What Is Nose Bleeding (Epistaxis)?
Nosebleed, also referred to as epistaxis, is one of the most common ear, nose, and throat (ENT) emergencies present to the emergency department or the primary care clinic. When there is bleeding from the nose, it is called nose bleeding. It is very common, particularly in young children and adults over 65. Nosebleeds are more common in adults and young children between 3 and 10 years.
What Are the Types of Nosebleeds?
The two types of nosebleeds are:
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Anterior (more common).
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Posterior (less common, but it requires medical attention).
What Are the Five Arteries That Supply the Nasal Cavity?
The five arteries that supply the nasal cavity and cause nose bleed when ruptured are:
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Anterior ethmoidal artery.
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Greater palatine artery.
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Posterior ethmoidal artery.
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Sphenopalatine artery.
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Superior labial artery.
What Are the Signs and Symptoms of Nose Bleeding?
The signs and symptoms of a nosebleed may include:
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Bleeding from one or both nostrils.
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The urge to swallow frequently.
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A sensation of flowing liquid at the back of the throat.
Does Nose Bleeding Indicate a Severe Medical Condition?
Nosebleeds can be scary to the person who gets them, but it rarely indicates a serious medical problem. The nose contains many blood vessels located close to the surface in the front and back of the nose. These blood vessels are very fragile and can bleed easily.
Why Does the Nose Bleed in Children?
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It is common in children during hot and dry weather conditions.
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Bleeding of up to 50-100 mL is common due to dryness.
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This happens because of disturbance in the mucociliary clearance, which means that the hair-like cells that form the inner lining of the nasal cavity stop working properly due to the lack of a fluid layer that allows their normal functioning.
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These hair-like cells are responsible for pushing the secretions backward towards the throat and keeping the sinuses and nasal cavity clean. When these cells fail to work, the mucus that accumulates dries up, and forms crusting, which leads to bleeding when removed by sneezing or nose picking.
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It is essential to understand this because this is the basis for treatment with saline nasal drops.
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It increases the solution layer within the nose and promotes mucociliary clearance.
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To avoid nasal bleeds, apply saline nasal drops 4 to 5 times a day during dry weather to keep the nose wet.
Why Does the Nosebleed in Adults?
Nosebleeds are usually caused by the rupture of a blood vessel within the nasal mucosa. The rupture of the tiny vessels can be spontaneous. Nosebleeds are more common in individuals who have medical conditions like allergies, leukemia, nasal polyps, or sinusitis. Individuals who take some types of medicines like anti-inflammatories, blood thinners, or nose sprays are also more prone to get nosebleeds. Nosebleeds can also occur due to trauma or secondary to other comorbidities or malignancies. An increase in the patient's blood pressure, anticoagulant medications, and clotting disorders can also increase the bleeding time and episode length.
What Are the Common Risk Factors for Nose Bleeding?
The common risk factors associated with nosebleeds are:
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Picking the nose.
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Having a cold.
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Blowing the nose too hard.
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Straining too hard on the toilet.
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Fragile blood vessels that bleed easily.
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Having an infection in the nose, throat, sinuses, or adenoids.
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Receiving a bump, knock or blow to the head or face.
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Having a stuffy nose from an allergy.
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Taking medications like anti-inflammatories, blood thinners, or nose sprays.
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An object that has been pushed up the nostril.
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Bleeding or clotting problem.
When to Consult a Doctor for Nosebleeds?
There is no need to consult a doctor for mild nosebleeds, which stop within 15 minutes. But seek emergency medical help if there are:
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Injury.
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Very heavy bleeding.
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Having trouble breathing.
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The nosebleed that lasts longer than 15 minutes.
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Nosebleed in children under two years.
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Under blood-thinning medication.
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Vomiting blood.
If there is nose bleeding in children suddenly without any accident, seek immediate help from a healthcare professional. Recurring nosebleeds can be a little disgusting, but they are usually nothing to worry about. However, it is important to discuss them with the doctor to investigate to ensure that no underlying medical condition is causing the bleeds.
Steps for Managing an Active Nasal Bleeding:
Step1:
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Do not lie down or lift your head upwards.
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Rather sit up and bend forwards with your mouth open and take deep breaths through your mouth.
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Lying down does not stop the bleeding but, in turn, increases the chance for the blood to enter the lungs, which can be fatal, or into the stomach, which will create gastric irritation and vomiting.
Step 2:
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Pinch your nose strongly at the soft part of the nose at a point where it is closest to the bony region for at least 10 to 15 minutes while maintaining firm pressure.
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The normal bleeding time is around 10 minutes, so it is important to follow this step religiously.
Step 3:
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If step 2 does not work, repeat it while keeping an ice pack over the nose to help stop the bleeding faster.
Step 4:
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Most important step!
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After the nose pinching, your nose will feel blocked because a blood clot has helped stop the bleeding.
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Please do not try to clear your nose by sneezing or rubbing your nose excessively.
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You will bleed from the nose again and will have to start all over from step 1.
Bleeding may be more if you are hypertensive or on blood-thinning drugs. In these cases, medical management for raised blood pressure or altering blood-thinning medications by the primary clinician is critical in managing the bleeding. Please note that pouring water over the head has no effect on the bleeding. It is important to see an ENT (ear, nose, and throat) doctor if the bleeding is profuse and not stopping with one or two attempts of the above technique. It is advised to continue following these steps while traveling to the hospital.
If there are recurring nosebleeds in a child, consult the doctor to identify the cause and commence a proper treatment. For example, if the nosebleed is due to ongoing infection, the doctor may prescribe an antibiotic ointment or medicine. Anemia in children due to heavy blood loss through nose bleeding is very rare.
How to Prevent Nosebleeds?
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Recurring nosebleeds may need treatment like minor surgery to cauterize (burn) the blood vessels in the nose.
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Avoid picking the nose after a nosebleed. Instead, blow it gently.
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Prevent the inside of the nose from drying out by using a humidifier or putting a small amount of lubricant cream inside the nose.
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Drinking plenty of fluids and eating fibers can cure the nosebleed that is caused due to straining on the toilet due to constipation.
Conclusion:
Nosebleeds are common and do not always indicate a chronic medical problem. But the current age and health status of the patient should be taken into consideration in the management of nosebleeds. Therefore, if this happens to your little ones or elderly loved ones, you know the possible causes and the things to be done to manage them.
