Nosebleeding: What is it?

Nose bleeding also known as epistaxis, a nosebleed is the loss of blood from a blood vessel in the nose. It is very common since the blood vessels in the nose are fragile and they bleed very easily. Around 60% of all people have a nosebleed at least once in their lifetime. It most commonly occurs in children between the age of 2 and 10, adults between the age of 45 and 65, pregnant women, people who take blood thinners, and people who have blood clotting conditions.

There are two types of nosebleeds –

1. Anterior nosebleed – When blood loss occurs from a blood vessel in the front of the nose, it is called an anterior nosebleed. These are usually harmless.
2. Posterior nosebleed – If loss of blood occurs in the back of the nose and flows down the throat, it is called a posterior nosebleed. These can be dangerous.

Causes

Nosebleeds can occur due to various reasons.

The exact cause of anterior nosebleeds isn’t known. However, it may be caused by –

• A huge blow or knock to the nose, leading to blood vessels getting damaged
• Inflammation of sinuses
• Septum deviation
• High altitude
• Picking the nose often
• Blowing the nose too often when one has a cold, nasal allergy, or the flu
• Climates with low humidity and dry climates can cause dryness and cracks inside the nose
• Excessive use of medication such as NSAIDs or blood thinners
• Using drugs such as cocaine excessively
• Liver disease, which causes blood clotting, and frequent nosebleeds, in turn

Posterior nosebleeds can occur due to –

• Deficiency of calcium
• Certain types of tumours
• Nasal surgery
• High blood pressure
• Exposure to certain chemicals causing irritation to the mucous membrane
• Leukaemia, haemophilia, or other blood diseases

Some other causes of nosebleeds include a broken nose, Thrombocytopenia, Stuart-Prower factor deficiency, nephritis, Von Willebrand disease, deficiency of factor 2, 5, or 7, liver cirrhosis, Leishmaniasis, foreign object getting stuck in the nose, Osler-Weber-Rendu disease, Aortic coarctation, Ebola, idiopathic Thrombocytopenic purpura, Rheumatic fever, and Celiac disease.

Symptoms

The major symptom of a nosebleed is blood coming out of the nose. It can either be light or heavy and may come out of one or both nostrils. Generally, medical attention isn’t required in case of a nosebleed. However, if it lasts longer than 20 minutes or occurs after a trauma or injury, you should consult a doctor as it could be a posterior bleed, which can be dangerous.

Diagnosis

If you are experiencing a severe nosebleed and consult a doctor, they will perform a physical examination to determine the reason behind it. They will examine your nose to check if a foreign object is stuck. They will also review your symptoms, medical history as well as medications you are taking, if any. There isn’t a significant test to determine the reason behind a nosebleed. Some diagnostic tests that can be performed to determine the cause of a nosebleed include CBC (complete blood count), PTT (partial thromboplastin time), CT scan, nasal endoscopy, and X-ray of the nose and face.

Treatment

Depending on the type of nosebleed and its cause, there are various treatment options for a nosebleed.

Anterior nosebleeds

Anterior nosebleeds can usually be treated at home. Since these nosebleeds occur from the front of the nose, to stop them, sit up and squeeze the nose’s soft part. Keep both the nostrils closed for at least 10 minutes and breathe through the mouth. Lean slightly forward. You shouldn’t lie down if you have a nosebleed, as this can lead you to swallow the blood, causing stomach irritation, nausea, and vomiting. After 10 minutes, release the nostrils to check if the bleeding is stopped. Applying a cold compress on the bridge of your nose or using a nasal decongestant spray can also help stop nosebleeds. If the nosebleed doesn’t stop on its own, you may have a posterior bleed that might require further treatment.

Posterior nosebleeds

In posterior nosebleeds, bleeding occurs from the back of the nose and tends to go down your throat. These aren’t that common and more serious. If your nosebleed doesn’t stop at home, you shouldn’t try to treat it at home and consult your medical provider.

• If a posterior nosebleed occurs due to a foreign object getting stuck in the nose, the doctor can remove it.
• Cauterization may be used in case of nosebleeds that are persistent. In this procedure, the blood vessels in the nose are burnt using silver nitrate or a heating device. The nose is then packed with foam, cotton, or gauze. A balloon catheter may also be used so that pressure can be applied to the blood vessels to stop the bleeding.

Other options

If nosebleeds occur due to underlying conditions, other treatment options are –

• Septal surgery – If you have a crooked septum from birth or due to an injury, septal surgery can be performed to straighten it and in turn, reduce the frequency of nosebleeds.
• Ligation – This surgery is done as a last resort. In this procedure, the blood vessels that cause nosebleeds are identified and their ends are tied. In some cases, the artery from which these blood vessels branch out is also tied. If it is identified that the source of bleeding is even further, more surgery may be required.

Prevention

Nosebleeds can be prevented in the following ways –

• Avoid picking your nose as it can cause nosebleeds, especially if you have long fingernails.
• Try to use decongestants and antihistamines in moderation, as these can cause the nose to become dry.
• Humidifiers can keep the air moist and help prevent nosebleeds.
• To keep the nasal passage moist, use saline sprays or gels.
• Decrease the intake of aspirin as it can cause the blood to become thin, leading to nosebleeds.

Outlook

In most cases, nosebleeds aren’t serious and can be treated at home. Most of the time, these are sudden and stop on their own. Many reasons can contribute to nosebleeds. If you experience them frequently, you can follow the above-mentioned steps to try and prevent nosebleeds. In case of posterior bleeds, you should consult your doctor immediately.

*Reviewed by Dr Arpit Sharma, Consultant - ENT and Head Neck Surgeon