What to Do If You or Your Child Suddenly Start Bleeding from the Nose?

What Is Epistaxis?

Epistaxis is the minor bleeding from blood vessels in the nose. Since the blood vessels in the nose are very fragile, they can bleed easily on exposure to many factors. Profuse bleeding from the nose can lead to life-threatening complications.

How Prevalent Is Epistaxis?

Epistaxis is commonly seen in children between 2 to 10 years and older adults between 50 to 80 years. It is not uncommon for the nose to bleed in a child who has a nose-picking. One needs to be aware of the causes and the immediate first-aid in such cases.

What Are the Causes of Epistaxis?

Bleeding from the nose is known as Epistaxis. Nasal bleeding can occur due to various reasons. In an older adult, a rise in blood pressure will usually cause bleeding from the nose. Other causes are common cold, infections in sinuses, weather changes, bleeding disorders, and cancers of the nose and sinuses. Adolescent male bleeding profusely should be investigated to rule out an angiofibroma tumor.

The factors that cause epistaxis or nose bleeding are broadly classified as:

• Local (fracture due to a sharp blow, nose-picking, etc.)

• General factors.

Nosebleed generally starts from just inside the nose entrance, on the middle, harder part of the nasal septum (the wall between the two nasal cavities). Blood vessels of this region, being fragile, rupture easily and begin to bleed. The factors that can cause nosebleed possibly are:

• Structural or anatomical deformities like hereditary hemorrhage.

• Cocaine use.

• Vascular disorders.

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• Allergic rhinitis.

• Deviated or perforated nasal septum.

• Connective tissue disease.

• Infectious disease (cold) or high blood pressure.

• Nasal sprays and prolonged usage of nasal steroids (particularly prolonged or improper use of nasal steroids).

• Vitamin C and vitamin K deficiency.

• Middle ear barotrauma due to sudden change of pressure.

• Surgery such as functional endoscopic sinus surgery.

• Exposure to warm, dry air for prolonged periods.

• Certain drugs like aspirin, warfarin, isotretinoin, desmopressin, etc.

• In pregnancy rarely due to hypertension and hormonal changes.

What Are the Types of Epistaxis?

The epistaxis is classified into two depending on their origin as:

• Anterior epistaxis.

• Posterior epistaxis.

Anterior Epistaxis:

Anterior epistaxis is the commonly occurring type of nosebleed, usually involving one nostril. Anterior epistaxis is the bleeding from the nose's anterior (frontal) part. The arteries that supply the anterior part of the nose and septum are called the Kiesselbach plexus. These arteries can be easily traumatized and bleed.

Posterior Epistaxis:

Posterior epistaxis refers to bleeding from the posterior part of the nasal cavity (bleeding that occurs in the back of the nose). It is less common than anterior epistaxis. The venous plexus that is located in the posterior end of the inferior meatus in the nasal cavity is the woodruff plexus. Only about ten percent of cases of epistaxis are posterior epistaxis. Posterior epistaxis usually involves both nostrils. In these types of epistaxis, the blood can also flow backward and get swallowed or coughed up (hemoptysis).

How to Diagnose Epistaxis?

Most nosebleed cases are self-diagnosed and treated at home, especially the anterior nosebleeds. People who have severe and unresolved nosebleeds to home remedies should seek medical advice. The doctor may ask for the following tests like blood tests and medical history. Often, posterior epistaxis is diagnosed only after failing to manage anterior epistaxis or noticing bleeding into the posterior pharynx or throat. It is often harder for healthcare professionals to visualize the source of posterior bleeding in a physical examination; thus, a clinician usually performs a nasal endoscopy to help identify the origin of the bleed.

How to Manage Epistaxis?

Depending on the cause and diagnosis of the nosebleed, treatment is prescribed. Generally, when the nosebleed starts as home treatment, the patient is made to sit up straight, pinch the nose, and hold their head backward.

Pouring cold water slowly overhead or keeping a wet cloth relieves the condition in the majority of the cases.

What to Do If You or Your Child Suddenly Start Bleeding from the Nose?

The first aid measures to be taken during a nosebleed are:

1. Pinch the soft part of the nose with the thumb and index finger for five to ten minutes.

2. Keep the mouth open and breathe.

3. Rub ice over the bridge of the nose.

4. Do not panic and reach the doctor for further treatment.

The doctor will examine the nose and decide on further testing and treatment based on the cause of Epistaxis. He may advise nasal endoscopy and cauterization of the blood vessel. If the bleeding is profuse, it may require nasal packing and hospitalization.

How to Prevent Epistaxis?

Here are a few tips you can use to prevent nosebleeds:

1. Keep the child upright and gently tilt their head forward slightly. Because leaning their head back can cause the blood to run down their throat. It will cause a bad taste and can make the child cough, gag, or even vomit.

2. Avoid nose-picking as much as possible, and keep your fingernails short. Try not to blow your nose too often, and only gently when you do, especially during winter and allergy seasons. If you are taking cold or allergy medications, make sure you follow the instructions that come with the package.

3. If participating in any activities that can endanger the nose and head, wear proper protective headgear.

4. Avoid excessive alcohol drinking and smoking.

How Severe Is Nosebleeds?

Bleeding from the nose can be alarming, but all nosebleeds are not severe, often treated at home. However, some should be checked by the doctor.

Can Nosebleeds Recur?

A few children may experience nosebleeds one or two times a year, but others seem to get them more frequently. Since the lining of the nose is overly irritated, the exposed blood vessels can bleed even at the smallest instigation.

Conclusion:

A few nosebleeds that start from the back of the nose may usually involve large blood vessels, resulting in heavy bleeding that can be dangerous. This may require medical attention, mainly if the bleeding occurs after an injury or when the bleeding has not stopped even after applying 20 minutes of direct pressure to your nose. If you have frequent nosebleeds, consult with your doctor because this could be an early sign of other medical problems that need to be diagnosed.

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