Nose bleeding

Symptoms Of 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 

Causes Of Nose bleeding

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 can be caused by hot, low-humidity climates or heated indoor air. The environment causes the nasal membrane to dry out and become crusty or cracked and 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 (aspirin and warfarin) reduce the blood's ability to clot and hence prolong 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 a longer time

• Snorting cocaine can cause nasal problems like permanent physical damage or nose bleeds

• The deviated septum can block one side of the nose and reduce airflow, leading to crusting or nose bleeding in certain people
  
  

Some of the other less common causes of nosebleeds include:

High Blood Pressure (Hypertension): Although there is no direct link between nosebleeds being a signs of high blood pressure, a hypertensive crisis consisting of a sudden, severe increase in blood pressure can cause increased pressure in the blood vessels and lead to nosebleeds.

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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 disease within the nasal cavity can cause bleeding. Some of the 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-  It is inflammation of the inside of the nose caused by allergens, such as pollen, dust, and mold.

• Nasal polyposis- It is noncancerous growth on the lining of your nasal passages or sinuses.

• Wegner granulomatosis- Inflammation of the blood vessels of the nose.

• Tuberculosis- It is an infectious disease that usually affects the lungs.
  
  

Hereditary hemorrhagic telangiectasia (HHT): It is a genetic vascular disorder, which leads to the development of small lesions called telangiectasia, which can burst and bleed.

Pregnancy: Nosebleeds can be experienced during pregnancy on account of hormonal changes. 

Types Of Nose bleeding

Nose bleeding is described by the site of the bleeding. The two main types of nose bleeding are: 

Anterior nose bleeding

It originates towards the front of the nose and causes blood to flow out through the nostrils.  Capillaries and small blood vessels in this area of the nose are fragile and can easily break and bleed. This is the most common nosebleed found in children and is usually not serious. 

Posterior nose bleeding 

It originates toward the back of the nasal passage, near the throat. Posterior nosebleeds are considered to be more serious than anterior nosebleeds. It causes heavy bleeding, which may flow down the back of the throat and is more common in adults. 

Risk Factors For Nose bleeding 

Atmospheric changes 

Conditions like high altitudes, dry climatic conditions, and cold weather are known to dry out the nasal membrane and cause nose bleeding. 

Habits 

Certain habits like putting a finger in the nose or aggressively picking the nose can lead to tearing of the nasal mucous membrane leading to epistaxis. 

History of bleeding disorders 

Individuals having a history of blood clotting disorders can have heavy bleeding in the case of any nasal injury. 

Inflammatory conditions

Individuals with various inflammatory conditions like the common cold, sinusitis, allergies, and nasal polyps are known to have nose bleeding as a common symptom. 

Blood thinning medications

Individuals with prolonged use of anticoagulants (blood-thinning drugs) like aspirin, and warfarin are known to bleed easily as these drugs have blood-thinning properties. 

Stress

Stress and anxiety are risk factors for nose bleeding. Research has shown that individuals having psychological issues are at a higher risk for chronic, recurring, or unexpected nosebleeds.

If a person is feeling anxious then he tends to pick his nose which could also trigger bleeding. 

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Smoking and excessive alcohol intake 

Nicotine is a dangerous substance in cigarettes that can act as an irritant in the nasal mucosa and cause nose bleeding. Excessive alcohol intake can also lead to epistaxis as alcohol inhibits blood clotting and dilates the blood vessels. 

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Diagnosis Of Nose bleeding 

History 

If an individual is experiencing nose bleeding the doctor would ask questions like:

• Duration of the nosebleed

• How often do you experience nose bleeding

• Amount of blood lost during the incident 

• Drug history to point out the use of drugs that may promote bleeding, including aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), other 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 

• Vitals are evaluated. With active bleeding, treatment usually takes place simultaneously with evaluation.

• Examination of the nose is done to determine the source of the bleeding and what may have caused it. Equipment like a small speculum is used to hold the nostril open. Various light sources like a headlamp or an endoscope (lighted scope) are used to check the inside of the nasal passages.

• A topical spray with anesthetic and epinephrine is helpful for vasoconstriction to help in controlling the bleeding and to aid in the visualization of the source. 

