Nosebleed: Causes, Diagnosis, Treatment & Prevention

 

A nosebleed, also known as epistaxis, occurs when blood is lost from the tissue lining the inside of the nose. Nosebleeds are caused by dry air. You can prevent them and treat them with easy steps. Although being bothersome, nosebleeds are typically not a serious problem.

What is epistaxis?

The medical term for a nosebleed is epistaxis. One or both nostrils may experience a nosebleed, which is defined as a loss of blood from the tissue lining the inside of the nose. Usually, only one nostril is impacted.

There are numerous tiny blood vessels in your nose. The air you breathe is made warmer and more moistened by these tubes. However, they are located near the inside of your nose. Your blood vessels may dry and irritate when air passes through your nose. This makes it very simple for them to shatter or get hurt, which might result in a nosebleed.

Nosebleed types:

Nosebleeds come in two main types. Medical professionals categorize them according to the bleeding place.


Anterior nosebleed:

The lower portion of the septum, the wall separating your nose's two sides, is where an anterior nosebleed begins. The tiny blood vessels and capillaries in the front of your nose are fragile and prone to break and bleeding. The most common type of epistaxis is typically not life-threatening. You can usually treat these nosebleeds at home.

Posterior nosebleed:

Deep within your nose is where a posterior nosebleed happens. This type of bleeding is brought on by a bleed in the bigger blood vessels near your throat in the back of your nose. Heavy bleeding may ensue, sometimes flowing down the back of your throat. For this type of nosebleed, you might need to see a doctor immediately.

What symptoms of a nosebleed are present?

Usually, the only symptoms you'll experience are blood in your nose. Blood may flow down the back of your throat and into your stomach if you have a posterior nosebleed. This may result in nausea and a bad taste in the back of your throat.

You might have a medical condition if you have other symptoms.

Causes:

While most nosebleeds only affect one nostril, they can simultaneously affect both. There are numerous causes of epistaxis, and Thankfully, the majority are not serious.

Dry air is the most common cause of nosebleeds. Generally, the air is drier in:

• Climates that are hot and humid

• High-altitude locations

• The rooms that are heated

The sensitive tissue inside your nose, known as the nasal membrane, dries out and becomes crusty or cracked when exposed to dry air. Then, when you rub, pick, or blow your nose, it's more likely to bleed.

Additionally, you might get a nosebleed if you:

• Put something in your nose

• Injured your face or nose

• Have a septum deviant

• Have a sinus or upper respiratory infection that causes you to cough, sneeze, and blow your nose constantly?

• Possess either nonallergic or allergic rhinitis, which is an inflammation of the nasal lining

• Regular use of nasal sprays containing decongestants or antihistamines can cause your nasal membranes to become dry

• Take blood thinners such as warfarin, NSAIDs, or aspirin

• Breathe chemicals from cleaning products, fumes from your job, or other strong smells

• Use recreational drugs that you inhale through your nose, such as cocaine.

 The following are less frequent reasons for nosebleeds:

•  Use of alcohol

•  Hemophilia and von Willebrand disease are examples of bleeding disorders

•  High blood pressure

•  Atherosclerosis

•  Surgery for the nose and face

•  Nasal cancers

•  Polyps in the nose

•  Thrombocytopenia due to immune

•  Leukemia

•  Hemorrhagic telangiectasia that is inherited

•   Pregnant

Risk factors:

Nosebleeds can happen to anyone. In their lifetimes, most people will experience at least one case. However, nosebleeds are more common in some people. Among them are:

• Children from two to ten years old. Children are more susceptible to nosebleeds due to dry air, colds, allergies, and sticking their fingers or objects in their noses.

• Adults in the 45–80 age range. As you get closer to 50, blood may clot more slowly. Atherosclerosis, or the hardening of the artery walls, high blood pressure, and bleeding disorders are also more common at this age.

• Those who are expecting. Pregnancy causes the blood vessels in your nose to enlarge, increasing the pressure on the sensitive blood vessels that line your nose.
• individuals using drugs that thin the blood. These medications include warfarin and aspirin.

• Those with disorders related to blood coagulation. These include von Willebrand disease and hemophilia.

 Diagnosis:

When is a nosebleed a cause for concern?
Most nosebleeds are not serious, though it can be alarming to see blood coming out of your nose. Usually, you can take care of them at home. However, you ought to contact a medical professional if:

• You frequently get nosebleeds.

