Nose Bleeds

What causes Nosebleeds (Epistaxis)?

A nosebleed is a fairly common condition though it can be scary when it happens. The nose has plenty of blood vessels within it. Many of these are close to the surface, and sometimes when the blood vessel breaks, it can result in a lot of bleeding. Most nosebleeds are thankfully not due to nose tumor or cancer.

There can be many different reasons for what causes nosebleeds, but the factor responsible most nosebleed causes is identified as dry air. Breathing of dry air leads to the drying out of your nasal membranes. This in turn leads to the formation of crusting, which can lead to itching or discomfort. Often, it is this discomfort that leads people to scratch or pick at it, during which, might unintentionally damage the blood vessels in the area and makes it a frequent cause of nosebleeds. Air humidifiers can help to reduce nosebleeds if you live in an area where air is dry, or use air conditioning in your living environment.

Among the most common causes of nosebleeds include excessively hard/frequent nose blowing or sneezing may damage the fragile blood vessels in the nose as well. If you find yourself getting frequent nosebleeds after sneezing, it is suggested for you to keep 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 make the tiny and fragile blood vessels additionally so, and may cause bleeding with little or no contact. Other conditions such as blood clotting or bleeding disorders may also play a factor in the frequency or ease of nosebleeds happening in a person.

Other common causes of nosebleeds include medication for allergies, sinus problems or flu/cold like drugs containing antihistamines or decongestants can also cause dry nasal membranes and 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 a nosebleed happening.

Do know that most nosebleeds do not require you to seek medical advice or attention. You should seek medical attention when your nosebleed:

  1. Lasts longer than 20 minutes
  2. Happens as a result of trauma or injury, such as falling, getting hit in the face/nose, car accident.

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

When nose bleeding happens, it is important to apply first aid immediately. Below is a section on how to stop nose bleed:

You should 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 nosebleed. Lying down may cause you to unintentionally swallow the blood, which may bring irritation to your stomach. 

During this time you should tilt your head forward and you can apply ice pack to your forehead/nose bridge or suck on some ice. Most nose bleeding 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 seek medical advice from a doctor if you are unable to stop the nosebleed yourself.

Nosebleeds in kids are common. Most are frequently due to nose rubbing or digging. This can be unnoticed by the parents as it can occur when the child is sleeping and is unaware of the injury to the nose. Allergic rhinitis is frequently associated with nose bleeding in kids and this must be managed well to treat the nosebleed.

During pregnancy, the blood flow to the nose actually increases. The lining within the nose also becomes thinner and allergic rhinitis can worsen, leading to an increased risk of nosebleeds.

You should consult a doctor or ENT specialist. You will need a thorough nasoendoscopy to assess your nose and sinuses and exclude conditions like tumors. A nasoendoscopy is a relatively painless procedure performed under local anesthesia and takes a few minutes in the ENT doctor’s clinic. You can return back to work and normal activities after a nasoendoscopy.

The doctor or ENT specialist will see where the cause of the nosebleeds are. 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 (apply a chemical paste on the area) can help reduce bleeding. It is also important to treat concomitant allergic rhinitis if there is any to reduce any nasal rubbing or trauma to the nose. The commonest cause of nose bleeding is actually nasal rubbing or trauma.

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