Can Nasal Bleeding Occur as a Result of Underlying Medical Conditions?

FREQUENTLY ASKED QUESTIONS ABOUT NASAL BLEEDING

1) WHAT IS NOSE BLEED ?

A nosebleed also known as epistaxis occurs when blood flows from one or both nostrils. It is caused by rupture of the tiny blood vessels which are located close to the surface in the front and back of the nose. These are very fragile and they bleed easily.

Most often nosebleeds are only annoying and not a disease per se.

There are two types of nosebleeds based on the site of the bleed.

Anterior nosebleeds occurs from the front of the nose from the fragile
and delicate small vessles just inside the opening of the nose.This is the
most common type and is usually not serious. These nosebleeds are more
common in children and are usually able to be treated at home.

Posterior nosebleeds are very rare and occurs from the back of the nose.
This can be a more serious nosebleed than an anterior nosebleed. These
nosebleeds, cannot be treated by pinching the nose. It can result in heavy
bleeding, which may flow down the back of the throat. You may need
medical attention right away for this type of nosebleed. This type of
nosebleed is more common in adults.

2) WHO CAN HAVE NOSEBLEEDS?

Anyone can get a nosebleed. However, there are people who are more
likely to have a nosebleed like:

Children between ages 2 and 10.

Colds, allergies and sticking fingers and objects into their nose make children more prone to nosebleeds.

Adults between ages 45 and 65.

Blood may take longer to clot in mid-life and older adults. They are also more likely to be taking blood thinning drugs, have  high blood pressure ,  atherosclerosis

Pregnant women.

Blood vessels in the nose expand while pregnant, which puts more pressure on the delicate blood vessels in the lining of the nose.

Those with bleeding disorders

3) WHAT ARE THE CAUSES OF NASAL BLEEDING?

Nosebleeds have many causes. Most of the causes are not serious. The causes can be either local causes or general causes. Sometimes nasal bleeding can occur without any cause.

Some of the local causes of nosebleeds are:

1. Violent and forceful nose blowing damaging the delicate blood vessels
of the nose.

2. Picking the inside of your nose especially if it is done often, the inside
of the nose gets irritated and can bleed. This is common in children.

3. Colds  (upper respiratory infections) and  sinusitis , especially episodes
that cause repeated sneezing, coughing and nose blowing

4. Climate: Hot climates, dry air can cause drying & crack inside the nose
leading to nosebleed

5. Trauma to the nose and/or face

6. Anatomical variations like deviated nasal septum  (an abnormal shape
of the wall that separates the two sides of the nose).

7. Atmospheric changes like high altitudes

8. Frequent use of nasal sprays and medications to treat itchy, runny or
stuffy nose which can in turn dry out the nasal membranes.

9. Tumours of nose and nasopharynx

Some of the general causes are:

  1. Systemic Hypertension, Atherosclerosis
  2. Blood and Bleeding disorders such as Hemophilia
  3. Liver disease can cause clotting issues and hence can result in frequent or severe nosebleeds.
  4. Blood-thinning drugs (aspirin,  non-steroidal anti-inflammatory drugs , warfarin, and others).
  5. Pregnancy

4) WHAT IS THE FIRST AID FOR NASAL BLEEDING?

Following steps is to be performed when there is nose bleeding:

1. Relax and calm down

2. Make the person to sit up straight and lean forward slightly. They should not lie down or tilt backwards as it could result in blood going down the throat and causing choking
3.  With index and thumb finger, firmly pinch the soft part of the nose for 5 to 10 minutes.
4. Ask them to breathe through their mouth
5.  Place a cold cloth or icepack on the bridge of the nose to further constrict the nostrils.
6. Keep pinching your nose continuously for at least 5 minutes before checking if the bleeding has stopped. If your nose is still bleeding, continue squeezing the nose for another 10 minutes.
7. If the bleeding is severe & doesn’t stop even after 20 minutes or if there is heavy bleeding then immediately rush to medical aid.

5) WHAT IS THE TREATMENT OPTIONS AVAILABLE FOR NASAL BLEEDING?

A minor nosebleed that has stopped may doesn’t require treatment at all.

Treatments depend on the cause and also on the site of the nosebleed.
Some of the treatment options available are:

Nasal packing. Gauze, special nasal sponges or foam or an
inflatable latex balloon is inserted into your nose to create pressure
at the site of the bleed. The material is often left in place for 24 to
48 hours before being removed.

Cauterization. This procedure involves applying a chemical
substance (silver nitrate) or heat energy (electrocautery) to seal the
bleeding blood vessel.

Medication adjustments/new prescriptions. Reducing or
stopping the amount of blood thinning medications can be helpful.
In addition, medications for controlling blood pressure may be
necessary.

Surgical repair of a broken nose or deviated septum if this is
the cause of the nosebleed.

Ligation. In this procedure, the blood vessel responsible is tied off
to stop the bleeding.

6) WHEN TO WORRY ABOUT NASAL BLEEDING?

Although seeing blood coming out of your noise can be alarming, most
nosebleeds are not serious and can be managed at home. Some, however,
should be checked by your doctor.

Make an appointment to see your doctor if

  • You cannot stop the bleeding after more than 15 to 20 minutes of
    applying direct pressure on your nose as described in the steps
    above.
  • The bleeding is rapid or the blood loss is heavy.
  • You are having difficulty breathing.
  • You have vomited because you’ve swallowed a large amount of blood.
  • Your nosebleed is due to a blow to your head or due to any serious injury (fall, car accident, hit to your face or nose).
  • If you have frequent nosebleeds, see your doctor. This could be an early sign of other medical problems that needs to be investigated.

7) WHAT ARE THE MEASURES TO PREVENT NASAL BLEEDING?

1. Most nosebleeds occur during dry climate and cold winter. So use a humidifier in the home, especially in bedrooms. Use Petroleum jelly, antibiotic ointment, which may help to keep the nasal passages moist.

2. Avoid not to pick or blow the nose too harsh & vigorously.

3. If the nosebleed is related to an underlying medical condition like liver
disease or a chronic sinus condition, consult your doctor.

4. Avoid lifting or straining after a nosebleed.

5. If you have a history of high blood pressure, keep it under control because which is also a cause for the nosebleed.

6. Avoid putting anything solid into your nose, including fingers.Keep
your child’s fingernails short.

7. Quit smoking . Smoking dries out your nose and irritates it.

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