nosebleed

Nosebleed

 

Definition

A nosebleed is bleeding from the nose; the medical term for it is epistaxis.

Description

Unexpected bleeding from anywhere is cause for alarm. Persistent bleeding should always be investigated because it may be the earliest sign of cancer. Fortunately, nosebleeds are rarely a sign of cancer. A much more common cause of nosebleeds is injury from picking or blowing or fisticuffs. People with hay fever have swollen membranes that are fragile and more likely to bleed.

Most nosebleeds (about 90%) come from the front of the septum, that plane of cartilage that separates the nostrils. These are called anterior nosebleeds. The lower front part of the septum has a mass of blood vessels on either side called Kiesselbach's plexus that is easy to injure. Nosebleeds from the more remote reaches of the nose are called posterior nosebleeds. They are less common, are less likely to have a benign cause, and are much harder to manage.

Nosebleeds are most likely to occur in children between the ages of two and 10 years, in part because younger children frequently insert small objects in the nose or pick at the tissues lining the nose. Nosebleeds in adolescents may indicate cocaineabuse. Nosebleeds in older adults may result from arteriosclerosis or high blood pressure.

Causes and symptoms

Nosebleeds may result from a number of different causes:

• local infections (colds, sinus infections)
• systemic infections (scarlet fever, typhoid fever, malaria)
• drying of the membranes lining the nose, often during heating season in colder climates
• medications, most commonly, overuse of nasal decongestant sprays
• trauma (from foreign objects in the nose; scratching or picking with the fingers; or blunt trauma to the face)
• tumors in the nasopharynx or paranasal sinuses
• cocaine abuse
• bleeding disorders (leukemia, liver disease, hemophilia and other hereditary clotting disorders)

Treatment

The first treatment is to pinch the patient's nostrils together, have them sit forward, and ask them to stay that way for 5-10 minutes. This method usually stops nosebleeds originating in Kiesselbach's plexus. The patient should not tilt his or her head backward, as this position may cause blood to drip backward into the throat or windpipe. It is best to hold the head upright.

In the case of small children, the doctor may examine the inside of the nose to check for foreign bodies, evidence of scratching or picking, etc. Small foreign bodies (watch batteries, dried peas or beans, buttons, etc.) can be removed by suction if necessary. The doctor may also have to remove clotted blood by suction.

Bleeding that continues originates from the back of the nose in most cases and will flow down the throat. If that happens, emergency intervention is needed.

As an emergency procedure, the nose will be packed front and/or back with cotton gauze and a rubber balloon from a Foley catheter. This treatment is not comfortable. Having no place to flow, the blood should clot, giving the ear, nose and throat specialists (otorhinolaryngologists) a chance to find the source and permanently repair it. If the packing has to remain for any length of time, antibiotics and pain medication will be necessary—antibiotics because the sinuses will be plugged up and prone to infection. Nose packing may so interfere with breathing that the patient will need supplemental oxygen.

Newer options for controlling posterior nosebleeds include the use of Surgicel, Merocel, or other oxidized cellulose products that expand with moisture. These may control the bleeding without the need for bulky nasal packing.

Many bleeds are from small exposed blood vessels with no other disease. They can be destroyed by cautery, usually done by applying silver nitrate to the affected area. Larger vessels may not respond to cautery. The surgeon may have to tie them off, which is known as ligation. Another technique that is sometimes used with larger vessels is embolization, in which the doctor injects a chemical to block or close the blood vessel.

Alternative treatment

Estrogen cream, the same preparation used to revitalize vaginal tissue, can toughen fragile blood vessels in the anterior septum and forestall the need for cauterization. Botanical medicines known as styptics, which slow down and can stop bleeding, may be taken internally or applied topically. Some of the plants used are achillea (yarrow), trillium, geranium, and shepherd's purse (capsella-bursa). Homeopathic remedies can be one of the quickest and most effective treatments for epistaxis.

