The medical term for a nosebleed is epistaxis. Because of the position of the nose – right in the middle of the face – and its high density of blood vessels, most of us will have had at least one nosebleed at some time during our lives.
Although seldom a cause for alarm, nosebleeds can be life-threatening in rare cases.
Nosebleeds are most often caused by local trauma but can also be caused by foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air.
Tumors and vascular malformations are also potential causes of nosebleeds, but they are rare.
Spontaneous nosebleeds are fairly common, especially in children. When the mucous membrane (a mucus-secreting tissue inside the nose) dries, crusts, or cracks and is then disturbed by nose-picking, it is likely to bleed.
Because the nose is full of blood vessels, any minor injury to the face can cause the nose to bleed profusely.
Nosebleeds are also common in people taking anticoagulants (blood-thinning medications, such as Aspirin), as well as in older people whose blood may take longer to clot. If the person taking anticoagulants, has hypertension (high blood pressure), or a blood-clotting disorder, the bleeding may be harder to stop and could last over 20 minutes.
Nosebleeds can be classed as anterior or posterior.
In anterior nosebleeds, the bleeding comes from the wall between the two nostrils. This part of the nose contains many delicate blood vessels. Anterior nosebleeds are easily treated at home; this is likely to be the type of nosebleed seen in a child.
In posterior nosebleeds, the bleeding originates further back and higher up the nose in an area where artery branches supply blood to the nose; this is why the bleeding is heavier. Posterior nosebleeds are often more serious than anterior nosebleeds and may require medical attention. They are more common in adults.
Causes of anterior nosebleeds
Sometimes, the cause of anterior nosebleeds is unknown. However, common causes include:
- Picking the inside of the nose, especially if this is done often, if the fingernails are long, and if the inside of the nose is already irritated or tender.
- A knock or blow to the nose could damage the delicate blood vessels of the mucous membrane.
- Sinusitis – an inflammation of the sinuses (air-filled cavities of the bone and skull surrounding the nose).
- A cold, flu or a nasal allergy can cause a nosebleed for various reasons: People with these conditions blow their nose more often. Also, the inside of the nose may be irritated and tender during a viral infection, making it more susceptible to bleeding.
- Deviated septum – when the wall separating the two nostrils is off center, or deviated.
- Hot climates with low humidity or changes from bitter cold to warm, dry climates can cause drying and cracking inside the nose, which can lead to a nosebleed.
- High altitude – as altitude increases, the availability of oxygen decreases, making the air thinner and drier. The dryness can cause the nose to bleed.
- Excessive use of certain kinds of medications, such as blood thinners or non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen.
- Liver disease can interfere with blood clotting and result in frequent and/or severe nosebleeds.
- Excessive use of illegal drugs, such as cocaine.
Posterior nosebleed causes
- high blood pressure
- nasal surgery
- calcium deficiency
- exposure to chemicals that may irritate the mucous membrane
- blood diseases, such as hemophilia or leukemia
- some tumors
Other causes of nosebleed
Broken nose – a crack or break in the bone or cartilage of the nose.
Foreign body in the nose – this happens more commonly in children e.g. Lego.
Low platelet count (thrombocytopenia) – individuals are more prone to bleeding.
Osler-Weber-Rendu disease – a rare condition, affecting 1 in 5,000 people; it is a genetic disorder of the blood vessels that leads to excessive bleeding.
Factor X deficiency (Stuart-Prower factor deficiency) – a condition caused by a protein deficiency.
Aortic coarctation – a congenital narrowing of the aorta.
Glomerulonephritis (nephritis) – acute kidney inflammation, commonly caused by an immune reaction.
Ebola – one of Ebola’s late-stage symptoms is a bleeding rash all over the body.
Von Willebrand disease – a bleeding disorder due to a deficiency of von Willebrand factor.
Idiopathic thrombocytopenic purpura – a condition in which the blood does not clot correctly. Individuals experience excessive bleeding and bruising.
Deficiency of factor II, V, or VII – these rare conditions affect blood clotting and increase the chances of nosebleed.
Rheumatic fever – a complication of Strep throat.
Liver cirrhosis – following long-term exposure to toxins.
Celiac disease – an allergy to gluten.
Leishmaniasis – a parasitic disease transmitted by the sand fly.
The main symptom of a nosebleed is blood coming from the nose, which can range from light to heavy. The blood comes out of either nostril (usually, only one nostril is affected).
If the nosebleed occurs while lying down, it is common to feel liquid in the back of the throat before the blood comes from the nose. It is best not to swallow the blood as it could cause feelings of nausea and vomiting. Severe nosebleeds require immediate medical attention. Things to watch for include:
- heavy bleeding
- palpitations (an irregular heartbeat)
- swallowing large amounts of blood that causes vomiting
- shortness of breath
- turning pale
The first step is to stop the bleeding:
- Sit down and pinch the soft parts of the nose firmly, breathe through the mouth.
- Lean forward (not backward) to prevent blood from draining into the sinuses and throat, which can result in inhaling the blood or gagging.
- Sit upright so that the head is higher than the heart; this reduces blood pressure and slows further bleeding.
- Continue putting pressure on the nose, leaning forward, and sitting upright for a minimum of 5 minutes and up to 20 minutes, so that the blood clots. If bleeding persists for more than 20 minutes, medical attention is required.
- Apply an ice pack to the nose and cheek to soothe the area and avoid strenuous activity for the next few days.
Individuals are recommended to seek medical attention if they suffer from frequent nosebleeds (it could be an indication of an underlying problem), had an injury to the head, or take anticoagulants (blood thinning medications) and the bleeding does not stop.
If a doctor suspects there is an underlying cause, such as hypertension (high blood pressure), anemia, or a nasal fracture, they may run further tests, such as checking blood pressure and pulse rate; they might also order an X-ray before recommending a suitable treatment option.
There is an array of treatment options physicians have to offer; these include:
Nasal packing – stuffing ribbon gauze or special nasal sponges as far back into your nose as possible, putting pressure on the source of the bleed.
Cautery – a minor procedure that cauterizes (burns) the area where the bleeding is coming from to seal it off; this is used if the specific blood vessel can be identified. However, the area around the cautery sometimes begins to bleed.
Septal surgery – a surgical procedure to straighten a crooked septum (the wall between the two nose channels), whether it was like that from birth or from an injury. This can reduce the occurrence of nosebleeds.
Ligation – a “last resort” surgical procedure that involves tying the ends of the identified blood vessels causing the bleeding. Sometimes even the artery from which the blood vessels stem is tied off. If the source of the bleed is further back, more major surgery may be required.
- Avoid picking the nose.
- Apply lubricating ointment, such as petroleum jelly (Vaseline), inside the nose; especially in children whose nosebleeds are most commonly attributed to crusting inside the nostrils.
- Avoid blowing the nose too hard, or too frequently.
- Use a humidifier at high altitudes or in dry climates.
- To prevent recurring nosebleeds, avoid exertion or strenuous activity for a minimum of 1 week after the previous nosebleed.