Lab tests 

Lab tests are rarely required to diagnose nosebleeding.  In certain severe conditions following tests are done:

• Complete blood count (CBC): For individuals having nose bleeding, a CBC is done to map the reduced hemoglobin level for bleeding management in patients with heavy and recurrent nosebleeds. 

• Coagulation studies: Patients with symptoms or signs of a bleeding disorder and those with severe or recurrent epistaxis are evaluated for prothrombin time (measures the time it takes for a clot to form in a blood sample), and partial thromboplastin time (a blood test that looks at how long it takes for blood to clot). 

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Imaging studies 

Tests like Computed Tomography (CT) scans and Magnetic Resonance Imaging (MRI) may be rarely indicated in cases where a malignancy or growth is suspected.

Prevention Of Nose bleeding

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 the 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 act as an irritant in the nasal mucosa and can cause nose bleeding. Quitting smoking and drinking is always a good idea.

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Consume vitamin K-rich foods 

Vitamin K-rich foods like spinach, mustard greens, kale broccoli, and cabbage, are involved in the formation of collagen that helps in creating a moist lining inside the nose. Vitamin K  helps keep the blood vessels in good condition preventing them from rupturing easily and green leafy vegetables also facilitate blood clotting. 

Load your diet with Vitamin C-rich foods 

Vitamin C-containing foods or supplements on a daily basis may help make the blood vessels become stronger and thus less vulnerable to rupture and cause nose bleeding. 

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Stay hydrated 

Not drinking an adequate amount of water in a day can also dry the mucous membranes causing nose bleeds. Therefore, it is recommended to have enough water throughout the day. 

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Specialist To Visit

Doctors that can help you diagnose and treat nose bleeding include:

• ENT specialist
  
  

An ENT specialist, also called an otolaryngologist, is a doctor who has special training in diagnosing and treating diseases of the ear, nose, and throat. An ENT specialist can diagnose the condition and, if needed, can also look deep inside the nose using a special camera or endoscope to both treat the problem and ensure there isn't a more serious condition like a tumor or malignancy causing it.

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Treatment Of Nose bleeding

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 having 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

It is a procedure in which tiny particles such as gelatin sponges or beads, are used to block a blood vessel. This procedure will stop 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 is a surgical procedure that 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 worked.

Home Care For Nose bleeding

If you find yourself in a situation where blood is bleeding from your nose. Follow the following steps:

• Relax and make yourself calm

• Sit upright and lean your body and your head slightly forward

• Breathe through your nose

• Pinch together the soft part of the nose to stop bleeding 

• If your nose is still bleeding, continue squeezing the nose for another 5 minutes

• You can also apply cold compression to the bridge of your nose for a few minutes. This will help constrict blood vessels and stop bleeding.

• After the bleeding stops, do not bend over, strain, or lift any heavy objects
  
  

Here are a few home remedies that can help relieve nose bleeding. It is always better to take consent from your doctor before trying these:

Saline water 

Dryness during the winter season in the nasal membrane is one of the most common causes of nose bleeding. To solve this problem, soothe and moisturize the nasal membranes with saline water. Saline water can be made by adding some water in a bowl and in this adding a few drops of saline solution, and mixing them well. 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 present in the ACV  helps constrict the 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 bleeding in one go. 

Nettle leaf 

Nettle leaves work as a natural astringent and a hemostatic agent. Nettle's solution helps keep allergy-related nosebleeds in control. The leaves can be brewed and tea is made. Once the solution cools down, dip the cotton pad in the solution and place it on the nose, for 5-10 minutes until the bleeding stops.

Complications Of Nose bleeding

Frequent nosebleeds can lead to various complications like

• Sinusitis: During sinusitis, there is inflammation and swelling in the nose. It leads to damage to the nasal blood vessels resulting in nosebleeds. 

• External nasal deformity: Nasal deformities are abnormalities in the shape or structure of the nose. In some cases, the deformity can be a result of trauma or nose bleeding. 

• Hemorrhage: Sudden nose bleeding if severe with excessive bleeding can lead to hemorrhage.

• Cardio-vascular compromise: In certain life-threatening cases, especially following surgery, nose bleeding can lead to cardio-vascular shock which can prove to be fatal.

• Anemia: Episodes of chronic nose bleeding for a long duration can lead to anemia from blood loss.