Nosebleeds are one of the most common everyday ailments in our society. Often, a violent blowing of the nose or a light blow is enough to cause the fine blood vessels of the human nasal mucosa to burst. In some cases, this occurs more frequently and without any apparent cause, so that one can speak of a chronic nosebleed.
What is chronic nosebleed?
Similar to impaired blood clotting, high blood pressure can also be a possible cause of chronic nosebleeds. Chronic nosebleeds, which are referred to as epistaxis in medical jargon, can occur as symptomatic sequelae of various underlying diseases and thus due to a wide variety of factors and with varying frequency and intensity. The human nasal mucosa is extremely well supplied with blood and is traversed by the finest capillary systems, which can burst due to various factors and cause more or less massive bleeding in the nose. In the case of sensitive mucous membranes, even slight shocks or blowing the nose are often enough to sporadically trigger such bleeding. If it is a chronic nosebleed, it usually occurs abruptly and without any directly recognizable reason, but with recurring regularity. In this case, the respective underlying cause should be clarified by a physician.
Causes
As a rule, a chronic variant of nosebleed is a consequence of a disease elsewhere. In many cases, this is due to a vascular disease or a disorder of blood clotting, which in turn can be caused by metabolic disorders or by long-term use of various medications. Similar to disturbed blood coagulation, high blood pressure can also be a possible cause of chronic nosebleeds. Often, however, there is also an underlying local disease: Any disorders in the nasopharynx can cause swelling of the nasal mucosa as a result of a cold, indirectly triggering chronic bleeding in the nose. Pollen or animal hair allergies also promote excessive swelling of the nasal mucosa and can thus be causative for recurrent bleeding. Benign or malignant nasal tumors also come into consideration as a possible cause of chronic nosebleeds: if the tumors grow excessively inside the nose, they can permanently injure the mucosa and promote severe bleeding. Deformities of the nasal septum, either congenital or caused by an accident, also not infrequently trigger chronic bleeding in the nose; protruding spurs or cartilage can severely injure the mucosa, causing irreparable damage. Another factor that is often causally responsible for chronic nosebleeds is the consumption of certain drugs or contact with aggressive chemicals, which usually cause tears and holes in the sensitive nasal mucosa.
Diseases with this symptom
- Blood clotting disorder
- Common cold
- Polyps
- Metabolic disorder
- Hay fever
- Drug addiction
- Hypertension
- Animal hair allergy
- Drug allergy
Diagnosis and course of the disease
Regularly, chronic nosebleeds are easy to diagnose based on the clear symptoms. To initiate appropriate therapy, the attending physician therefore first determines the existing underlying disease that triggers the bleeding. By determining the blood values and with the aid of medical procedures such as MRI and CT, the endogenous cause can be determined with appropriate precision. Another decisive clue for the diagnosis are the accompanying symptoms, which occur in combination with the nosebleeds and can provide considerable information about the respective underlying disease. Those affected often complain of toothache and pain in the inner and outer areas of the nose. If a purulent secretion is discharged from the nose, this may be the first sign of a nasal tumor. In many cases, there is also severe fatigue and an increased feeling of weakness. If chronic nosebleeds are accompanied by further bleeding in atypical parts of the body, this may indicate a blood coagulation disorder. If additional fever occurs, the suspicion of another chronic infection is strengthened.
Complications
Chronic nosebleeds carry various risks due to blood loss on the one hand and injuries to the mucosa on the other. In severe nosebleeds, for example, there is a risk of circulatory collapse and permanent secondary damage due to the anemia that occurs. There is also the risk of blood entering the trachea and causing respiratory distress or even vomiting. In the case of arterial nosebleeds, the rapid loss of blood can cause the patient to bleed to death. Less severe are symptoms such as fatigue and tiredness that occur as a result of blood loss. The first signs are pale skin and tremors, and the symptoms increase constantly and can also lead to circulatory collapse if left untreated. In addition, chronic nosebleeds cause the body to lack vitamin B12, iron and other minerals, which can lead to a variety of other complications. Typical, for example, is pernicious anemia, which occurs as a result of vitamin B12 deficiency and leads to mucosal changes, burning of the tongue and other symptoms. The cooling compresses and tempo tissues frequently used for chronic nosebleeds favor complications such as hypoxia or sinusitis. In general, nasally inserted wipes or bandages promote circulatory disturbances of the mucosa and thus, in extreme cases, may cause toxic shock syndrome. Inappropriate treatment measures, such as placing the head on the back of the neck and allowing the blood to run back into the nose, may in turn lead to further discomfort.
When should you see a doctor?
