TWYDIL® C Equine Calming Supplement

Each batch of TWYDIL® C (Calmin) has been laboratory tested for quality and compliance with international anti-doping rules. Confidently feed our calming supplement as it is safe for all horses and can be legally used on the day of competition.

To keep equine athletes training, performing and competing at their best, it’s important to understand that they have additional nutritional needs.  You can’t feed a performance horse the same way you feed an easy-keeper and expect the same results. In addition to a high quality complete feed, performance horses require fuel for energy and additional nutrients for muscle function and recovery. Maintaining a balanced diet will keep your athlete healthy while allowing him to perform at optimal levels.

Energy Source for Horses in Heavy Work

Horses receive fuel (energy) through healthy carbohydrates and fats. They can be found in top of the line horse feeds and performance supplements. Choosing a conditioning supplement that contains essential fatty acids can improve your horse’s skin, coat and hoof health. This allows your horse to maintain a healthy body weight while providing enough carbs and fats to fuel him through rigorous exercise without increasing the amount of food he eats.

Essential Vitamins and Minerals

Most horse’s vitamin and mineral requirements can be met with a commercially made feed fortified with extra nutrients. However, performance horses have an increased nutritional requirement when they are worked hard. While it can be challenging to meet their vitamin and mineral needs, not providing enough nutrients can be detrimental to the health and performance of your equine athlete.

All performance horses can benefit from additional nutrients but Vitamin E is crucial to muscle recovery because it prevents oxidative damage. This antioxidant also helps maintain normal nerve and muscle function as well as helps support the immune system. Because most supplements that contain Vitamin are often partnered with Selenium, you may want to consult with your veterinarian or equine nutritionist to check your horse’s selenium levels.

Protein and Amino Acids

Protein and amino acids are the building blocks for creating muscle tone and a strong topline in your equine athlete. Commercial feeds are often available in varying levels of protein different sources. Amino acids are significant components of muscle protein and are essential for muscle growth, development and repair. Using a performance supplement can increase the protein, aminos, vitamins and minerals that your horse needs without having to feed additional grain.

Electrolytes and Water

Your horse cannot store extra electrolytes so you must replenish what he has lost in sweat every single day. Horse sweat is composed of high levels of sodium, chloride, potassium, calcium and magnesium. Keeping your working horse’s electrolytes balanced is important because it supports his urge to drink water. Electrolytes also support most bodily functions including the nervous system, healthy digestion and normal muscle function.

As with any animal, providing plenty of fresh water is essential to life. Horses can easily lose anywhere from 1 to 4 gallons of sweat depending on performance level and air temperature. Equine athletes should consume anywhere from 10 to 20 gallons or more of water per day to maintain proper hydration.

Providing Extra Nutrition To Performance Horses The Right Way

While feeding a high-quality complete feed that is designed for the specific nutritional needs of performance horses, each horse has different needs that often can’t be met solely by bagged feed. That’s why TWYDIL USA proudly offers scientifically formulated supplements that have been thoroughly tested and proven to support the additional nutritional needs of your exquisite equine athlete.

We offer a full line of supplements for your competition horse that are safe, all-natural and certified drug-free. Shop our full line of TWYDIL® performance horse supplements and choose the one that is right for your athletes individual needs. Our experts are available to help you find the feed additive that will most benefit your horse.

You’ve been trying to get your horse fit for competition but most days he seems lazy and lethargic. The veterinarian gave him a complete check-up, including blood work and he’s healthy as a….ahem, horse. Like people, some equines just have laid-back personalities while others may need an extra boost of energy from an improved feed regimen and supplementation.

Choose a Feed Made for Performance Horses

What you put into your equine athlete is directly related to their performance. Working horses need to eat a diet high in fats and protein. The calories in healthy fats act as a fuel source while the protein helps build muscle. If your horse is underweight, during workouts, his body is burning any fat stores available for energy. An overweight horse tends to be slow moving, lethargic, and can even sustain injuries from toting around that extra weight around. Resist the temptation to overfeed and focus on providing plenty of hay and a complete feed designed for your horse’s specific needs.

Are You Feeding Electrolytes?

Horses that live in hot, humid temperatures need to have their electrolytes replenished daily. This is especially true of horses in training even in cooler climates. When they sweat heavily, water and horse feed alone cannot consistently replace the minerals lost during workouts. Equine athletes that are feeling depleted and rundown may seem sluggish and lethargic when asked to perform. A few weeks on electrolytes may give your horse a much-needed energy boost.

Is Your Training Routine Becoming Repetitive?

All equestrians are guilty of putting their horse through the same paces every day. Same warm-up, same workout. Believe it or not, horses can get bored with the same old routine. If your horse has been cleared by the vet and he’s being fed the proper nutrition but he’s still acting like a giant slug, try changing up the workouts to get his attention. Normally train in an arena? Hit the trails. Pointing him at the same jump course day after day? Add new, interesting jumps or gymnastics. Even horses can appreciate variety.

Energy Support for Equine Athletes

The vet says your horse is healthy, he’s receiving the best nutrition and plenty of relaxing turnout time so why is he still not performing to his potential? If you’ve consistently noticed that your performance horse is lacking the endurance to get through his regular workouts, it may be time to look for a quality energy supplement. Even top athletes, human or equine, require a nutritional boost to fuel them through strenuous workouts and rigorous training.