Prevention

Both before and after a nosebleed, the patient should blow the nose gently and avoid picking or scratching the tissues that line it. Children with recurrent nosebleeds during heating season may benefit from the use of a cool-mist vaporizer to humidify the bedroom at night, or from the application of a small quantity of petroleum jelly to the inside of each nostril. Treatment of hay fever helps reduce the fragility of the tissues.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Epistaxis." Section 7, Chapter 86 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Bhatnagar, R. K., and S. Berry. "Selective Surgicel Packing for the Treatment of Posterior Epistaxis." Ear, Nose, and Throat Journal 83 (September 2004): 633-634.

Gluckman, William, DO, and Robert Baricella, DO. "Epistaxis." eMedicine October 11, 2004. http://emedicine.com/ped/topic1618.htm.

Gurney, T. A., C. F. Dowd, and A. H. Murr. "Embolization for the Treatment of Idiopathic Posterior Epistaxis." American Journal of Rhinology 18 (September-October 2004): 335-339.

Organizations

American Academy of Family Physicians (AAFP). 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. http://www.aafp.org.

American Academy of Otolaryngology—Head and Neck Surgery. One Prince Street, Alexandria, VA 22314-3357. (703) 836-4444. http://www.entnet.org.

Key terms

Cautery — The use of heat, electricity, or chemicals to destroy tissue.

Embolization — A technique for stopping bleeding by introducing a substance into larger blood vessels that blocks or closes them.

Epistaxis — The medical term for nosebleed.

Kiesselbach's plexus — An area on the anterior part of the nasal septum that has a rich supply of blood vessels and is a common site of nosebleeds. It is named for Wilhelm Kiesselbach, a nineteenth-century German otolaryngologist.

Septum — The partition that separates the two nostrils. It consists of membranes, cartilage, and bone.

Styptic — Any remedy with an astringent and hemo-static (stopping bleeding) quality.

epistaxis

 [ep″ĭ-stak´sis]

hemorrhage from the nose, usually due to rupture of small vessels overlying the anterior part of the cartilaginous nasal septum. Minor bleeding may be caused by a blow on the nose, irritation from foreign bodies, or vigorous nose-blowing during a cold; sometimes it occurs in connection with menstruation. If bleeding persists in spite of first aid measures, medical attention is advisable. Called also nosebleed.

Sometimes nosebleed has serious underlying causes. Arteriosclerosis is a possible cause in the elderly. Polyps, other fleshy growths in the nose, food allergy, hypertension, vitamin deficiencies, or a disease producing a bleeding tendency may produce nosebleed. If the nose bleeds often or profusely, or if the bleeding is difficult to stop, a health care provider should be consulted.

Bleeding from the nose that does not originate in the nose itself is a serious indication that some damage has been done internally, either by injury or disease. Medical attention is necessary to trace the bleeding to its source. The blood probably originates in the stomach, the lungs, within the skull, or in passages related to these parts.

First Aid Measures: The victim should sit up with the head tilted forward to avoid aspiration of blood. The soft portion of the nose is grasped firmly between the thumb and forefinger, for 5 to 15 minutes. Once bleeding stops the patient should rest for an hour or so and for several hours should avoid stooping, lifting, or vigorously blowing the nose. If bleeding continues, a health care provider may have to pack the nose. Sometimes cauterization of the bleeding vessel is necessary. In some cases surgery to clip the vessels may be done. Blood loss from a nosebleed can be considerable and there is danger of hemorrhagic shock.

ep·i·stax·is

(ep'i-stak'sis),

Bleeding from the nose.

Synonym(s): nasal hemorrhage, nosebleed

[G. fr. epistazō, to bleed at the nose, fr. epi, on, + stazō, to fall in drops]

nosebleed

/nose·bleed/ (nōz´blēd) epistaxis.

nosebleed

(nōz′blēd′)

n.

