Nose bleeding

The signs and symptoms of nose bleeding include:

• Bleeding from either or both nostrils
• Sensation of flowing liquid at the back of the throat
• Excess blood loss from the nose may lead to dizziness, fainting, and confusion

The inside of the nose consists of tiny, delicate blood vessels that can become damaged and bleed relatively easily. Some of the common causes of nosebleeds include:

• Dry air, which can be caused by hot, low-humidity climates or heated indoor air. This environment causes the nasal membrane to dry out and become crusty or cracked, making it more likely to bleed when rubbed.
• Blowing the nose with force.
• Nose picking.
• A minor injury to the nose.
• Inserting objects into the nose.
• Cold or allergies.
• Blood-thinning drugs (such as aspirin and warfarin) reduce the blood's ability to clot, thereby prolonging bleeding.
• Repeated use of nasal sprays to treat allergies can dry out the nasal membrane.
• Inhaling chemical irritants, such as ammonia, can begin to burn away the lining of the nose if inhaled for an extended period.
• Snorting cocaine can cause nasal problems, including permanent physical damage or nosebleeds.
• A deviated septum can block one side of the nose and reduce airflow, leading to crusting or nosebleeding in certain individuals.

Some of the other less common causes of nosebleeds include:

• High Blood Pressure (Hypertension): Although there is no direct link between nosebleeds and high blood pressure, a hypertensive crisis, which consists of a sudden and severe increase in blood pressure, can cause increased pressure in the blood vessels and lead to nosebleeds.
• Nasal tumors: These tumors can cause blockage in the nose and lead to a decreased sense of smell and nosebleeds.
• Inflammatory conditions: Various types of inflammatory or granulomatous diseases within the nasal cavity can cause bleeding. Common examples include:
  • Bacterial sinusitis: A bacterial infection of the sinuses, the hollow spaces in the bones of the face around the nose.
  • Allergic rhinitis: Inflammation of the inside of the nose caused by allergens, such as pollen, dust, and mold.
  • Nasal polyposis: Noncancerous growths on the lining of the nasal passages or sinuses.
  • Wegener granulomatosis: Inflammation of the blood vessels of the nose.
  • Tuberculosis: An infectious disease that usually affects the lungs.
• Hereditary hemorrhagic telangiectasia (HHT): A genetic vascular disorder that leads to the development of small lesions called telangiectasia, which can burst and bleed.
• Pregnancy: Nosebleeds can be experienced during pregnancy due to hormonal changes.

Risk Factors for Nosebleeding

• Atmospheric Changes: Conditions such as high altitudes, dry climates, and cold weather can dry out the nasal membrane, leading to nosebleeds.
• Habits: Actions like inserting a finger into the nose or aggressive nose-picking can tear the nasal mucous membrane, resulting in epistaxis.
• History of Bleeding Disorders: Individuals with a history of blood clotting disorders may experience heavy bleeding from nasal injuries.
• Inflammatory Conditions: Conditions such as the common cold, sinusitis, allergies, and nasal polyps are associated with nosebleeds as a common symptom.
• Blood-Thinning Medications: Prolonged use of anticoagulants, such as aspirin and warfarin, can increase the likelihood of bleeding due to their blood-thinning properties.
• Stress: Stress and anxiety are recognized risk factors for nosebleeds. Research indicates that individuals with psychological issues may be at higher risk for chronic or unexpected nosebleeds. Anxiety can lead to nose-picking, which may trigger bleeding.
• Smoking and Excessive Alcohol Intake: Nicotine in cigarettes can irritate the nasal mucosa, causing nosebleeds. Excessive alcohol consumption can also contribute to epistaxis, as it inhibits blood clotting and dilates blood vessels.

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History

• Duration of the nosebleed
• Frequency of nose bleeding episodes
• Amount of blood lost during the incidents
• Drug history to identify the use of medications that may promote bleeding, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet drugs, heparin, and warfarin
• History of smoking or alcohol intake
• History of bleeding disorders (including family history) and conditions associated with defects in platelets or coagulation, particularly cancer, cirrhosis, HIV, and pregnancy

Physical Examination

Lab Tests

• Complete Blood Count (CBC): For individuals experiencing nose bleeding, a CBC is performed to assess the reduced hemoglobin level for bleeding management in patients with heavy and recurrent nosebleeds.
• Coagulation Studies: Patients exhibiting symptoms or signs of a bleeding disorder, as well as those with severe or recurrent epistaxis, are evaluated for prothrombin time (which measures the time it takes for a clot to form in a blood sample) and partial thromboplastin time (a blood test assessing how long it takes for blood to clot).

