What causes nosebleeds? How are they diagnosed and treated? Discover the answers to these questions and more in this informative article on nosebleeds.

Understanding the Causes of Nosebleeds

Nosebleeds, also known as epistaxis, are a common occurrence, affecting up to 60 million people in the United States each year. These incidents happen when a blood vessel inside the nose bursts, leading to bleeding. The nose has a rich supply of blood vessels located close to the surface, making them prone to breaking and causing nosebleeds.

One of the most common causes of nosebleeds is dry indoor air, particularly during the winter months when the use of indoor heating can dry out the nasal passages. This can be addressed by using a humidifier or applying over-the-counter saline nose drops a few times a day. Nosebleeds may also be a side effect of using nasal sprays or certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or warfarin, which can hinder the body’s ability to clot.

Differentiating Between Anterior and Posterior Nosebleeds

Nosebleeds can be categorized into two main types: anterior and posterior. Anterior nosebleeds typically start in the front of the nose or the nasal septum, the cartilage that separates the nostrils. These are the more common type of nosebleeds and usually come from one nostril at a time.

In contrast, posterior nosebleeds originate from larger blood vessels in the back of the nose. These can be more severe, as the blood may flow back toward the mouth and throat, as well as out the nostrils. Posterior nosebleeds are less common than anterior nosebleeds and require prompt medical attention, as they can be a sign of an underlying medical condition, such as hypertension or, in rare cases, an aneurysm or cancer.

When to Seek Medical Attention for Nosebleeds

Most nosebleeds can be treated at home by gently squeezing the soft portion of the nose for 15 minutes while sitting upright. However, certain situations warrant immediate medical attention. These include:

• Nosebleeds that last more than 20 minutes
• Frequent nosebleeds
• Nosebleeds that occur after a major trauma, such as a car accident
• Nosebleeds accompanied by dizziness or lightheadedness
• Excessive bleeding from the nose
• Nosebleeds in children younger than 2 years old

Diagnosing and Treating Nosebleeds

To determine the cause of a nosebleed, a healthcare professional, typically an otolaryngologist (an ear, nose, and throat specialist), will perform a physical examination and may use an endoscope to look inside the nose. They may also order additional tests, such as a CT scan of the nose and sinuses.

The treatment of a serious or chronic nosebleed is highly individualized and depends on factors such as the severity of the bleeding, any underlying medical conditions, and the use of blood thinners. Common treatment options include the use of nasal sprays, topical therapies, cautery (applying heat to seal a bleeding vessel), and nasal packing (placing a gauze-like material or an inflatable balloon in the nose to apply pressure).

When Surgery is Recommended for Nosebleeds

In some cases, surgery may be necessary to treat nosebleeds, particularly posterior nosebleeds or those that do not respond to nonsurgical treatments. Minimally invasive surgical procedures can be used to isolate and repair the blood vessel causing the bleeding.

The surgical process typically involves the insertion of an endoscopic tube through the nostrils to locate and treat the problematic artery. This approach can effectively stop the bleeding and prevent future nosebleeds in some patients.

Prevention and Management of Nosebleeds

While nosebleeds can be a common and sometimes frightening experience, there are steps you can take to prevent and manage them. Using a humidifier, applying saline nose drops, and avoiding medications that can interfere with clotting can all help reduce the risk of nosebleeds.

If you do experience a nosebleed, remain calm and follow the appropriate first-aid steps, such as gently squeezing the soft portion of your nose and keeping your head higher than your heart. If the bleeding persists or becomes a recurring issue, it’s important to seek medical attention to determine the underlying cause and receive appropriate treatment.

Nosebleeds (Epistaxis) > Fact Sheets > Yale Medicine

Overview

You’re in a public place, maybe a supermarket, and you suddenly realize your nose is bleeding—and you don’t have a tissue. It’s embarrassing, but surprisingly common.

Nosebleeds occur when a blood vessel inside your nose bursts. The medical name for nosebleeds is epistaxis. Each year, up to 60 million people in the United States have nosebleeds. They are mostly likely to occur in the winter, when cold weather and indoor heating dry the nasal passages.

Most nosebleeds are minor and the bleeding stops on its own, but some people will need medical attention. If you have chronic nosebleeds, it’s a good idea to be evaluated by a specialist, says Peter Manes, MD, a Yale Medicine otolaryngologist. “We have extensive experience with all types of nosebleeds, from the simple to the exceedingly complicated,” Dr. Manes says.

