Nosebleeds can be quite dangerous, threatening the life of the patient. Fortunately, most nosebleeds are not dangerous and can be easily stopped. There are two types of nosebleeds, depending on which part of the nose is bleeding from. Depending on this, nosebleeds are divided into anterior and posterior bleeding.
· Anterior nosebleeds account for more than 90% of all nosebleeds. Bleeding usually comes from a blood vessel in the very front of the nose, more precisely, in the so-called Kisselbach zone of the nasal septum. This zone contains an abundant network of blood vessels. Anterior nosebleeds are relatively easy to stop and practically do not pose a threat to the life of the patient.
Posterior nosebleeds are much less common than anterior nosebleeds. They tend to be more common in older people. The bleeding usually comes from an artery at the back of the nose. These arteries are usually larger and do not collapse well, so such nosebleeds are more dangerous, do not stop well and often require hospitalization.
Almost every family has ever experienced the problem of nosebleeds. Nosebleeds tend to occur most often during the winter months, in dry, cold climates. They can occur at any age but are most common in children aged 2 to 10 and adults aged 50 to 80.
Bleeding from the nose: causes
The most common cause of nosebleeds is trauma to the nose. Trauma to the outside of the nose, such as a blow to the face, or trauma to the inside, such as picking one's nose, blowing one's nose hard, or frostbite, can cause nosebleeds.
Other causes of nosebleeds include the inability or poor ability of the blood to clot. This is observed, for example, when using the drugs warfarin or aspirin. Liver disease can also lead to impaired blood clotting. Hemophilia and other blood disorders can also cause bleeding disorders. Abnormal blood vessels and tumors in the nose are rare but possible causes of nosebleeds. However, a relatively common cause of nosebleeds is high blood pressure. In children, adenoids can cause venous stasis in the nasal cavity and play an important role in their frequent nosebleeds.
Bleeding from the nose: symptoms
Bleeding usually comes from only one nostril. If the bleeding is strong enough, then the blood can fill the entire nasal cavity on the side of the lesion, and then the nasopharynx, after which the blood is in the other half of the nasal cavity, which simulates the bilateral nature of nosebleeds. Blood from the nasopharynx can get into the throat and stomach, such patients “spit up” blood, pull out coffee-colored vomit. Signs of excessive blood loss include dizziness, delirium, confusion, and fainting.
Bleeding from the nose is difficult for patients to tolerate psychologically. It seems to them that they are dying, they are horrified by what is happening, they often behave inappropriately. In fact, almost all nosebleeds do not pose a real threat to the life of the patient and in most cases they can be easily stopped.
When to See a Doctor for Nosebleeds:
·- If there are repeated episodes of nosebleeds
- If, in addition to nosebleeds, there is bleeding from other parts of the body, such as when urinating or blood in the stool
- If nosebleeds occur from slight touching of the nose
- if you are taking blood-thinning medications, including aspirin or warfarin
· - If you have an underlying disease that can affect your blood clotting system, such as liver disease, kidney disease, hemophilia, and so on
· - If you have recently completed chemotherapy
You should contact the clinic urgently if:
· - Nosebleeds continue for more than 10 minutes.
· - There are repeated episodes of nosebleeds within a short time.
·- You feel dizzy or goosebumps, and there is a feeling that you are going to faint.
·- You have a fast heartbeat or trouble breathing.
- You are coughing up blood or vomiting blood.
·- You have a rash on your body or a temperature higher than 38.5°C.
· When examining the nasal cavity, ongoing nosebleeds or blood clots are observed that obstruct the nasal passage when the nosebleed has stopped. For a normal examination, the doctor sanitizes the nasal cavity from clots, with continued bleeding, he tries to stop the bleeding with gauze swabs moistened with vasoconstrictor drugs, for example, adrenaline, naphthyzinum, and so on. Often, after these procedures, it is possible to see the source of bleeding in anterior nosebleeds. If there is no bleeding, then it is better to examine the nasal cavity with an endoscope.
The source of bleeding in posterior nosebleeds is very difficult to determine. Bleeding is difficult to stop with the usual method. However, using an aspirator, cleaning the nasal cavity and simultaneously examining the nasal cavity with a conventional method or with an endoscope, one can confidently make a diagnosis of posterior bleeding.
· Be sure to conduct laboratory tests to assess the degree of blood loss. This largely depends on the tactics of treatment.
Bleeding from the nose: treatment
Minor bleeding from the nose does not require special intervention.
·- Keep calm.
·- Sit up straight.
·- Tilt your head forward. Do not bend backwards, as you will only achieve swallowing of blood and fill the stomach with blood.
- Pinch your nostrils with your thumb and forefinger for 10 minutes.
·- Spit out the blood that gets into the throat. Never swallow as this will cause unnecessary vomiting.
After the bleeding has stopped:
· - Try to prevent the causes of nasal irritation, do your best to avoid sneezing, coughing.
- Nasal ice packs may be used, although there is no conclusive evidence for this.
· - Humidify the air in your room. Dry air is another unfavorable factor in terms of possible nosebleeds.
Anterior nosebleed - doctor's help
- Minor bleeding from the nose that has stopped does not require treatment at all.
- If the source of bleeding, the blood vessel is well visualized, the doctor can cauterize it with the help of special chemicals, for example, silver nitrate. Cauterization is an effective method if there is bleeding from the vessels of the Kisselbach zone of the nasal septum.
- In more complex cases, tamponade of the nasal cavity is required. The idea is to put pressure on the walls of the nasal cavity, on bleeding vessels with the help of tampons installed in the nasal cavity, and thereby stop the bleeding. There are other options for stopping bleeding, for example, a hemostatic sponge, special tubes with inflatable cuffs, and so on, the decision to use which one of them is up to the doctor.
· - After tamponade and complete stop of nasal bleeding, in most cases, patients are discharged for outpatient aftercare. Tampons in the nose remain, as a rule, for 2-3 days. Patients are required to receive antibiotics and drugs that enhance blood clotting.
Posterior nosebleed - doctor's help
- The very fact of posterior nosebleeds is an indication for urgent hospitalization. Most often, posterior nosebleeds do not stop on their own. The use of anterior tamponade, as in the case of anterior nosebleeds, is generally ineffective in these cases. In such cases, the so-called posterior nasal tamponade is used. It is carried out with the help of special pre-prepared tampons for the posterior tamponade of the nasal cavity.
·- However, given the fact that this is a rather painful process, posterior tamponade requires some preparation, meaning the use of sedatives and painkillers
- Posterior tamponade, as a rule, remains in place for 2 to 3 days. If the bleeding does not stop, then the issue of surgical treatment using an endoscope is decided. As a rule, in most cases, it is possible to visualize the source of bleeding and stop bleeding by coagulation or clipping.
Your Steps After Stopping a Nosebleed
·- No matter how hard it is for you, do not try to remove the nasal swab.
- Try to avoid any irritation of the nose. Don't blow your nose. Try your best not to sneeze or cough. Avoid any activity that can raise your blood pressure.
- If possible, do not take drugs that can disrupt your clotting system, such as ibuprofen, naproxen, thromboass, warfarin.
with the right treatment tactics, the prognosis is almost always favorable.