Nosebleeds are common. They may be scary, but they rarely indicate a serious medical problem. The nose contains many blood vessels. These blood vessels are located in the front and back of the nose, close to the surface. They are very fragile and bleed easily. Nosebleeds are common in adults and children between the ages of 3 and 10.
There are two kinds of nosebleeds. An anterior nosebleed occurs when the blood vessels in the front of the nose break and bleed. A posterior nosebleed occurs in the back or the deepest part of the nose. In that case, blood flows down the back of the throat. Posterior nosebleeds can be dangerous.
Nosebleeds (epistaxis, nose bleed) can be dramatic and frightening. Fortunately, most nosebleeds are not serious and usually can be managed at home, although sometimes medical intervention may be necessary. Nosebleeds are categorized based on where they originate, and are described as either anterior (originating from the front of the nose) or posterior (originating from the back of the nose).
Anterior nosebleeds make up most nosebleeds. The bleeding usually originates from a blood vessel on the nasal septum, where a network of vessels converge (Kiesselbach plexus). Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a health care practitioner.
Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually originates from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist (an ear, nose, and throat specialist).
Nosebleeds tend to occur more often during winter months and in dry, cold climates. They can occur at any age, but are most common in children aged 2 to 10 years and adults aged 50 to 80 years. For unknown reasons, nosebleeds most commonly occur in the morning hours.
Causes of Nosebleeds
There are many causes of nosebleeds. A sudden or infrequent nosebleed is rarely serious, but if you have frequent nosebleeds, you could have a more serious problem.
Dry air is the most common cause of nosebleeds. Living in a dry climate and using a central heating system can dry out the nasal membranes, which are tissues inside the nose. This dryness causes crusting inside the nose. Crusting may itch or become irritated, and if scratched or picked, the nose can bleed.
Taking antihistamines and decongestants for allergies, colds, or sinus problems can also dry out the nasal membranes and cause nosebleeds. Frequent nose blowing is another cause of nosebleeds.
Other common causes of nosebleeds include:
object stuck in the nose
chemical irritants
allergic reaction
injury to the nose
repeated sneezing
nose picking
cold air
upper respiratory infection
large doses of aspirin
Other causes of nosebleeds include high blood pressure, a bleeding disorder, blood clotting disorder, and cancer.
Most nosebleeds do not require medical attention. However, you should seek medical attention if your nosebleed lasts longer than 20 minutes or occurs after an injury. This may be a sign of a posterior nosebleed.
Injuries that might cause a nosebleed include a fall, a car accident, or a punch in the face. Nosebleeds that occur after an injury may indicate a broken nose, skull fracture, or internal bleeding.
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.
Diagnosing a Nosebleed
If you seek medical attention for a nosebleed, your doctor will conduct a physical examination to determine a cause. He or she will check your nose for signs of a foreign object. Your doctor will also ask questions about your medical history and current medications.
Alert your doctor to other symptoms you may have, as well as any recent injuries. There is no single test to determine the cause of a nosebleed. However, your doctor might use diagnostic tests to find the cause of nosebleeds. These tests include:
a complete blood count: a blood test to check for blood disorders
nasal endoscopy: examination of the nose
partial thromboplastin time: a blood test that checks how long it takes your blood to clot
CT scan of the nose: imaging test that takes cross-sectional pictures of the nose
X-ray of the face and nose: imaging test that uses radiation to produce pictures of the nose
How to Treat a Nosebleed
You can self-treat a nosebleed at home. While sitting up, squeeze the soft part of your nose. Make sure that your nostrils are fully closed. Keep your nostrils closed for 10 minutes, lean forward, and breathe through your mouth.
Do not lie down when trying to stop a nosebleed. Lying down can result in swallowing blood and can irritate your stomach. Release your nostrils after 10 minutes and check to see if the bleeding has stopped. Repeat these steps if bleeding continues.
You can also apply a cold compress over the bridge of your nose or use a nasal spray decongestant to close off the small blood vessels.
See a doctor if you’re unable to stop a nosebleed on your own. If a foreign object caused your nosebleed, your doctor can remove the object. A medical technique called cauterization can also stop persistent or frequent nosebleeds. This involves your doctor burning the blood vessels in your nose with silver nitrate (a compound used to remove tissue) or a heating device. Your doctor may also pack your nose with cotton or gauze to apply pressure to your blood vessels and stop bleeding.
How to Prevent Nosebleeds
Several tips can help prevent future nosebleeds, including:
using a humidifier in your house to keep the air moist
avoiding picking your nose
limiting your intake of aspirin, which can thin your blood and contribute to nosebleeds
use antihistamines and decongestants in moderation
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