What causes nosebleeds?

The nose has an especially rich supply of blood vessels that are located close to the surface, where they can easily break and bleed.

Minor nosebleeds typically start in the front of the nose (an anterior nosebleed), or from the nasal septum, the cartilage that separates the nostrils. Most of these nosebleeds come from one nostril at a time.

A common cause of nosebleeds is dry indoor air, especially problematic in the winter. You can head off this kind of a nosebleed by regularly using a humidifier or by applying over-the-counter saline nose drops in each nostril a few times a day. You can also prevent dryness by rubbing a water-based lubricant on the inside of the nose.

Nosebleeds may be a side effect of using nasal sprays, or cold and allergy medicines. Nosebleeds can also be caused by a bump or blow to the nose.

If you often or regularly take nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin or warfarin, which hinder clotting, your nosebleeds may be especially difficult to stop.

The more severe type of nosebleed typically starts in larger blood vessels in the back of the nose (posterior nosebleed). The blood may flow back toward the mouth and throat as well as out the nostrils. 

Posterior nosebleeds are far less common than anterior nosebleeds and they require prompt medical attention because they can signal an underlying medical condition. Hypertension is the most common disease associated with severe nosebleeds. In rare cases, nosebleeds can be a sign of an aneurysm or underlying cancer.

When should you see a doctor for a nosebleed?

If your nosebleed is coming from the front of your nose, you can usually care for yourself at home. 

While sitting down, gently squeeze the soft portion toward the bottom of your nose between your thumb and finger. Do this for about 15 minutes. Do not tilt your head back, since this can cause the blood to flow back down your throat. It’s important to sit up straight, keeping your head higher than your heart. 

If your nosebleed lasts more than 20 minutes, or if you are having nosebleeds frequently, see your doctor.

Some nosebleeds require immediate emergency care. This is true for a nosebleed that happens after a major trauma, such as a car accident; if your nosebleed is accompanied by feeling dizzy or lightheaded; if the amount of blood coming from your nose is excessive; or if your nosebleed interferes with breathing. You also want to seek emergency care for a child younger than 2 years old who is having a nosebleed.

How are nosebleeds diagnosed and treated?

The medical specialty that provides care for the ear, nose and throat is otolaryngology. To understand what’s causing your nosebleed, your doctor will begin with a physical exam. He or she will look inside the nose using an endoscope, a tube with a tiny camera at the end of it. The specialist may also want a CT scan of the nose and sinuses, or other tests.

Treatment of a serious nosebleed or chronic ones is highly individualized. Your doctor will consider such factors as how severe the bleeding is, other medical conditions and treatments that may be causing the bleeds, and whether you use blood thinners.

Most nosebleeds can be treated without surgery and without going to the hospital, using one of the following approaches:

• Nasal sprays
• Topical therapies
• Cautery, which is a procedure that involves applying heat to seal a bleeding vessel shut
• Nasal packing, placing a gauze-like material or an inflatable balloon in the nose to put pressure on the bleeding vessel

When is surgery recommended for nosebleeds?

Posterior nosebleeds (toward the back of the nose) and nosebleeds that don’t respond to nonsurgical treatments may require surgery.  Minimally invasive surgery can isolate and repair a blood vessel that is the cause of bleeding.

The surgical procedure starts with insertion of an endoscopic tube through the nostrils. The goal is to find and treat the artery that is causing the problem. “The blood vessel has many different branches—the challenge, frankly, is making sure you’re finding all the branches,” says Dr. Manes. “If you don’t find them all, you haven’t done the job.”

Endoscopic surgery can be done without an incision and often leaves no scars. Pain is usually mild and recovery quick.  While most nosebleed surgery can be done on an outpatient basis, people with more severe conditions may require an overnight hospital stay.

Yale Medicine surgeons are specialists in trans-nasal endoscopy. They use a thin endoscope less than 6 millimeters in diameter—about the width of three stacked nickels. The procedure is easy for patients to tolerate and can be performed without anesthesia.

Does Yale Medicine offer any particular advantages in the treatment of chronic or severe nosebleeds?

While a nosebleed is usually a simple problem that can be treated without surgery, some patients’ conditions are complicated. A doctor may need to consider other medical conditions an individual may have, or consider whether the patient is using medications such as blood thinners.

