Introduction:
Nosebleeds are one of the most common ear, nose and throat (ENT) emergencies that patients make appointments for at clinics or urgent care. Nosebleeds can be frightening, but are not usually serious, especially in children, and can be treated at home. The most common reasons for nosebleeds are picking your nose, minor injury, blowing your nose very hard, and a sudden change in the environmental humidity or temperature, causing the inner layer of the nose to dry and crack easily. There can also be other serious problems that cause bleeding from the nose and require immediate medical attention.1,2 In this article, we can understand what a nosebleed is, what causes it, and how to manage it when you experience an episode of nosebleed.
Nosebleeds:
The medical term for nosebleeds is Epistaxis. During a nosebleed, blood flows from one or both nostrils and can be light or heavy bleeding lasting from a few seconds to 15 minutes or more. It is estimated that 60% of people will have at least one nosebleed.3 Although seeing blood coming from the nose can be worrying, it’s usually not a serious condition and can be treated at home. A large number of blood vessels close to the surface in the lining of the nose make it an easy target for injury and therefore bleeding.
There are two types of nosebleeds of which one is more serious than the other:
- Anterior nosebleed: This type of nosebleed is usually seen in children and can be easily managed at home. In anterior nosebleeds, bleeding starts from the front part of the nose on the lower part of the septum (the wall that separates both nostrils). The blood vessels on the front part of the nose are very fragile and can easily break and cause minor bleeds. This is the most common type of nosebleed and is usually not serious.3
- Posterior nosebleed: In posterior nosebleeds, bleeding starts from the larger blood vessels situated in the back part of the nose near the throat. It occurs deep inside the nose and can be more severe than an anterior nosebleed. The bleeding can be heavy, which may cause blood to flow down the back of the throat. Posterior nosebleeds are more seen in adults, and it requires immediate medical care.3
Causes
Listed below are some of the most common causes of nosebleeds:
Blood clotting disorders
Conditions that affect the blood vessels or how the blood clot can cause heavy nosebleeds and might need medical intervention to get under control. Blood clotting diseases such as haemophilia or leukaemia can provoke and worsen bleeding. Also, patients on blood thinning medication like warfarin, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs) can experience nosebleeds, which need emergency care.
Injury
Minor injuries like picking your nose frequently and blowing your nose too hard can cause scratches and minor bleeding inside the nose, which can be controlled at home. However, a significant injury or broken nose bone will need medical attention.
Dry Air
Low humidity or dry air can cause dryness inside the nose. If your house is very dry or if you live in a dry climate, our nostrils can dry out, causing minor nasal bleeding.
Other less common reasons for nosebleeds are:
- High blood pressure
- Deviated nasal septum
- Nasal polyps
- Nasal tumour
- Pregnancy
- Alcohol use
What to do if you have a nosebleed?
- Stay relaxed, and don't panic!
- Sit upright and slightly lean forward and pinch the soft part of the nose against the bone that forms the bridge of the nose (just above the nostrils) for 10 to 15 minutes.
- Breathe through your mouth while pinching the nose this will drain the blood into the nose rather than the back of your throat.
- Place an ice pack covered by a towel on the bridge of the nose
- Try to stay upright rather than lying down, as it will help in reducing the blood pressure in the blood vessels of the nose and help in stopping nosebleeds.
After the nosebleed stops for the next 24 hours, try not to blow or pick your nose or remove any scabs, avoid alcohol and hot drinks, and do no weight lifting or vigorous activity.
If it's minor bleeding, these steps will help stop it, and you won't need any medical treatment. However, if bleeding does not stop, if you get recurrent nosebleeds, if you are on blood thinning medicines, or have any chronic medical illness, you must contact your health care provider or emergency department for urgent care.
Summary
Although bleeding from the nose can be pretty terrifying at first, it is not a serious problem and can be easily managed at home. To prevent nosebleeds, use a humidifier at home if the air is dry, be gentle while picking or blowing your nose and wear helmets or head guard while doing activities where there are chances of injury to the face and nose.
FAQs
What should I do if my nose doesn't stop bleeding?
After following the above-mentioned steps to handle a nosebleed at home, if bleeding from the nose is still not under control, you must make an urgent appointment with the GP or go to an emergency room for medical care.
If doctors can locate where the bleeding is starting, they might seal it with a stick with some medication on it to stop the bleeding. If they cannot identify the exact spot from where it's bleeding, they might pack your nose with sponges to stop the bleeding, and you may have to stay in the hospital for a day or two, depending on the severity of the problem.
Are nosebleeds a symptom of COVID-19?
COVID-19 is a new infectious disease which has caused a huge pandemic globally, and still, research is going on to identify the most effective treatment and vaccination. The common symptoms experienced by patients testing positive for COVID-19 are more flu-like symptoms of fever, cold, throat pain and cough. Ongoing studies are being conducted to determine if epistaxis or nosebleeds are also a symptom of COVID-19 or if they are experienced by patients with a severe infection or are a side effect of some treatments given to aid coronavirus symptoms.4 Till now, there is no research to confirm that nosebleeds are a symptom of COVID-19.
When should I be worried about frequent nosebleeds?
Make an urgent GP appointment or visit urgent care if you are getting frequent nosebleeds and if you fall in any of the following category:1,2,3
- If you are taking blood thinning medications like aspirin, warfarin, NSAIDs etc
- If you have a medical history of blood clotting diseases like haemophilia or leukaemia
- If you are a known case of high blood pressure
- If your nose bleeds, come and go regularly
- A child under the age of 2 years
- You develop symptoms of anaemia like fatigue, shortness of breath and pale complexion.
- In pregnant or elderly people
References
- Nosebleed [Internet] Cited: 22 January 2022 Available from: https://www.nhs.uk/conditions/nosebleed/
- Nosebleed [Internet] 12 April 2022 Available from: https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/nosebleed
- Nosebleed (Epistaxis) [Internet] Available from: https://my.clevelandclinic.org/health/diseases/13464-nosebleed-epistaxis
- Epistaxis in hospitalized patients with COVID-19, Valeria Dell’Era,Riccardo Dosdegani,Paolo Aluffi Valletti, and Massimiliano Garzaro Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459174/