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Imaging Studies

The following pointers can help in preventing nose bleeding:

General Measures

• Avoid blowing your nose too forcefully.
• Use a saline nasal spray or drops 2-3 times a day in each nostril to keep your nasal passages moist.
• Avoid picking your nose and keep your fingernails short.
• At night, keep the air moist by using room humidifiers.
• Wear protective headgear if involved in activities that could result in an injury to the face and nose.
• Consider changing medications that increase bleeding. Blood-thinning medications such as aspirin and ibuprofen can increase bleeding. Consult your doctor for their replacement.
• Avoid drinking and smoking. Overconsumption of alcohol and smoking can irritate the nasal mucosa and cause nose bleeding. Quitting smoking and drinking is always advisable.
• Consume vitamin K-rich foods. Foods like spinach, mustard greens, kale, broccoli, and cabbage are involved in collagen formation, helping to create a moist lining inside the nose. Vitamin K helps maintain the integrity of blood vessels, preventing them from rupturing easily, and green leafy vegetables facilitate blood clotting.
• Load your diet with Vitamin C-rich foods. Daily intake of Vitamin C-containing foods or supplements may strengthen blood vessels, making them less vulnerable to rupture and causing nose bleeding.
• Stay hydrated. Not drinking an adequate amount of water can dry the mucous membranes, leading to nose bleeds. It is recommended to drink enough water throughout the day.

The doctor will attempt to stop the bleeding as the first course of action. The doctor may also assess the person’s blood pressure and pulse.

Treatment depends on the cause and could include:

• Medications:
  • Nasal sprays can be used at the time of bleeding. Oxymetazoline and phenylephrine hydrochloride (Neofrin) can be used short-term to help with congestion and minor bleeding if a person is not experiencing high blood pressure.
  • Oral or topical tranexamic acid is effective in stopping bleeding for a 10-day period after a single application.
• Nasal Packing:

  A doctor may insert ribbon gauze, nasal sponges, foam, or an inflatable latex balloon into the nose to create pressure at the site of the bleeding. The material is often kept in the nasal cavity for 24 to 48 hours.

• Cauterization:

  In this procedure, heat energy (electrocautery) and a chemical substance (silver nitrate) are used to seal the bleeding blood vessel.

• Embolization:

  This procedure involves using tiny particles such as gelatin sponges or beads to block a blood vessel, effectively stopping the bleeding from the nose. However, doctors rarely recommend this for nosebleeds.

• Septal Surgery:

  If a deviated septum is causing frequent nosebleeds, a doctor may straighten it during surgery.

• Ligation:

  This surgical procedure involves tying the ends of the identified blood vessels or arteries causing the bleeding. Doctors often use this procedure if other treatment options have not been effective.

If you find yourself in a situation where blood is bleeding from your nose, follow these steps:

• Relax and calm yourself.
• Sit upright and lean your body and head slightly forward.
• Breathe through your nose.
• Pinch together the soft part of your nose to stop the bleeding.
• If your nose continues to bleed, maintain pressure for another 5 minutes.
• You can also apply cold compression to the bridge of your nose for a few minutes to help constrict blood vessels and stop the bleeding.
• After the bleeding stops, avoid bending over, straining, or lifting heavy objects.

Here are a few home remedies that can help relieve nosebleeds. It is always advisable to consult your doctor before trying these:

• Saline water: Dryness during the winter season in the nasal membrane is a common cause of nosebleeds. To address this, soothe and moisturize the nasal membranes with saline water. Saline water can be made by adding a few drops of saline solution to a bowl of water. Put a few drops of this solution in your nose to moisten the inner lining of the nasal passages.
• Apple cider vinegar (ACV): The acid in ACV helps constrict blood vessels, thus stopping the bleeding. Dip a cotton ball in vinegar and place it in the affected nostril for about 5 to 10 minutes; this usually stops the bleeding quickly.
• Nettle leaf: Nettle leaves act as a natural astringent and hemostatic agent. A nettle solution can help control allergy-related nosebleeds. Brew the leaves to make tea. Once the solution cools, dip a cotton pad in it and place it on your nose for 5 to 10 minutes until the bleeding stops.

Frequent nosebleeds can lead to various complications, including:

• Sinusitis: Sinusitis involves inflammation and swelling in the nose, which can damage the nasal blood vessels and result in nosebleeds.
• External Nasal Deformity: Nasal deformities are abnormalities in the shape or structure of the nose. In some cases, these deformities can result from trauma or recurrent nosebleeds.
• Hemorrhage: Severe and sudden nosebleeds can lead to hemorrhage if excessive bleeding occurs.
• Cardiovascular Compromise: In certain life-threatening situations, especially following surgery, nosebleeds can lead to cardiovascular shock, which may be fatal.
• Anemia: Chronic episodes of nosebleeds over an extended period can result in anemia due to blood loss.