Many blood vessels are present on the surface of the nose, which are fragile and can bleed easily. The bleeding can be stopped with little pressure and some patience. While not serious, the nosebleeds can be uncomfortable and alarming. The article aims to explore the causes, prevention, and treatment of nosebleeds.
What is a nosebleed?
Nosebleeds, medically known as epistaxis, occur when blood vessels within your nose lining burst. Nosebleeds are of two main types:
- Anterior nosebleeds: The bleeding occurs in the front portion of the nose. This is the most common type of nosebleed, as this area is vulnerable to bleeding due to the thinness of the blood vessels in this location.
- Posterior nosebleeds: The bleeding originates from the higher up in the nose and causes heavier bleeding. Posterior nosebleeds are prevalent in adults, particularly in those with high blood pressure or facial injuries, and are considered more dangerous.
Who gets nosebleeds?
You may get nosebleeds at any age. Moreover, nosebleeds are quite common, as most people have had nosebleeds at least once in their lives. Nosebleeds often occur in:
- Children between 2 to 10 years
- Adults between 45 to 80 years
- Pregnant women
- People taking blood coagulation medication
- People with blood clotting disorder
What causes nosebleeds?
The most common causes for nosebleeds are dry climate, heated indoor air during winters, steroid nasal spray, nose picking, or injury to the nose. Intense nosebleeds occur in people taking anticoagulants. Other causes are sinusitis, allergies, aspirin use, bleeding disorders, chemical irritants, cocaine use, common cold, deviated septum, an object in the nose, nasal sprays, non-allergic rhinitis, and trauma to the nose. Less commonly, nosebleeds are seen with alcohol use, hereditary hemorrhagic telangiectasia, leukaemia, immune thrombocytopenia, nasal and paranasal tumours, nasal polyps, and nasal surgery
What happens before a nosebleed?
Nosebleeds can be spontaneous, which can be initiated by trauma, the use of certain medications, secondary to other comorbidities, or malignancies. The nose contains many small blood vessels that bleed easily. An increase in the patient’s blood pressure can increase the length of the bleeding episode.
During winter, nosebleeds occur more often because indoor air becomes drier, and cold viruses are more common. As this dry air moves through the nose, it irritates and dries out the membranes lining the inside of the nose. Crusts can form and bleed when irritated. Anticoagulant medication, or bleeding disorders, also induces spontaneous bleeding and increases bleeding time.
Anterior nosebleeds are common and are caused by Kiesselbach’s plexus. The causative blood vessels can be diagnosed through careful nasal examination. Posterior nosebleeds are presumed to be due to Woodruff’s plexus. The bleeding is often difficult to control and occurs in both nostrils or into the nasopharynx, where it is swallowed or coughed up and presents as hemoptysis. A greater flow of blood into the posterior pharynx can be generated, enhancing the risk of airway compromise or aspiration.
What are nosebleed symptoms?
The signs and symptoms of a nosebleed are:
- Bleeding from either or both nostrils
- Feeling the sensation of some liquid flowing at the back of the throat
- Urgency to swallow frequently
How can I stop my nosebleed?
- Try to remain calm, as crying, laughing, and talking can cause more bleeding
- Sit up and lean your head forward slightly
- Pinch the nostrils tightly at the soft part of the nose below the nasal bone
- Breathe through your mouth
- Hold the nostril closed for 5 minutes. Repeat the procedure until the bleeding stops
How can I prevent nosebleeds?
You can avoid having a dry, bloody nose by following these measures:
- Fingernails must be cut short to prevent scratching within the nose
- Avoid putting fingers or objects in your nose
- Blow your nose gently
- Use a humidifier or cool vaporiser during winter
- During summer, coat your nose with petroleum jelly to prevent drying
- Quit smoking, as it can dry your nose lining
How many days will my nosebleed last?
While most nosebleeds resolve on their own, persistent or severe bleeding requires medical attention. The nosebleeds can last for a few seconds to 15 minutes or more. If bleeding persists for more than 20 minutes or occurs after an injury, it indicates a posterior nosebleed, necessitating a consultation with your doctor.
How can my nosebleed be treated?
When the bleeding does not stop, you must seek medical attention. The doctor may use ribbon gauze or a sponge to stop bleeding. You may be required to stay in the hospital for a day or two, depending on your condition. A nasal pack may be inserted into both nostrils when conservative methods fail to stop nosebleeds.
After the nosebleeds stop, the doctor may prescribe you an antiseptic cream to be used inside your nose. This stops scab formation or crusting. Additionally, you must stop taking any blood-thinning medication during your nosebleeds. If you already take these medications, immediately notify your doctor.
Why won't my nosebleed stop?
- Posterior nosebleeds in older age groups are harder to control
- Blood thinners can worsen your nosebleeds, prompting medical attention
- Bleeding disorders like haemophilia and Von Willebrand disease can induce heavy nosebleeds
Can allergies cause nosebleeds?
Certainly, allergies cause nosebleeds as they make the inner nose lining dry, irritated, and inflamed. As a result, the tiny blood vessels within the nose rupture and cause nosebleeds. Frequent blowing of the nose also irritates the mucosa and causes nosebleeds. Additionally, the antihistamines and nasal decongestants used for alleviating allergy symptoms can cause nosebleeds by drying the mucosa.
Can dehydration cause nosebleeds?
Dehydration can dry the mucosa within the nose, which increases the risk of nosebleeds. A sneeze, scratch, or nose blow can rupture the blood vessels within the nose and initiate nosebleeds.
References
Tabassom A, Dahlstrom JJ. Epistaxis. [Updated 2022 Sep 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435997/
Krulewitz, N. A., & Fix, M. L. (2019). Epistaxis. Emergency Medicine Clinics of North America, 37(1), 29–39. https://doi.org/10.1016/j.emc.2018.09.005
Gottlieb, M., & Long, B. (2023). Managing Epistaxis. Annals of Emergency Medicine, 81(2), 234–240. https://doi.org/10.1016/j.annemergmed.2022.07.002
Patient education: Nosebleeds (epistaxis) (Beyond the Basics) – UpToDate
