Nose Bleeding - How & Why

NOSE BLEEDING – How and Why

What causes a nosebleed?

Bleeding from the nose may be due to nasal trauma, irritation of the mucosa by dust or by dry air, upper respiratory infection or allergic rhinitis or coagulation defect. This is otherwise called as epistaxis.

Some are quite frightening, and a few are even life threatening. Physicians classify nosebleeds into two as

1. Anterior nosebleed: Most nosebleeds begin in the lower part of the septum, the semi- rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. This type of nosebleed comes from the front of the nose and begins with a flow of blood out of one nostril when the patient is sitting or standing.
2. Posterior nosebleed: More rarely, a nosebleed can begin high and comes from deep in the nose and flows down the back of the mouth and throat even if the patient is sitting or standing.

If the patient is lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow posteriorly, especially if the patient is coughing or blowing his nose.

It is important to try to make the distinction since posterior (back of nasal cavity) nosebleeds are often more severe and almost always require a physician’s care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure and in cases of injury to the nose or face.

Nosebleeds in children are almost always of the anterior type. Anterior nosebleeds are common in dry climates or during the winter months when heated, dry indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented when placing a bit of lubricating cream or ointment about the size of a pea on the end of the fingertip and then rub it up inside the nose, especially on the middle portion of the nose (the septum).

Treatment:

Treatment of acute nosebleed is by application of direct pressure and if necessary, topical vasoconstrictor. It is a natural tendency to lie down if nose bleed occurs. It is safer to sit-up than to lie down. While sitting one has to pinch the nose and look down while breathing through the mouth. This is continued for 5 minutes. Many physicians suggest any of the following lubricating creams or ointments. They can all be purchased without a prescription: Neosporin, Soframycin or Vaseline. Up to three applications a day may be needed, but usually every night at bedtime is enough. A saline nasal spray or drops will also moisten dry nasal membranes.

If bleeding persists or recurs, cautery with silver nitrate or anterior nasal packing may be necessary. Using an endoscope, a tube with a light for seeing inside the nose, the ENT surgeon may find a problem within the nose that can be treated. He or she may recommend cauterization (sealing) of the blood vessel that is causing the trouble. This is done as an out patient procedure.

To prevent rebleeding after initial bleeding has stopped:

• Do not pick or blow nose.
• Do not strain or bend down to lift anything heavy.
• Keep head higher than the heart.
• Use a humidifier during dry winter months.

If rebleeding occurs:

• Attempt to clear nose of all blood clots.
• Use nose drops like Nasivion or Otrivin into bleeding nose 4 times/day.
• Pinch all the soft parts of the nose together between the thumb and two fingers. Press firmly toward the face – compressing the pinched parts of the nose against the bones of the face. Hold it for 5 minutes (timed by a clock).
• Call a doctor if bleeding persists.

Nose Bleeding Causes

• Allergies, infections, or dryness that cause itching and lead to picking of the nose.
• Vigorous nose blowing that ruptures superficial blood vessels in the elderly and in the young.
• Clotting disorders that run in families or are due to medications.
• Fractures of the nose or of the base of the skull that can cause bleeding and should be regarded seriously when the bleeding follows a head injury.
• Rarely, tumors (both malignant and nonmalignant) have to be considered, particularly in the older patient or in smokers.

Prevention of nosebleeds:

Prevention of further nosebleeds may include use of lubricating application to the mucosa, humidification of air, and avoidance of dusts and other irritants.