• Anemia symptoms include feeling weak, faint, exhausted, cold, or having pale skin.

• Around the time you begin taking a new medication, you get a nosebleed.

• Your nosebleeds and unusual body bruising could be signs of a more serious condition like leukemia, a nasal tumor, or a blood-clotting disorder like hemophilia or von Willebrand disease.

If your child has a nosebleed and is younger than two years old, call your pediatrician. It's a good idea to bring up any nosebleeds during your child's next checkup, regardless of their age.

What treatments are available for epistaxis?

 The cause of the bleeding determines how to treat a nosebleed.  What is required in your case will be explained by your provider.  Treatment options for epistaxis may include:

•  Packing of the nose.  To apply pressure at the bleeding site, your healthcare provider may place gauze, special nasal sponges or foam, or an inflatable latex balloon inside your nose.  Before removing the material, your provider might want to leave it in place for 24 to 48 hours.

•  Caution.  This process entails sealing the bleeding blood vessel with either heat energy (electrocautery) or a chemical (silver nitrate).  To numb the inside of your nose, your healthcare provider first applies a local anesthetic spray to your nostril.

• Changes to medications or new prescriptions. It may be beneficial to cut back on or stop taking blood thinners altogether. Additionally, blood pressure medications might be required. A blood clotting drug called tranexamic (Lysteda®) may be prescribed by your doctor.

• Removal of foreign bodies. Your provider will remove the foreign object if it is the cause of the nosebleed.

• Surgery. A broken nose can be fixed surgically, and a deviated septum can be corrected with a septoplasty.

• Ligation. To stop the bleeding, your doctor will tie off the blood vessel that is causing it.

How can I prevent nosebleeds?

The following advice can help you avoid nosebleeds:

• To keep your nasal passages moist, use a saline nasal spray or drops to each nostril two to three times a day. You can make these products at home or buy them over the counter.

• To add moisture to the air, place a humidifier in your bedroom at night or add one to your furnace.

• Using a cotton swab, apply a nasal gel or ointment to your nostrils. OTC ointments include products like Bacitracin®, Vaseline®, and Ayr Gel®. Make sure the swab doesn't go deeper than 1/4 inch into your nose. The majority of pharmacies sell these gels and ointments.

• Try not to blow your nose too hard.

• Sneeze with your mouth open. constantly sneeze into a tissue or your elbow.

• Avoid putting anything solid into your nose, including your fingers.

• Limit your use of medication like ibuprofen and aspirin may increase bleeding. Before altering your medication regimen, always consult your healthcare provider. This is particularly crucial for prescribed medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and warfarin (Coumadin®).

• If you find it difficult to manage your nasal allergy symptoms with over-the-counter or prescription medications, consult your healthcare provider. When using over-the-counter medications, be sure to carefully follow the instructions. Using them excessively can result in nosebleeds.

• Give up smoking. Smoking irritates and dries out your nose.

• If you engage in activities that could cause injuries to your face or nose, wear protective headgear.

• Teach your child not to put things up their nose to prevent nosebleeds. Maintaining short fingernails for your child is also a smart idea. Additionally, your pediatrician can provide more advice.

References:

• Tabassom A, Cho JJ. Epistaxis (https://www.ncbi.nlm.nih.gov/books/NBK435997/). 2022 Sep 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Accessed 12/18/2024.

• American Academy of Family Physicians. Nosebleeds (https://familydoctor.org/condition/nosebleeds/). Last updated 6/2023. Accessed 12/18/2024.

• Merck Manual Consumer Version. Nosebleeds (https://www.merckmanuals.com/home/ear,-nose,-and-throat-disorders/symptoms-of-nose-and-throat-disorders/nosebleeds). Last reviewed 5/2023. Accessed 12/18/2024.

• American Academy of Otolaryngology — Head and Neck Surgery. Nosebleeds (https://www.enthealth.org/conditions/nosebleeds). Last reviewed 12/2019. Accessed 12/18/2024.

• Seikaly H. Epistaxis (https://pubmed.ncbi.nlm.nih.gov/33704939/). N Engl J Med. 2021 Mar;384(10):944-951. Accessed 12/18/2024.