What Is a Nosebleed? What Causes Nosebleeds?

The medical term for nosebleed is epistaxis. We can also say nasal hemorrhage. The human nose, and those of many animals are rich in blood vessels. Because of the position of the nose - right in the middle of the face - and all its blood vessels, most of us will have had at least one nosebleed at some time during our lives.

According to Medilexicon's medical dictionary, epistaxis means "Bleeding from the nose". Nosebleeds are seldom a cause for alarm but can be life threatening in rare cases.

Spontaneous nosebleeds are fairly common, especially in children. When the mucous membrane (a mucus-secreting tissue) inside the nose dries, crusts, or cracks (the skin splits open) and is then picked, it is likely to bleed.

Because the nose is full of blood vessels and is inconveniently situated in the middle of the face, any minor injury to the face can cause the nose to bleed profusely.

Nosebleeds are also common in people taking anti-coagulants (blood-thinning medications, such as Aspirin), as well as in older people whose blood may take longer to clot. If the patient is taking anti-coagulants, has hypertension (high blood pressure), or a blood-clotting disorder, the bleeding may be harder to stop and could last over 20 minutes.

The English word "epistaxis" is derived from the ancient Greek word epistazo. The prefix epi means "above, upon or besides" and stazo means "to drip from the nostril"; hence, the Greek word epistazo, which means "to bleed from the nose".

There are two types of nosebleeds:

• Anterior nosebleed
  
  The bleeding originates from the lower nasal septum (nasal partition - the wall between the two nostrils). This part of the nose contains many delicate blood vessels that receive blood from the carotid arteries, two principal arteries in the front of the neck that supply blood to the head and neck. The slightest knock or bump can cause these vessels to bleed. Anterior nosebleeds are easily treated at home. This is likely to be the type of nosebleed seen in a child.


• Posterior nosebleed
  
  The bleeding originates further back and higher up the nose where artery branches supply blood to the nose, which is why it is heavier. Posterior nosebleeds are often more serious than anterior nosebleeds and may require medical attention. They are more common in adults.

What causes nosebleeds?

Causes of anterior nosebleeds
Sometimes, the cause of anterior nosebleeds is idiopathic (unknown). However, common causes include:


• Blowing your nose hard - also blowing your nose too frequently.


• Picking the inside of your 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 or flu - this could be for various reasons. Partly because people with colds and flu blow their nose more often - nose blowing raises the risk of nosebleeds. The inside of the nose may be irritated and tender during a vital infection, making it more susceptible to bleeding.


• Deviated septum - when the wall separating the two nostrils is off center, or deviated.


• Climate - 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 could cause the nose to bleed.


• Nasal allergies.


• Excessive use of certain kinds of medications, such as anticoagulants (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.

Causes of posterior nosebleeds:


• Hypertension (high blood pressure)
• Nasal surgery (surgery of the nose)
• Calcium deficiency
• Exposure to chemicals that may irritate the mucous membrane

Posterior nosebleeds are sometimes symptoms of other conditions, such as blood diseases (e.g. leukemia or hemophilia) or tumors.

What are the risk factors for a nosebleed?

A risk factor is something that increases the chances of developing a disease or condition. For example, smoking increases the risk of developing lung cancer. Therefore smoking is a risk factor for lung cancer.

Common risk factors for nosebleeds are:

• Infection
• Self-induced minor injuries such as picking the nose
• Hypertension (high blood pressure)
• Alcohol abuse
• Inherited bleeding disorders
• Certain contact sports, such as martial arts, boxing, and rugby

What are the signs and symptoms of a nosebleed?

The main symptom of a nosebleed is blood coming out of 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 you are lying down, you may feel liquid in the back of your throat before the blood actually comes out of your nose. Do not swallow the blood as it could cause you to become nauseous and vomit.

Severe nosebleeds require immediate medical attention. Things to watch for include heavy bleeding, palpitations (an irregular heartbeat), swallowing large amounts of blood that cause you to vomit, shortness of breath, or turning pale.

What are the treatment options for a nosebleed?

The first step to stopping any nosebleed is always the same: stop the bleeding. This can be done by complying with the following steps:

• Sit down and pinch the soft parts of your nose firmly, breathing through your mouth.


• Lean forward, not backward, in order to prevent the blood from draining into your sinuses and throat, which can result in inhaling the blood or gagging.


• Sit upright so that your head is higher than your heart to reduce blood pressure and consequently stop further bleeding.


• Continue putting pressure on the nose, leaning forward, and sitting upright for a minimum of five 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 your nose and cheek to soothe the area and try not to strain yourself for the next few days.

It is recommended that you seek medical attention if you 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 your physician 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 your blood pressure and pulse rate or an X-ray, before recommending a suitable treatment option.

A broken nose can permanently change the shape of your nose. If this is the case, a physician can attempt to set the nose back in place manually, but sometimes surgery is required.

There is an array of treatment options physicians have to offer. Some of them 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; used if the specific blood vessel can be identified. However, the area around the cautery sometimes begins to bleed. Be sure to go over the risks and benefits with your physician.


• 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. Your physician will be able to explain the procedure and its risks and benefits in detail.


• 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. Be sure to go over details with your physician.

How can a nosebleed be prevented?

• Avoid picking your nose.


• Apply lubricating ointment, such as petroleum jelly (Vaseline), inside your nose; especially in children whose nosebleeds are most commonly attributed to crusting inside the nostrils.


• Avoid blowing your nose too hard, or too frequently.


• Use a humidifier at high altitudes or in dry climates.


• If you are prescribed anticoagulants (blood-thinning medications) discuss your concerns with your physician.


• To prevent recurring nosebleeds, avoid exerting or straining yourself for a minimum of one week after the previous one.