Nosebleeds
Nosebleeds (called epistaxis) are caused when tiny blood vessels in the nose break. Nosebleeds are very common and affect many people at some point in their lives. In the US, about 60% of people will experience a nosebleed in their lifetime. They can happen at any age but are most common in children around the ages of 2 to 10, and adults around the ages of 50 to 80.
What are nosebleeds?
Most nosebleeds occur in the front part of the nose and start on the nasal septum, the wall that separates the 2 sides of the nose. The septum contains blood vessels that can be easily damaged. Irritation from blowing the nose or scraping with the edge of a sharp fingernail is enough to tear the vessels and cause a nosebleed. Anterior nosebleeds are also common in dry climates, or during winter months when dry, heated indoor air dehydrates the nasal membranes and makes the blood vessels more likely to rupture.
Causes of nosebleeds may include:
- Allergies, infections or dryness
- Vigorous nose blowing
- Problems with bleeding caused by genetic or inherited clotting disorders
- Medications that prevent blood clotting
- Fractures of the nose or the base of the skull
- Hereditary hemorrhagic telangiectasia, a disorder involving birthmark-like blood vessel growths inside the nose
- Tumors, both malignant (cancerous) and nonmalignant (benign)
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Types of nosebleeds
There are 2 types of nosebleeds. Anterior nosebleeds occur when the bleeding is coming from the front of the nose. Posterior nosebleeds occur when the bleeding originates from farther back in the nose, often where the source of bleeding cannot be seen without examination.
Nosebleeds diagnosis and treatment
It is important to try to determine if the nosebleed is anterior or posterior. Posterior nosebleeds are often more severe and almost always require a physician’s care.
When dry air is believed to be the cause of the nosebleed, it may result in crusting, cracking and bleeding. This can be prevented by placing a light coating of saline gel, petroleum jelly or an antibiotic ointment on the end of a Q-tip and gently applying it inside the nose, especially on the middle portion of the nose (the septum).
Follow these steps to stop an anterior nosebleed:
- Stay calm. A person who is agitated may bleed more profusely.
- Sit up and keep the head higher than the level of the heart.
- Lean forward slightly so the blood doesn’t drain into the back of the throat.
- Gently blow any clotted blood out of the nose. Spray the nose with a nasal decongestant.
- Using the thumb and index finger, pinch all the soft parts of the nose.
- Hold the position for 5 minutes. If it is still bleeding, hold it again for an additional 10 minutes.
If the bleeding continues, seek medical care. Treatment administered by a medical professional at this point may include cautery (a technique in which the blood vessel is burned with an electric current, silver nitrate or a laser to stop the blood flow) or nasal packing.
More rarely, a nosebleed can begin high and deep within the nose and flow down the back of the mouth and throat, whether the patient is sitting or standing. Posterior nosebleeds differ from anterior nosebleeds because direct pressure on the outside of the nose will not stop the bleeding, and spraying the nose with a decongestant is less likely to work. It is important to seek prompt medical care if the bleeding does not stop to prevent heavy blood loss.
Posterior nosebleeds are more likely to occur in older people and people with previous nasal or sinus surgery or injury to the nose or face. Generally, treatment includes cautery and/or packing the nose. The nose may be packed with a special gauze, sponge or an inflatable balloon to put pressure on the blood vessel.
If frequent nosebleeds are a problem, it is important to consult an ENT (ear, nose, and throat) specialist, or otolaryngologist, who will carefully examine the nose before making a treatment recommendation.
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