 “We have a variety of different treatments—both medical treatments and surgical treatments that aren’t easy to find elsewhere,” says Dr. Manes. For complex cases, Yale Medicine’s otolaryngologists consult with interventional radiologists, hematologists, imaging experts and other top Yale Medicine specialists to ensure that all related problems a patient may have are being addressed.

Dr. Manes says that with proper care from an experienced specialist, people who are treated for nosebleeds and related complications can expect an excellent prognosis.

Epistaxis – StatPearls – NCBI Bookshelf

Ayesha Tabassom; Julia J. Cho.

Last Update: September 12, 2022.

Continuing Education Activity

Epistaxis (nosebleed) is one of the most common ear, nose, and throat (ENT) emergencies that present to the emergency room or primary care. There are two types of nosebleeds: anterior (more common), and posterior (less common, but more likely to require medical attention). The source of 90% of anterior nosebleeds lies within Kiesselbach’s plexus (also known as Little’s area) on the anterior nasal septum. This activity reviews the cause, pathophysiology, and presentation of epistaxis and highlights the role of the interprofessional team in its management.

Objectives:

• Recall the causes of epistaxis.

• Describe the common anatomic locations of epistaxis.

• Summarize the treatment options for epistaxis.

• Review the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by epistaxis.

Access free multiple choice questions on this topic.

Introduction

Epistaxis (nosebleed) is one of the most common ear, nose, and throat (ENT) emergencies that present to the emergency department or the primary care clinic. There are two types of nosebleeds: anterior (more common), and posterior (less common, but more likely to require medical attention). The source of 90% of anterior nosebleeds is within Kiesselbach’s plexus (also known as Little’s area) on the anterior nasal septum. There are five named vessels whose terminal branches supply the nasal cavity:

1) Anterior ethmoidal artery

2) Posterior ethmoidal artery

3) Sphenopalatine artery

4) Greater palatine artery

5) Superior labial artery

The watershed area of these five vessels is in the anterior nasal septum, comprising Kiesselbach’s plexus. This lies at the entrance to the nasal cavity and so is subject to extremes of heat and cold, and of high and low moisture, and is easily traumatized. The mucosa over the septum in this area is especially thin, making this the site of the majority of epistaxis. More rarely, vessels in the posterior or superior nasal cavity will bleed, leading to the so-called “posterior” epistaxis. This is more common in patients on anticoagulants, patients who are hypertensive, and patients with underlying blood dyscrasia or vascular abnormalities. Management will depend on the severity of the bleeding and the patient’s concomitant medical problems.[1][2][3]

Etiology

There are multiple causes of epistaxis which can be divided into local, systemic, environmental, and medication-induced.

Local causes:

• Digital manipulation

• Deviated septum

• Trauma

• Chronic nasal cannula use

Systemic causes:

• Alcoholism

• Hypertension

• Vascular malformations

• Coagulopathies (von Willebrand disease, hemophilia)

Environmental factors:

Medications:

• NSAIDs (ibuprofen, naproxen, aspirin)

• Anticoagulants (warfarin)

• Platelet aggregation inhibitors (clopidogrel)

• Topical nasal steroid sprays

• Supplement/alternative medications (vitamin E, ginkgo, ginseng)

• Illicit drugs (cocaine)

While epistaxis is a very common spontaneous problem, rarer etiologies such as neoplasms or vascular malformations must always be in the differential diagnosis, particularly if additional symptoms such as unilateral nasal obstruction, pain, or other cranial nerve deficits are noted. [4][5][6]

Epidemiology

Nosebleeds are rarely fatal, accounting for only four of the 2.4 million deaths in the United States. About 60% of people have experienced a nosebleed during their life, and only 10% of nosebleeds are severe enough to warrant treatment/medical intervention. They occur most commonly in children ranging from 2 to 10 years old and the elderly ranging from 50 to 80 years old.  

Pathophysiology

Nosebleeds are caused by the rupture of a blood vessel within the nasal mucosa. Rupture can be spontaneous, initiated by trauma, use of certain medications, and/or secondary to other comorbidities or malignancies. An increase in the patient’s blood pressure can increase the length of the episode. Anticoagulant medications, as well as clotting disorders, can also increase the bleeding time.

Most nosebleeds occur in the anterior part of the nose (Kiesselbach’s plexus), and an etiologic vessel can usually be found on careful nasal examination.

