Definition and Overview

Nosebleed, medically known as epistaxis or nasal hemorrhage is a condition characterized by blood draining out through the nostrils. The condition is a relatively common occurrence due to the location of the nose in the middle of the face as well as the amount of blood vessels found in the nose. A nosebleed seldom causes alarm, but in rare cases could be life-threatening if left untreated.

There are two general types of nosebleed:

  • Anterior nosebleed - Majority of nosebleeds are anterior, where blood drains out from the wall between the two nose channels (septum) inside the nose. This vulnerable area, called Little’s area, is rich in sensitive blood vessels that are delicate and prone to damage.

  • Posterior nosebleed - This uncommon type of nosebleed occurs when the bleeding originates from the nasal cavity, located inside the nose between the brain and roof of the mouth. Most posterior nosebleeds tend to be more serious than anterior nosebleeds such that medical attention may be necessary.

Causes of Nosebleeds

Among common causes of anterior nosebleed include:

  • Sinusitis, an inflammation of the sinus cavity at the back of the nose
  • Blowing the nose too hard, resulting in trauma to blood vessels
  • Picking the inside of the nose that can physically traumatize the nasal lining
  • Nasal irritation, blocked or stuffy nose linked to colds or flu
  • Nasal allergies or hay fever
  • Excessive use of illegal drugs, such as cocaine
  • Excessive use of certain medications such as blood thinners, nasal decongestants or anti-inflammatory drugs
  • Excessive or improper use of nasal sprays
  • Deviated septum caused by injury or congenital nose conditions
  • Climate or climate changes; hot climates with low humidity as well as dry climates can cause drying and cracking of the nasal lining, which can lead to a nosebleed

On the other hand, some of the major causes of posterior nosebleeds are as follows:

  • Calcium deficiency
  • As an aftermath of nasal surgery
  • Hypertension (high blood pressure) or atherosclerosis (hardened arteries)
  • Exposure to chemical irritants
  • Trauma in the head
  • May be a symptom of a more serious underlying condition such as leukemia and other blood disease or tumour in the nasal cavity

Key Symptoms

Nosebleed occurs when there is blood coming out of the nose. Blood flow from the nose can range from light (a few drops) to heavy (profuse) and may come out of either nostril or on both. If standing up, a nosebleed feels like a trickle coming out, much like having colds. If lying down, you may feel the liquid building up at the back of the throat before the blood starts to come out of the nose. It is important not to swallow the blood as it can lead to nausea and vomiting.

Although most nosebleeds are not severe, it is important to watch out for heavy bleeding. Heavy bleeding is often accompanied by palpitations, shortness of breath, skin turning pale, nausea and vomiting when blood is swallowed.

Who to See and Available Treatments

Most nosebleeds, especially anterior types, are not serious and do not need immediate medical attention. However, in worse cases such as that mentioned below, it is best to seek medical help immediately:

  • when the nosebleed involves a profuse amount of blood
  • when the nosebleed is accompanied by difficulty in breathing
  • when you feel weak or faint during or after the nosebleed
  • when the nosebleed does not stop after 30 minutes even with compression
  • when the nosebleed results from an injury, such as trauma or accident
  • when the patient is under two years of age (as this is very rare)

You can see your general practitioner or go to the nearest emergency care facility for immediate attention. If you are losing a lot of blood, make sure to have someone drive you or to call an ambulance, instead of driving yourself.

When you see a general practitioner, your nosebleed will be assessed in terms of severity and the most probable cause. Your nose will be physically examined, as well as your vital signs - pulse and blood pressure included. If the cause of the nosebleed is not apparent, blood tests may be recommended. Your doctor can refer you to an EENT or eyes, ears, nose and throat specialist if you have recurring nosebleeds. If your GP suspects a serious underlying condition, such as a blood-related disease or tumour, you will be referred to the appropriate specialists for further evaluation.

Treatment for nosebleeds

Most nosebleeds don't require medical attention. Often, first aid or self-care is enough to stop the bleeding.

  • Sit down in an upright position and pinch both nostrils (while breathing through your mouth)
  • Do not lean backward, but forward to ensure blood does not drain into the throat or sinus.
  • Put pressure on the nose while sitting upright for about five to up to 15 minutes. This will put pressure on the bleeding vessels to stimulate clotting and stops the flow of blood.

If the bleeding does not stop after doing the aforementioned steps, it is important to seek medical help immediately.

Patients who have recurring nosebleeds require a more aggressive treatment to stop the condition. Among treatments for epistaxis include:

  • Nasal packing: when a ribbon gauze or nasal sponge is inserted into the nose to put pressure on the source of bleeding

  • Nasal cautery: involves the cautery (burning) of the identified area where the bleeding is rooted from (usually performed under anesthetic)

  • Septal surgery: a procedure for straightening crooked nasal septum due to congenital reasons or trauma

  • Ligation: a surgical procedure where the ends of blood vessels causing the nosebleed are tied at the end

An EENT may also suggest additional treatments for more serious cases of nose bleeding such as blood transfusions and tranexamic acid medication to aid in blood’s clotting mechanism.

After recovery from a nosebleed, it is important to treat the nose with extreme care to avoid recurrence or infection. Picking or blowing of the nose, strenuous exercise, alcohol, and lying flat must be avoided within 24-48 hours. It is important not to remove any crusts that may form inside the nose, as it is part of the healing process.

References:

  • American Academy of Otolaryngology - Head and Neck Surgery. “Nosebleeds.” Available: http://www.entnet.org/HealthInformation/Nosebleeds.cfm
  • American College of Emergency Physicians. “Nosebleeds.” Available: http://www.emergencycareforyou.org/EmergencyManual/WhatToDoInMedicalEmergency/Default.aspx?id=260&terms=nosebleeds
  • Gillott, Caroline. Medical News Today: “What is a nosebleed?” Available: http://www.medicalnewstoday.com/articles/164823.php
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