Epistaxis, commonly known as nosebleeds, can occur in people of all ages. It has a higher prevalence in two age groups: children between 5 and 15 years old and elderly individuals taking blood thinners. The most commonly involved area in nosebleeds is called Littles area, which is the anterior part of the nose where blood vessels converge and can be fragile. Nosebleeds often occur in the morning or late evening.
Here are some risk factors for nosebleeds:
Children with nasal obstruction tend to pick their noses, leading to minor injuries in Littles area and subsequent bleeding.
High blood pressure can increase the frequency of nosebleeds, so regular monitoring is important.
Blood thinners and anticoagulants, commonly prescribed for heart or neurological conditions, affect blood coagulability and may contribute to nosebleeds. Consultation with a doctor is necessary before stopping these medications.
Clotting disorders can result in prolonged bleeding from minor cuts, tooth extraction, skin bruises, and nosebleeds.
Common causes of nosebleeds include:
Dry air, which can dry out nasal membranes and make them more susceptible to bleeding and infections.
Nose picking. Other causes of nosebleeds include:
Acute sinusitis (sinus infection).
Allergies.
Use of aspirin or blood thinners like warfarin and heparin.
Chemical irritants such as ammonia.
Chronic sinusitis.
Cocaine use.
Common cold.
Deviated septum.
Foreign body in the nose.
Nasal sprays used for allergies, especially with frequent use.
Nonallergic rhinitis (chronic congestion or sneezing unrelated to allergies).
Trauma to the nose. Less common causes of nosebleeds include:
Alcohol use.
Hereditary hemorrhagic telangiectasia.
Immune thrombocytopenia (ITP).
Leukemia.
Nasal and paranasal tumors.
Nasal polyps.
Nasal surgery.
Pregnancy.
For small nosebleeds, applying pressure on the fleshy part of the nose for 15 minutes can typically control the bleeding. If the bleeding stops after applying pressure, no further treatment is required. It’s important to avoid touching the nose repeatedly and avoid straining for a few days.
You should see an ENT specialist if you experience repeated or uncontrolled nosebleeds. Treatment options include:
For minor abrasions causing inactive bleeds, simple antiseptic cream may be sufficient.
Active bleeds can be managed by packing the nose or directly sealing the bleeding vessel.
The bleeding vessel can be sealed using silver nitrate or diathermy, which involves passing a weak electric current across the blood vessel with the help of an endoscope.
Nosebleeds caused by nasal masses may require surgical removal.
If other treatments fail, embolization, performed by an interventional radiology doctor, may be necessary.
Nosebleeds, known as epistaxis, occur when small blood vessels in the nose rupture. They are common and can happen to anyone at some point in their life. The symptoms of a nosebleed depend on whether it is anterior or posterior:
Anterior nosebleeds start with a flow of blood from one or both nostrils while sitting or standing.
Posterior nosebleeds can start deep within the nose and flow down the back of the mouth and throat, even when sitting or standing.
The most common cause of nosebleeds is the drying out of nasal membranes, often due to dry air or winter months with heated indoor environments. Other causes include nose picking, acute sinusitis, allergies, aspirin use, bleeding disorders, blood thinners, chemical irritants, chronic sinusitis, cocaine use, common cold, deviated septum, foreign body in the nose, nasal sprays, nonallergic rhinitis, trauma to the nose, and less commonly, alcohol use, hereditary hemorrhagic telangiectasia, immune thrombocytopenia, leukemia, nasal and paranasal tumors, nasal polyps, nasal surgery, and pregnancy.
Treatment for nosebleeds depends on whether they are anterior or posterior. For anterior nosebleeds, follow these steps:
Stay calm and help a young child stay calm.
Sit up and keep the head higher than the heart.
Lean forward slightly to prevent blood from draining into the throat.
Gently blow out any clotted blood and spray the nose with a nasal decongestant.
Pinch all the soft parts of the nose between the thumb and index finger for five minutes. If the bleeding persists, hold for an additional 10 minutes.
Posterior nosebleeds require medical attention, as direct pressure on the outside of the nose won’t stop the bleeding. Treatment may involve cautery (burning the blood vessel with an electric current, silver nitrate, or laser) or packing the nose with gauze, a sponge, or an inflatable balloon to apply pressure on the blood vessel.
If frequent nosebleeds are a concern, it’s important to consult an ENT specialist for a thorough examination. Prevention measures include keeping the nasal lining moist with saline gel, petroleum jelly, or antibiotic ointment, keeping children’s fingernails short, using a humidifier to counteract dry air, using saline nasal spray, quitting smoking, avoiding nose picking and blowing the nose, avoiding straining or heavy lifting, and keeping the head higher than the heart after initial bleeding has stopped. Contact your doctor if bleeding persists after 30 minutes or if a nosebleed occurs after a head injury.
In summary, nosebleeds can occur in individuals of all ages, with various causes and treatment options. Most nosebleeds are minor and can be managed with first aid measures. Severe or recurrent nosebleeds may require medical intervention, and an ENT specialist can provide appropriate treatment based on the underlying cause of the nosebleeds.