Bleeding from the posterior or superior nasal cavity is often termed a posterior nosebleed.   This is usually presumed due to bleeding from Woodruff’s plexus, which are the posterior and superior terminal branches of the sphenopalatine and posterior ethmoidal arteries. These are often difficult to control and are associated with bleeding from both nostrils or into the nasopharynx, where it is swallowed or coughed up, presenting as hemoptysis.  It can generate a greater flow of blood into the posterior pharynx and have a higher risk for airway compromise or aspiration due to increased difficulty in controlling the bleed.

History and Physical

The history should include duration, severity, frequency, laterality of the bleed, inciting event, and interventions provided prior to seeking care.  Inquire about anticoagulant, aspirin, NSAID, and topical nasal steroid use. Obtain a relevant family history, particularly relating to coagulopathy and vascular/collagen disease, as well as any history of drug and alcohol use.

Prepare proper equipment and proper personal protective equipment (PPE) before beginning the physical examination.   Equipment may include a nasal speculum, bayonet forceps, headlamp, suction catheter, packing, silver nitrate swabs, cotton pledgets, and topical vasoconstrictors and anesthetic. Have the patient in a seated position in an exam chair in a room with suction available. Carefully insert the speculum and slowly open the blades to visualize the bleeding site. A headlight is essential to allow for hands-free illumination, and clot may need to be suctioned from the nasal cavity to identify the bleeding source.

A posterior nosebleed is not easy to visualize and may be suggested by active bleeding into the posterior pharynx without a visualized vessel on nasal examination. Nasal endoscopy greatly increases the success in identifying the bleeding source.

Evaluation

Differentiating an anterior or posterior is key in management. Diagnosis of anterior bleeding is can be made by direct visualization using a nasal speculum and light source. A topical spray with anesthetic and epinephrine may be helpful for vasoconstriction to help control bleeding and to aid in the visualization of the source. Usually, the diagnosis of posterior bleeding is made after measures to control anterior bleeding have failed. Clinical features of posterior bleeding can include active bleeding into the posterior pharynx in the absence of an identified anterior source; high-flow posterior bleeds may cause blood to emanate from both nares. Labs may be obtained if necessary, including a complete blood cell count (CBC), type and cross match, and coagulation studies, though should not delay treatment of an active bleed. Imaging such as x-ray or computed tomography have no role in the urgent or emergent management of active epistaxis.

Treatment / Management

Start with a primary survey and address the airway, ensure the airway is patent.  Next, assess for hemodynamic compromise. Obtain large-bore intravenous access in patients with severe bleeding and obtain labs. Reverse blood clotting as necessary, if there is a concern with medication use.[7][8][9]

All patients with moderate to severe nose bleeding should have two large-bore intravenous lines and infusion of crystalloid. The monitoring of oxygen and hemodynamic stability is vital.

Treatment for anterior bleeding can be started with direct pressure for at least 10 minutes. Have the patient apply constant direct pressure by pinching the nose over the cartilaginous tip (instead of over the bony areas) for a few minutes to try to control the bleed. If that is ineffective, vasoconstrictors such as oxymetazoline or thrombogenic foams or gels can be employed. It is important to remove all clot with suction before any attempt at treatment is made. The reasons are twofold: 1) Clot will prevent any medication from reaching the vessel itself and 2) if packing becomes necessary, the clot can be pushed into the nasopharynx and aspirated. If topical treatments are unsuccessful, proceed with nasal examination to identify and cauterize the vessel with silver nitrate. If this too is unsuccessful, anterior nasal packing is necessary. This can be performed with absorbable packing material such as surgicel or fibrillar, or with devices such as anterior epistaxis balloons, or nasal tampons (Rapid Rhino). If silver nitrate is used to cauterize a septal blood vessel, only use it on one side of the septum to prevent septal perforation. Thermal coagulation is painful and should rarely be attempted in an emergent setting.

Traditional petrolatum gauze can be used if one does not have access to balloons or tampons.

If none of this is successful, the bleeding may be from the posterior or superior nasal cavity. Symptoms can include active bleeding from both nostrils or active bleeding present in the posterior pharynx. Longer (7.5cm) nasal tampons are available that provide some more posterior pressure and can be employed in this situation. Formal posterior nasal packing should only be performed by experienced personnel as it requires admission and telemetry monitoring, and sometimes intubation. It is associated with higher rates of complications like pressure necrosis, infection, or hypoxia, and may trigger a nasal-cardiac reflex (sudden bradycardia after nasal packing – if this occurs, remove the pack immediately). Foley catheters can be used by experienced personnel to tamponade a posterior bleed. If a posterior pack is placed, a formal petrolatum gauze anterior pack must be placed as well to create a closed, tamponaded space in the nasopharynx.