If nosebleeds have no clearly identifiable cause, such as the mechanical impact of a blow or exceptionally violent rubbing when blowing the nose, and if they occur several times for seemingly no reason, they are referred to as chronic nosebleeds. Chronic nosebleeds, which seem to come out of the blue, are not simply a nuisance. Chronic nosebleeds can have a disease-related cause and should therefore always be clarified by a doctor. Chronic nosebleeds can be caused by increased blood pressure, blood vessel disease or blood clotting disorders. Some metabolic diseases or medications taken can also trigger it. In case of a severe cold with impairment of the nasopharynx, there is a reasonable suspicion of the connection of the nosebleed with the swollen and overstimulated nasal mucosa. Allergies to pollen or animal hair can have a similar effect. Of course, in the case of chronic nosebleeds, growths in the nose, malformations as well as tumors must also be considered. The treating physician should also ask his patient about any – usually occupational – exposure to aggressive chemicals and about any drug use. In addition to the general practitioner, an internist, ear, nose and throat specialist, allergist or surgeon may be consulted for the treatment of chronic nosebleeds. In the event of an unusually severe chronic nosebleed with high blood loss, the emergency physician should be called immediately as a precaution.
Treatment and therapy
Similar to the diagnosis, the therapies and treatment options under consideration depend on the particular causative condition. If only a chronically swelling nasal mucosa is present, it can be treated with special sprays containing mainly decongestant agents. If the underlying cause is a bacterial infection, the patient can be effectively treated with an antibiotic. The medical approach to coagulation disorders and hypertension is similar: here, drug therapies are used to cure the affected person. In many cases, the cause of chronic nosebleeds can also be eliminated surgically. In the case of a curvature or deformation of the nasal septum, protruding cartilage and spurs can be completely removed by means of surgery. Malignant nasal tumors are treated in a similar manner; in the case of benign tumors, surgical removal is only an option if they obstruct breathing. By means of these and related treatment methods, chronic nosebleeds can usually be treated before they have serious consequences for the health of the affected person. If left untreated, the high blood loss can lead to serious secondary diseases in the patient; often, circulatory problems and even fainting spells occur.
Outlook and prognosis
In general, nosebleeds in the anterior region of the nose are not dangerous. Specific measures can be taken to stop the bleeding quickly.In the case of an allergic cause, such as hay fever, treatment can also last for years. If the bleeding persists over a longer period of time despite initiated measures, the bleeding can be inhibited by obliterating the injured blood vessel or by nasal tamponade. Bleeding at the back of the nose is more difficult to localize and control. This can be remedied with a clip or surgery. These methods will prevent further bleeding from the nose. However, if there is a serious underlying internal disease, it is possible for the bleeding to recur. In this case, it is important to have an early diagnosis made by an ENT specialist, which can significantly affect the chance of recovery. Especially if the alleged nosebleed is not caused by the nose at all, but by other parts of the body, such as esophageal varices. If the nosebleed remains untreated for a long time, especially if the amount of blood increases considerably, there is a risk of circulatory weakness or anemia (anemia). This can be life-threatening. Serious consequences can be prevented by quickly initiating an infusion or blood transfusion.
Prevention
However, chronic nosebleeds can usually be effectively averted in advance by taking various preventive measures. People who have a tendency to dry nasal mucous membranes should pay particular attention to a correspondingly humid room climate and sufficient ventilation at the workplace and in the bedroom. Nasal douches are also an additional way of moistening the mucous membranes and thus stimulating regeneration, which is particularly recommended during the heating period in the cold season. As an alternative, pharmacies provide a wide range of over-the-counter sprays and ointments that have a similar nourishing effect on the mucous membranes. Indispensable for the health of the nasal mucous membranes are also an appropriate lifestyle, sufficient physical exercise and a balanced diet.
What you can do yourself
Various measures alleviate chronic nosebleeds. A sufficiently humid room air is helpful. For example, a damp cloth can be hung over the heater or an indoor fountain can be set up. Nasal douches, nourishing sprays, nasal ointments or nasal oils are recommended. Inhalations with the help of saline solutions are also useful. In this way, the sensitive nasal mucosa is cared for and kept supple. Encrustations in the nose caused by a cold or previous nosebleeds are gently dissolved. The nose does not start bleeding again. For treatment in acute cases, there are also special nasal sticks that soothe the mucous membrane of the nose and close small wounds. If blood comes out of the nose, sufferers should sit bent forward and let the blood drip off. The nose should then be gently squeezed for at least ten minutes while breathing through the mouth. Cold compresses placed on the neck are also useful. They constrict the vessels and help to stop the bleeding. In addition, tamponade can stop further blood loss. Chronic nose picking or vigorous blowing should be avoided. It is important to drink enough fluids (at least 1.5 to 2 liters daily). This ensures the moistening of the mucous membranes. A healthy diet is also elementary in chronic nosebleeds. For example, vitamin C strengthens the small blood vessels in the nasal mucosa.