What are nose bleeds (Epistaxis)?

A nosebleed is a fairly common condition though it can appear scary. Bleeding usually happens when blood vessels in the nose —which are located close to the surface— breaks. Thankfully, most nosebleeds are not due to nose tumor or cancer.

What causes nose bleeds?

There can be many different reasons for what causes nosebleeds, with the most common factor being dry air. Breathing in dry air dries out your nasal membranes. This causes the formation of crusts in the nose, which can lead to itching or discomfort. Often, it is this discomfort that leads people to scratch or pick at it which might unintentionally damage the blood vessels in the area and makes it a frequent cause of nosebleeds.

Excessively blowing your nose or sneezing may damage the fragile blood vessels in the nose and cause nose bleeds as well. If you find yourself getting frequent nosebleeds after sneezing, try keeping your mouth open when you sneeze. This reduces the air pressure that passes through the nasal passages and lessens the chance of a nosebleed.

High blood pressure (or hypertension) may also cause bleeding even with little to no contact due to tiny and fragile blood vessels that come with the condition. Other conditions such as blood clotting or bleeding disorders may also contribute to the severity of nose bleeds.

Other common causes of nosebleeds include medication for allergies, sinus problems or flu/cold like drugs containing antihistamines or decongestants. These can cause dry nasal membranes which lead to nosebleeds. Aspirin taken in large doses, medication for management of high blood pressure or blood thinners may also contribute as a risk factor for nosebleeds happening.

When nose bleeds happen, it is important to apply first aid immediately. Below is a section on how to stop nose bleeds:

Pinch the lowest part of the nose at the softest part and apply firm pressure for 10 minutes. Do this while sitting up. Do not lie down when you are trying to stop a nose bleed as this may cause you to unintentionally swallow the blood, which may bring irritation to your stomach. 

Rather, tilt your head forward and apply an ice pack to your forehead/nose bridge or suck on some ice. Most nose bleeds will stop with these simple measures.

Release the pinch on your nose after 10 minutes and check if the nosebleed has been stopped. If it has not, you may repeat the above steps. 

You should go to a doctor if you are unable to stop the nosebleed yourself.

Most nose bleeds do not require you to seek medical advice or attention. However, you should seek medical attention when your nosebleed:

  • Lasts longer than 20 minutes
  • Happens as a result of trauma or injury, such as falling, getting hit in the face/nose, car accident.
  • Causes bruising in other parts of your body and bleeding in the gums

These may be signs that the nosebleed is a more serious type of nosebleeds, known as posterior nosebleeds, which can be dangerous.

During the consultation, the doctor or ENT specialist will do a thorough nasoendoscopy to assess your nose and sinuses. A nasoendoscopy is a relatively painless and fast procedure performed under local anaesthesia. Work and normal activities can be resumed after a nasoendoscopy.

Nose bleeds in kids are common. Most are frequently due to nose rubbing or picking. This can go unnoticed by parents as it can occur when the child is sleeping and is unaware of the injury to the nose. Nose bleeds in kids can also be a case of allergic rhinitis, which in this case must be monitored and managed well to treat the nose bleeds.

During pregnancy, blood flow to the nose actually increases. This is due to a thinning of the lining within the nose. Allergic rhinitis also heightens during pregnancy, which leads to an increase in nose bleeds.

The doctor or ENT specialist will first need to examine the cause of the nose bleeds. Frequently, the bleeding occurs from a ruptured vessel from the Little’s area on the nasal septum. If that’s the source, silver nitrate cautery can help reduce bleeding. Since allergic rhinitis causes nasal rubbing and trauma to the nose, it is important to treat it too.

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