If all of these measures are unsuccessful, the patient should be intubated for airway protection and interventional radiology consulted emergently for embolization. If this service is unavailable, operative ligation of the sphenopalatine and ethmoid arteries can be performed in the operating room by an otolaryngologist.

Differential Diagnosis

• Nasal tumor

• DIC

• Hemophilia

• Von Willebrand disease

• Rhinitis

• Foreign body in the nose

• Drug toxicity (Warfarin, NSAIDs)

Postoperative and Rehabilitation Care

Once the bleeding is controlled, it is important to arrange timely follow-up (within one week) with their primary care physician or an otolaryngologist. If any packing has been placed, this must remain undisturbed for 3-5 days before removal. Patients should begin an anti-staphylococcal antibiotic to prevent toxic shock syndrome. Underlying causes must be addressed before discharge (tight blood pressure control with goal SBP <120 mm Hg, reveral of any coagulopathy, etc.), and patients should use topical nasal saline in both nares to keep the packs moist and facilitate removal.

Pearls and Other Issues

Patients with anterior nosebleeds can be discharged if the bleeding is controlled and hemodynamic stability is observed for at least one hour in the emergency department (ED), as well as having all predisposing factors medically optimized. Follow up with an otolaryngologist or their primary physician should occur in one week and they should begin nasal saline three times daily. If non-biodegradable packing is used, patients should return to the ED or ENT for packing removal in three to five days. If a patient, including pediatric patients, require posterior packing, admission is required to monitor for complications, particularly cardiac arrhythmias.   All anticoagulants should ideally be discontinued but must be reversed or withheld to achieve the lowest dose acceptable if discontinuation is not possible.

Application of topical saline sprays or ointments to the nasal mucosa to ensure moisturization of the nasal mucosa can help to prevent recurrent epistaxis. Patients should also be advised to avoid hot foods, strenuous activity, blowing nose, or digital manipulation of the nose on discharge.

Enhancing Healthcare Team Outcomes

The care of nose bleeding is best performed by an interprofessional team. Most patients initially present to the emergency room and the triage nurse should be fully aware of the importance of admitting patients with a significant bleed. While most anterior nosebleeds can be arrested with digital pressure, a follow-up appointment is recommended in patients with repeat episodes. Even though nurses may not perform invasive procedures to stop the bleeding, they can be very effective in instructing patients how to properly compress the nose with fingers, which in most cases can arrest the bleeding.

Nasal packing is another option but the packing must be in place for three to five days, and repeated insertions and removals of various packs will only exacerbate the bleeding. Drug-induced nosebleeds may require a reversal of the INR and admission. The pharmacist should ensure that the patient does not restart the NSAID or other anticoagulant while the bleeding is active. A hematologist consult is recommended to deal with patients with coagulopathy. In rare cases, embolization or cauterization may be required to stop a nose bleed. If the bleeding is posterior and/or severe, an ENT consultation is necessary. In some cases, the invasive radiologist may be required to perform embolization to stop the bleeding. Nurses should monitor the oxygen and hemodynamic status of all patients with moderate to severe nose bleeds. These patients should have intravenous access with the transfusion of crystalloids. The team members should communicate with each other to ensure that the patient is receiving the acceptable standard of care treatment.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Epistaxis management supplies that may be needed for packing such as Rapid Rhino examples, Anterior and Posterior packing. Contributed by Tammy J. Toney-Butler, AS, RN, CEN, TCRN, CPEN

Figure

Nose bleed vessels. Image courtesy S Bhimji MD

References

1.

Fishman J, Fisher E, Hussain M. Epistaxis audit revisited. J Laryngol Otol. 2018 Dec;132(12):1045. [PubMed: 30674370]

2.

Send T, Bertlich M, Eichhorn KW, Ganschow R, Schafigh D, Horlbeck F, Bootz F, Jakob M. Etiology, Management, and Outcome of Pediatric Epistaxis. Pediatr Emerg Care. 2021 Sep 01;37(9):466-470. [PubMed: 30624421]

3.

