Nosebleed is the colloquial term for the medical term epistaxis. In most cases, nosebleeds are not dangerous. However, bleeding from the nose can be life-threatening and nearly impossible to treat. Dangerous bleeding often originates from the back of the nose.
Causes
First-aid measures for nosebleeds. Click to enlarge. The causes of nosebleeds vary. There are local-related nosebleeds and nosebleeds as a symptom of a general disease. In about 80% of cases, bleeding occurs from vessels in the anterior part of the nasal septum. Blood vessels emerge from the depth of the nasal septum to the surface. They are particularly sensitive and vulnerable in their course close to the mucosal surface. Curvatures of the nasal septum additionally promote bleeding in this area due to curvatures. This can lead to increased turbulence of the respiratory air, which can then lead to dehydration and incrustation of the mucous membrane. Rather more rarely, the cause of nosebleeds is found in the posterior and superior nasal sections or in the paranasal sinuses. Furthermore, diseases, such as high blood pressure or blood clotting disorders, increase the risk of getting nosebleeds.
Diseases with this symptom
- Flu
- Vitamin C deficiency
- Arteriosclerosis
- Willebrand-Jürgens syndrome
- Hypertension
- Osler’s disease
- Measles
- Typhoid fever
- Nasal septal deformity
- Nasal polyps
- Vitamin K deficiency
- Purpura Schoenlein-Henoch
- Eosinophilic granulomatosis with polyangiitis
- Arterial hypertension
- Nasal fracture
- Scurvy
- Blood clotting disorder
- Hemophilia
Localized nosebleeds
Localized nosebleeds often occur in young children. For the most part, it is not dangerous and quickly disappears on its own. It is largely caused by children’s own injuries (e.g., picking their nose too hard) or external injuries during play. Especially during play, children often injure their heads and noses through small scuffles. Furtherin, children have often picked up nasal foreign bodies through direct contact with sand and soil, which can lead to nosebleeds through further friction and irritation. However, allergy, drying of the nasal mucous membranes (e.g., due to air conditioning), and rhinitis (acute rhinitis) can also cause nosebleeds.
Nosebleeds as a symptom of disease
Nosebleeds can occur as a symptom of infectious diseases, such as influenza, typhoid or measles. Furthermore, also by vascular and circulatory diseases, such as arterial hypertension and arteriosclerosis. Blood thinners also frequently cause nosebleeds. Less common are nosebleeds due to vitamin C deficiency (scurvy), pregnancy, and hormonal changes.
Diagnosis and course
If blood (light, dark, clotted) leaks from the nose, the physician has several methods available to diagnose the cause. For example, he or she may perform a nasal endoscopy to determine the exact location of the bleeding. X-rays of the head are another option to detect or rule out injuries caused by blunt blows or the like. Blood tests are also a possibility. Nosebleeds usually occur suddenly. However, it is possible that vigorous nose blowing or boogers may unintentionally initiate the nosebleed. However, with countermeasures (cold in the neck), the intensity can be attenuated and stopped, so the nosebleed usually does not last long.
Diseases
- Hypertension
- Leukemia
Complications
Nosebleeds are mostly harmless and disappear on their own after a short time. However, if the nosebleed persists for a long period of time, anemia may develop. This occurs due to blood loss and leads to fatigue, deficiency symptoms and other complications. Anemia can also cause poor circulation with other symptoms such as chills and dizziness. With possible unconsciousness, there is a risk of blood entering the trachea or esophagus. Blood in the trachea can cause pneumonia or respiratory failure, while blood in the esophagus can enter the stomach, often leading to nausea and vomiting. In the case of arterial nosebleeds, there is a risk of hemorrhage.In addition, home remedies can lead to complications. For example, the typical practice of resting the head on the back of the neck can cause blood to enter the respiratory tract, while cooling the forehead and nose often exacerbates the bleeding. Depending on the underlying condition, nosebleeds can bring other symptoms that require independent treatment. During therapy, the prescribed drugs may cause allergic reaction, but normally the specialist treatment of nosebleeds proceeds without further complications.
When should you go to the doctor?
Epistaxis is not a cause for concern for a healthy person. If the nosebleed cannot be stopped after 20 minutes, excessive blood loss is the result. In this case, consulting a physician is recommended. If the nose bleeds conspicuously, pregnant women or frail people, a doctor should be consulted after five to ten minutes. In case of arterial bleeding in the upper part of the nose, immediate medical treatment is necessary. In this case, the bleeding passes through the throat. Bleeding of the nose often occurs after falls. In case of a visible injury, clarification and treatment in a hospital is advisable. If there is a discharge of light-colored fluid from the nose after a skull injury, it may be cerebrospinal fluid. Immediate notification of an emergency physician is essential! In case of frequent nosebleeds, it is advisable to make an appointment with a doctor. A first clarification (blood pressure check) can be done by the family doctor. Since special instruments are needed for further examination, a visit to the ENT physician is advisable.
Treatment and therapy
First of all, diseases such as high blood pressure and blood clotting disorders must be excluded as a cause in nosebleeds. Furthermore, medications can also have an influence on blood clotting in the nose. Tumors of the nose and sinuses, as well as vascular diseases, should also be ruled out before treatment. Acute nosebleeds should first be stopped by tilting the head forward to avoid swallowing the blood. Placing a damp and cold washcloth on the back of the neck constricts the blood vessels and the bleeding usually stops on its own. If the nosebleed is severe, or if the bleeding does not stop, a doctor should be consulted immediately. For further medical treatment, electrical or chemical sclerotherapy of the bleeding source can be applied. If this procedure is also not promising, a tamponade is inserted into the nose to stop the bleeding. This should remain in the nose for approximately two to three days and is usually very uncomfortable for the patient.
Outlook and prognosis
Usually, the nosebleed is only a temporary symptom and does not necessarily need to be treated by a doctor. Often, the nosebleed stops after a few minutes and can be easily stopped with a handkerchief, for example. However, the affected person should not lie on his back or lean his head back, as this will cause the blood to flow back again. This should be prevented. If the nosebleed occurs after a blow to the nose or after an accident, a doctor must be consulted urgently. It could be that the nose is broken, which is often not detected by patients. In case of a broken nose, the nose can be straightened properly only in the first days after the break. In this case, the visit to the doctor is mandatory. Even if the nose was not directly affected in an accident, a doctor should be consulted as well in case of nosebleeds. Nosebleeds occur relatively frequently in children. However, if it disappears after a few minutes, this symptom is not a problem. If the nosebleed persists, a doctor must be consulted. In this case, the nosebleed may indicate another serious illness that needs to be treated by a doctor.
What you can do yourself
The methods of self-help for nosebleeds depend greatly on the cause of the bleeding. If the nosebleed occurs after an accident or after a strong blow to the nose, it is advisable to see a doctor. Especially in case of other symptoms such as dizziness, pain in the nose or head, it may be a nosebleed. In this case, the patient must act quickly so that the bones do not grow crooked. Under no circumstances should the affected person lie on his back or lean his head backwards. This would only cause the blood to flow back.It is helpful to stuff a piece of tissue into the nostril to stop the bleeding. Usually, the nosebleed stops after a few minutes and does not lead to further problems or complications. Nosebleeds occur relatively often, especially in children, because they often pick their noses and their sinuses are not yet well developed. However, if the nosebleed occurs often and is not associated with certain activities, a doctor should be consulted. In this case, it may be a chronic problem that needs to be treated.