A nasal hemorrhage; bleeding from the nose.

adj. Informal

So high as to be supposed to cause a person's nose to bleed: the nosebleed seats in the stadium.

nosebleed

Etymology: AS, nosu + ME, blod, blood

abnormal hemorrhage from the nose. Emergency responses to nosebleed include seating the patient upright with the head thrust forward to prevent swallowing of blood. Pressure with both thumbs directly under the nostril and above the lips may block the main artery supplying blood to the nose. Alternatively, pressure with both forefingers on each side of the nostril often slows bleeding by blocking the main arteries and their branches. Continued bleeding may require the insertion of cotton or other absorbent material within the nostril and reapplication of pressure. Cold compresses on the nose, lips, and back of the head may help control hemorrhage. Continued bleeding may require cautery. Also called epistaxis.

nosebleed

ENT Hemorrhage from the highly vascularized nasal mucosa Etiology Trauma, spontaneous with dried nasal mucosa, common in dry climates in winter, infection, trauma, rhinitis, HTN, alcohol abuse, inherited coagulopathies and therapy with anticoagulants–eg, coumadin, warfarin, aspirin, or other anti-inflammatory agents Herbal medicine Yarrow, see there Vox populi → medtalk Epistaxis.

ep·i·stax·is

(ep'i-stak'sis)

Profuse bleeding from the nose.
Synonym(s): nosebleed.

[G. fr. epistazō, to bleed at the nose, fr. epi, on, + stazō, to fall in drops]

TECHNIQUE FOR CONTROL OF HEMORRHAGE FROM POSTERIOR NASAL CAVITY

TECHNIQUE FOR CONTROL OF HEMORRHAGE FROM POSTERIOR NASAL CAVITY

nosebleed

Hemorrhage from the nose.

See: illustration; epistaxis; Kiesselbach's areaillustration

ep·i·stax·is

(ep'i-stak'sis)

Bleeding from the nose.

[G. fr. epistazō, to bleed at the nose, fr. epi, on, + stazō, to fall in drops]

nosebleed,

n See epistaxis.

nosebleed

see epistaxis.

Patient discussion about nosebleed

Q. Why do litlle kids' nose's begin to bleed?

A. A nose starts to bleed when one of the small veins in its lining bursts. This is usually caused by something completely harmless, such as the child picking their nose, blowing it too hard or having their nose knocked while playing. Another reason could be that the child has pushed something inside their nose. Some children have veins that are closer to the mucous membrane of their nose than other children. Because the veins are very close to the skin, they are more likely to burst when the child picks, blows or rubs their nose, or plays rough games.

Q. Hi this is Wilson; I have a daughter, who is 5. She has frequent nose bleeds when she is behaving badly. Hi this is Bell; I have a daughter, who is 5. She has frequent nose bleeds when she is behaving badly. She has been screened by her school for ADHD and I haven’t had a chance to consult a doctor for her screening and exam for ADHD. I thought that her nose bleeds cause due to her behavior? I need help.

A. I don’t have an idea about this. But I think that you should first discuss these issues with your doctor. Also mention to the doctor if she has any problems with sleeping, like only sleeping 6 hours a night. Try with occupational Therapists which help children and adults with small motor issues like handwriting and also with sensory issues like learning how to calm down. Early intervention is always best.

Q. My son often has severe nose bleeds. What if any illness' holds this symptom? They wake him in the night. My son has these terrible nose bleeds and I am sooo worried. I have no health insurance and would appreciate some info if anyone has any. Since he was about 4, now 12, he usually has them in the middle of the night. He does have allergies and takes over the counter allergy meds for seasonal allergies. He also has a heat lamp in his bedroom for his dragon. However; I never thought the lamp could cause this because they started 5 years before he had his dragon that uses the heat lamp. I am very worried it could be serious. Any info would be appreciated.

A. does it happen when the allergy attack occur? because it can cause nose bleeding. does he have a bleeding problem? when he get's a cut, how long it takes until the bleeding stops?
deviated septum in the nose can also cause...
but my nephew has seasonal allergies, and he bleed from his nose sometimes. so i guess it's common.