Kitamura T, Takenaka Y, Takeda K, Oya R, Ashida N, Shimizu K, Takemura K, Yamamoto Y, Uno A. Sphenopalatine artery surgery for refractory idiopathic epistaxis: Systematic review and meta-analysis. Laryngoscope. 2019 Aug;129(8):1731-1736. [PubMed: 30613985]

4.

INTEGRATE (UK National ENT research trainee network) on its behalf: Mehta N, Stevens K, Smith ME, Williams RJ, Ellis M, Hardman JC, Hopkins C. National prospective observational study of inpatient management of adults with epistaxis – a National Trainee Research Collaborative delivered investigation. Rhinology. 2019 Jun 01;57(3):180-189. [PubMed: 30610832]

5.

Clark M, Berry P, Martin S, Harris N, Sprecher D, Olitsky S, Hoag JB. Nosebleeds in hereditary hemorrhagic telangiectasia: Development of a patient-completed daily eDiary. Laryngoscope Investig Otolaryngol. 2018 Dec;3(6):439-445. [PMC free article: PMC6302722] [PubMed: 30599027]

6.

Ramasamy V, Nadarajah S. The hazards of impacted alkaline battery in the nose. J Family Med Prim Care. 2018 Sep-Oct;7(5):1083-1085. [PMC free article: PMC6259556] [PubMed: 30598962]

7.

Joseph J, Martinez-Devesa P, Bellorini J, Burton MJ. Tranexamic acid for patients with nasal haemorrhage (epistaxis). Cochrane Database Syst Rev. 2018 Dec 31;12(12):CD004328. [PMC free article: PMC6517002] [PubMed: 30596479]

8.

Wong AS, Anat DS. Epistaxis: A guide to assessment and management. J Fam Pract. 2018 Dec;67(12):E13-E20. [PubMed: 30566119]

9.

Santander MJ, Rosenbaum A, Winter M. Topical tranexamic acid for spontaneous epistaxis. Medwave. 2018 Dec 10;18(8):e7372. [PubMed: 30550535]

Disclosure: Ayesha Tabassom declares no relevant financial relationships with ineligible companies.

Disclosure: Julia Cho declares no relevant financial relationships with ineligible companies.

Epistaxis: Causes and Treatment

Nosebleeds or epistaxis is a fairly common and most often sudden phenomenon. When blood vessels are broken, blood can drip or leak from the nostrils and run down the back of the throat. Sometimes at the same time, the pulse quickens, the pressure drops sharply and weakness is felt.

Factors causing epistaxis:

1. Injuries to the nose are not only direct blows or a consequence of a car accident, but also the ingress of foreign bodies into the nose or violation of the integrity of the mucous membrane during medical manipulations.

2. Bleeding can be caused by sinusitis, rhinitis or adenoid disease.

3. When the nasal septum is deviated, mucosal degeneration occurs.

4. Nosebleeds may occur in patients with nasal swelling.

5. Bleeding of mucous membranes can be affected by various diseases:

hypertension, atherosclerosis, blood diseases, beriberi, hemorrhagic diathesis, pathologies of the kidneys, liver or some infections.

6. Bleeding from the nose can be caused by external causes: sunstroke or a sudden pressure drop, for example, in climbers.

Common questions about bleeding:

– Why does my nose bleed at night?

Nocturnal nosebleeds may occur with an increase in arterial or intracranial pressure. Dry air in the room contributes to the violation of the mucosa. Be careful: if you take blood thinners before going to bed, breathing can be disturbed from heavy nosebleeds during sleep.

Why does an elderly person often bleed from the nose?

The point is age-related fragility of capillaries and high blood pressure – with this combination, nosebleeds can occur even during physical exertion or sneezing.

Bleeding from the nose in a child: what are the causes?

20% of children suffer from recurrent nosebleeds. In childhood, there is less resistance to acute respiratory diseases that thin the mucous membrane, and small noses often contain foreign objects, and children are not familiar with the toilet of the nose.

Where does blood flow from during epistaxis?

Bleeding can occur in the nasal cavity or outside it: in the sinuses, nasopharynx or cranial vessels. The anteroinferior nasal cavity is anatomically predisposed to epistaxis – such bleeding does not threaten health. Bleeding from the deep parts of the nasal cavity can cause serious blood loss and require medical intervention. Sometimes nausea, hemoptysis, pallor, malaise, rapid pulse, dizziness and thirst are observed along with nosebleeds.