Performance Enhancing Energy Supplements for Horses

Looking for a natural energy boost for your competition horse or senior equine? TWYDIL® H is a blood-building supplement that is fortified with essential vitamins and minerals. Our blood builder supports red blood cell health while helping your horse meet the demands of training, racing, showjumping and more. It is also recommended for older horses as well as those that are in recovery or nutrient-deficient. This drug-free energy supplement is safe for all equines and can be used prior to and on the day of competition.

EIPH or Exercise-induced pulmonary hemorrhage is common in Thoroughbreds and Standardbreds, especially those that race. It is bleeding, or epistaxis, from the nasal passages following extreme exertion. The bleeding may be accompanied by loud breathing, choking or excessive swallowing. According to Wag!, equines that suffer from bleeding airways may also show signs of distress. [1]

What Causes Equine Bleeding Attacks?

Possible causes include high lung blood pressures during intense exercise, lung inflammation, and shear forces within the chest generated during exercise. Research is ongoing, and the condition is likely due to multiple factors. – Merck Veterinary Manual. [2] Finding lesions in the lungs of EIPH horses may indicate that this condition is a disease rather than a result of extreme exercise. The possibility of it being a progressive disease is there but again, more research is needed for confirmation.[3]

Are Racehorses the Only Equines That Bleed After Running?

EIPH is a condition commonly found in the racing industry, however, bleeders can be found in other equine sports. Disciplines that require short but strenuous exertion such as polo, show jumping, barrel racing and eventing can also rupture the capillaries in the lungs releasing blood into the airways.

Veterinary Diagnosis Options

Not all equines will have bloody noses or blood-tinged mucus that drips from one of both nostrils. When the vet scopes your horse, they may only find blood within the lungs or airways. Only proper examination can determine if the bleeding is caused by exercise-induced pulmonary hemorrhage or another condition. Diagnostic tools helpful for confirming the cause of bleeding in equine lungs and airways: Endoscopic exam – Camera passed through the nose into the airways immediately after exercise Bronchial-alveolar lavage (BAL) fluid examination – Saline wash of the airways and air sacs to collect a fluid sample Trans-tracheal wash (TTW) fluid examination: An aseptic airway wash to collect fluids for in-depth cytological, culture and sensitivity testing. (done under sedation) Radiography, pulmonary scintigraphy and lung function tests – Used to eliminate other respiratory conditions that may be causing poor performance[4]

Recommended Treatment

Once a proper diagnosis is made, your veterinarian will decide what medication, if any, is needed for your bleeder. Medications such as furosemide, bronchodilators and corticosteroids may reduce the severity of the hemorrhagic episodes but may not stop the bleeding completely. [5] Complete recovery from a bleeding episode may take four to six weeks. In many states and countries a horse cannot race for at least 10 days after a bleeding episode. – EquiMed [6]

Bleeder EIPH Horse Supplements

Having a horse come out of the ring or off the track with a bloody nose can be unsettling. While we can’t cure EIPH, TWYDIL USA does offer a respiratory supplement intended to minimize oxidative stress and reduce inflammation. TWYDIL X is a proprietary formula created to provide essential support to the lungs and blood vessels. It helps reduce airway bleeding and promotes the recovery of lungs damaged by EIPH related episodes. Our all-natural respiratory aid meets international anti-doping requirements and is safe to use before, during and after competition. It can also be used as daily maintenance in horses with exercise-induced pulmonary bleeds as well as other respiratory conditions.

References:

1. “Exercise-Induced Pulmonary Hemorrhage in Horses”. Wag!. Web. Retrieved Jan. 22, 2021 from https://wagwalking.com/horse/condition/exercise-induced-pulmonary-hemorrhage-
2. Rush, Bonnie R. DVM, MS, DACVIM. “Exercise-Induced Pulmonary Hemorrhage in Horses.” Merck Veterinary Manual, May 2019. Web. Retrieved Jan. 22, 2021, from https://www.merckvetmanual.com/horse-owners/lung-and-airway-disorders-of-horses/exercise-induced-pulmonary-hemorrhage-in-horses
3. “Exercise Induced Pulmonary Hemorrhage in Horses: American College of Veterinary Internal Medicine Consensus Statement”. Journal of Internal Veterinary Medicine, May 2015. PMC – PubMed Central. Web. Retrieved Jan. 23, 2021 from  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895427/ 
4. Groenendyk, Jane, BVSC (HONS) BSC. “Exercise-induced Pulmonary Hemorrhage”. Horses and People. Web. Retrieved Jan. 23, 2021 from https://horsesandpeople.com.au/exercise-induced-pulmonary-hemorrhage/ 
5. Groenendyk, Jane, BVSC (HONS) BSC. “Exercise-induced Pulmonary Hemorrhage”. Horses and People. Web. Retrieved Jan. 23, 2021 from https://horsesandpeople.com.au/exercise-induced-pulmonary-hemorrhage/ 
6. EquiMed Staff. “Exercise-Induced Pulmonary Hemorrhage – Equine Diseases & Conditions. EquiMed, July 21, 2014. Web. Retrieved Jan. 23, 2021, from https://equimed.com/diseases-and-conditions/reference/exercise-induced-pulmonary-hemorrhage