First aid for nosebleeds

It is important to control blood loss: to stop nosebleeds, a person should be seated with the head tilted forward and forbidden to blow your nose, cold should be applied to the back of the nose and a swab with a 3% hydrogen peroxide solution should be placed in the nasal passage.

For frequent episodes, electrocautery or chemical cauterization is indicated. To avoid relapses, it is important to control not only the condition of the nasal cavity, but also blood clotting, the level of vitamins and minerals in the body and general immunity.

In St. Petersburg, comprehensive diagnosis and treatment of nosebleeds is carried out at the Duncan family clinic. If there is blood from the nose during a runny nose, or episodes of sudden bleeding occur, a timely appeal to the ENT will help solve the problem and eliminate its unpleasant consequences.

Recurrent nosebleeds – description, causes, symptoms, diagnosis and treatment

Recurrent nosebleeds – a signal for examination by a doctor, even if you can easily stop the bleeding yourself at home. The reason is that frequent blood loss leads to anemia and exhaustion of the body. Successful treatment is possible only after the cause of the pathology is discovered.

Symptoms of recurrent bleeding

Due to epistaxis, which recurs periodically, the patient may notice:

1. Weakness, headaches, fatigue, tinnitus.
2. Taste of blood in the mouth, blood in the stool (it turns black), vomiting blood, nausea.
3. Paleness of the skin and mucous membranes.
4. Dizziness, flies before the eyes.
5. Palpitations, shortness of breath, pressure fluctuations.
6. Decreased amount of urine.
7. Tendency to fainting, deterioration of attention, memory.

Even if such symptoms have not yet developed, but the person has recurrent nosebleeds, it is advisable to consult a doctor. This will help to avoid complications, prevent blood loss.

Who often has nosebleeds?

Adults and children face the problem. In childhood, this condition is most often associated with trauma or the presence of a foreign body in the nasal cavity. In young children, rhinoscopy reveals buttons, beads, small parts of toys, seeds, and bones. Another possible reason is that the child picks his nose, injures the mucous membrane with his fingernail, which causes bleeding from the nose. But sometimes the cause is a neoplasm of the nasal cavity or another area of ​​the respiratory system, pathology of the coagulation system. In this case, the earlier the disease is detected, the better the prognosis for treatment.

In adults, nosebleeds are often associated with chronic diseases of the nasal cavity, concomitant pathology of internal organs. In the elderly, with occupational diseases, in smokers, atrophy of the mucous membrane is often detected. It is thin, red, easily injured and bleeds when touched. In this case, the actions will be aimed at moisturizing, restoring the elasticity and protective properties of the mucous membrane, and eliminating provoking factors.

Causes of frequent nosebleeds

All causes can be conditionally divided into local – pathology of the nasal cavity, and general – concomitant diseases that affect the properties of blood vessels and blood clotting.

Local causes:

1. Foreign bodies. Periodically, blood flows from the same half of the nose, sometimes inflammation joins, and the discharge acquires a mucopurulent character. Difficulty breathing through this half of the nose is possible. If you bring the cotton wool to your nose, and close the other nasal passage, it will fluctuate a little.
2. Mucosal injury – bleeding is repeated until the mucosal area heals. If the patient rips off the crust in the nose, bleeding opens again in this place.
3. Atrophy – caused by malnutrition, dry air, impurities in the air, hormonal disorders.
4. Parasites – they have a complex development cycle. In one of the phases, the larvae can migrate through the body with blood, enter different organs – lungs, liver, brain, nasal cavity. They injure the mucosa, causing recurrent bleeding. Other symptoms may include appetite disturbances, weight loss, stool changes, fatigue, skin itching, and an increase in eosinophils in the blood.
5. Tumors of the nasal cavity, nasopharynx, and paranasal sinuses may present with intermittent bleeding, especially if they consist of vascular tissue. For example, juvenile angiofibroma.
6. Curvature of the nasal septum, hypertrophy of the turbinates lead to disruption of the normal passage of air, bone outgrowths (thorns, ridges) put pressure on the mucous membrane. Symptoms – violation of nasal breathing, headaches, bleeding from the nose.
7. Wrong technique for washing the nasal cavity and paranasal sinuses – the introduction of fluid under high pressure, strong blowing of the nose.

Common causes – any diseases that lead to increased fragility of blood vessels, their sharp expansion, disturbances in normal blood clotting. These diseases are:

1. Leukemia, coagulopathy, congenital or acquired decrease in the number of platelets, coagulation factors.
2. Diseases of the cardiovascular system – arterial hypertension.
3. Endocrine pathology – diabetes mellitus, tumors of the pituitary gland, adrenal glands, thyroid disease. Hyperglycemia leads to increased fragility of arterioles and capillaries.
4. Acute infectious process with fever, intoxication.
5. Autoimmune pathology – vasculitis (inflammation of the vessel wall).
6. Deficiency in the body of vitamins K and C, which are necessary for normal blood clotting.
7. Pulmonary tuberculosis.
8. Oncology, chronic intoxication.
9. Taking NSAIDs, anticoagulants, aspirin.

Diagnostics

Doctor visit:

1. Perform anterior and posterior rhinoscopy (examination of the nasal cavity with a nasal mirror), pharyngoscopy.
2. For a detailed examination of hard-to-reach areas, endoscopy of the nasal cavity is performed.
3. Take a blood test, urine test. In a biochemical analysis, the level of iron is determined. This allows you to judge the degree of anemia, the general condition of the body.
4. If a tumor in the nasal area is suspected, a piece of tissue is taken for histological examination.
5. According to indications, consultations of a therapist, an endocrinologist are prescribed.

At the time of bleeding, press down on the half of the nose where the blood is coming from. To do this, use a cotton swab dipped in a 3% hydrogen peroxide solution. You can apply cold to the bridge of the nose. If these measures do not help, the doctor will perform an anterior or posterior nasal packing. In severe cases, when these measures are ineffective, they resort to surgery – they tie up the large vessels that supply the nasal cavity with blood.

Effective methods for the treatment of recurrent bleeding are:

• cryotherapy on the bleeding area in the nasal cavity;
• laser coagulation of dilated thinned vessels.

Usually the source of bleeding is the area in front of and below the nasal septum, since the choroid plexus (Kisselbach’s area) is located close here. Small hemangiomas may also bleed.

If necessary, the doctor prescribes medications to reduce blood loss. These are drugs that:

• improve blood clotting;
• cause vasospasm of the nasal cavity;
• strengthen and make the walls of blood vessels more elastic;
• stabilize blood pressure.

In the period between bleedings, the actions of an otolaryngologist are directed:

1. To reduce atrophic processes, the mucous membrane is lubricated and irrigated with oil solutions. They soften the crusts, reduce the risk of re-bleeding.
2. Removal of a foreign body. While it is in the nose, any movement of it can provoke new bleeding. From pressure, the mucosa becomes thinner, it can tear. For removal, special nasal hooks are used. They are brought behind a foreign body and advanced to the exit from the nasal cavity. Do not try to pull out a foreign object on your own. Failed attempts often result in the interfering element being pushed even further. This makes it difficult for a doctor to subsequently remove it, and surgery may be required.
3. Treatment of chronic diseases of the nose. The nasal septum, if it is curved, must be aligned. For this, surgery is performed. Hypertrophied turbinates are reduced to normal sizes. Local preparations, cauterization achieve a decrease in the blood filling of the mucous membrane in the nasal cavity. Neoplasms are removed.

If anemia develops, correct iron levels with diet and medication. Achieving stabilization of blood pressure, in the presence of endocrine pathology, hormones are prescribed. If helminths are detected, a course of antihelminthic therapy is carried out.

Prevention

If a person has a tendency to nosebleeds, he should adhere to the following rules:

1. Walk a lot in the fresh air, avoid dry air (use indoor humidifiers if the heating or air conditioning is turned on).
2. Treat the pathology of ENT organs.
3. Quit smoking and alcohol abuse.
4. Wear a respirator when working with dust, harmful substances or small particles in the air.
5. An active lifestyle promotes normal blood circulation in all parts of the body.
6. Control the level of sugar, pressure, temperature. This helps keep blood vessels healthy. At temperatures above 38 ° C, with increased pressure and prolonged hyperglycemia, the risk of rupture of blood vessels inside the nose is higher.
7. Diversely eat, get vitamins C, K with vegetables, fruits, dietary supplements, multivitamin complexes.
8. Children should be taught not to put any objects up their noses, to pick with their fingers, to rip off crusts.
9. If nasal dryness is felt, irrigate with saline-based products.
10. For children, carefully trim nails to avoid sharp corners. Supervise babies when they play with small objects. The same points should be paid attention to if an adult has mental disorders.