The nosebleed or epistaxis is the bleeding of the nose, as a result of the rupture of blood vessels running under the nasal mucosa.
There are areas of the nasal septum in which hemorrhage is located in the vast majority of cases, such as in the so-called Kiesselbach locus (located in the antero-inferior area of the septum), due to the fact that the nasal mucosa is very thin and has little fabric underneath, which makes it little elastic.
The factor mentioned, together with the area where it is located, which is frequently subjected to pressure and blows, makes it the origin of 90% of epistaxis.
We should never consider a nosebleed as an unimportant event and not analyze its cause or take appropriate measures as soon as possible, as it can be impossible to contain and lead to serious health consequences.
The most intense nosebleeds come from the back or posterior part of the nasal septum, being more frequent in adults.
Collectively, nosebleeds appear more often in children.
Why is it produced?
There are two distinct groups of causes of nosebleeds.
Those produced by injuries or disease of the nasal mucosa itself:
- Idiopathic: It usually appears in children and young people, is of short duration, small amount and repeated and frequent appearance. The cause has not been found.
- Small trauma or injuries, such as picking the nose, especially in the area of the Kiesselbach locus, which cause single hemorrhages, which do not usually repeat.
- Rhinitis of any cause: By dryness, irritation, atrophy, chemical.
- Environmental factors: Dryness, heating, air conditioning, low atmospheric pressure, staying at high altitudes.
- Trauma leading to nasal and septum fractures.
- Foreign bodies introduced into the nose (common in children): the bleeding is slight but repetitive.
- Benign nasal septum tumor: hemangioma, which bleeds very easily, simply with minimal friction.
- Tumors of the nasal passages or paranasal sinuses: bleed, especially the malignant ones.
- Juvenile nasopharyngeal fibroma: Tumor formed by blood vessels, causing massive hemorrhages; appears in young males.
Nosebleeds are another symptom of a disease of the body that can affect areas other than the nasal passages.
- Arterial hypertension :
As a consequence of the excessive pressure that the blood exerts on the walls of the blood vessel, it can break it. They tend to be repetitive, and are more frequent in middle-aged men.
Flu , measles, common cold. They are usually small.
- Alterations in coagulation and blood components (either due to alteration in platelets or in the clotting mechanism):
Anemia, leukemia, Von Willebrand’s disease, hemophilia, overdose of oral anticoagulants.
- Rendu-Osler disease: mild
bleeding and in many areas of the septum at the same time.
Symptoms and diagnosis of nosebleed
The nosebleed produces, as its name suggests, the exit of blood through the nostrils. This can occur more or less abruptly, depending on the cause that produced it.
The blood can be bright red and come out intermittently, like pulsing, if it comes from an arterial vessel, or very dark and come out continuously if what is bleeding is a vein.
The amount of blood that is expelled may be greater or less depending on the cause of the epistaxis (it is greater in the case of vascular tumors, coagulation disorders or trauma to the face, and very small in nasal foreign bodies or rhinitis).
The blood may come out mixed with mucus or scabs, in the case of rhinitis, or even with pus or foul-smelling mucus, in the case of nasal foreign bodies.
Epistaxis can be accompanied by fever in infectious diseases, headache in hypertensive crises, or bleeding in other areas of the body in cases of alterations or coagulation.
The important thing is not the diagnosis of the nosebleed, which is evident as soon as you see the blood coming out of the nostrils, but rather trying to diagnose the cause of this, with a view to proper treatment and prevention of subsequent episodes.
For this, it is important to know if it is the first time that it occurs or if it has been repeated on other occasions; if there are members in the family to whom this has also happened and on several occasions.
It is necessary to analyze the diseases that the patient has, especially if he suffers from high blood pressure, a disease in which coagulation is impaired (hemophilia, leukemia, Von Willebrand’s disease), rhinitis, or if he takes oral anticoagulants.
It must be taken into account in what situation, place and position the subject was when this happened to him (height, dry environment, heating or air conditioning) and if before it happened something that could be related (he hit his face , picked his nose, sneezed).
Once all the possible information has been collected, it is necessary to try to know the place where the blood may come from, which will be investigated by directly viewing the inside of the anterior part of the nostrils with the rhinoscope.
The throat will also be looked at to see the bleeding path and assess the amount.
Blood pressure and heart rate will be measured, which will give an idea of the blood that has been lost so far and the impact that this is having on the body, as well as the need to take certain treatment measures.
If the bleeding persists, does not subside with the usual treatment measures, or a general illness exists or is suspected, other diagnostic tests will be performed:
- Blood and clotting tests (if anemia is suspected, clotting disorders).
- X-ray of the skull and nostrils (if trauma or tumors are suspected).
- Absolute rest.
- Leaning the body forward and mouth open to expel the blood and not swallow it.
- Squeeze the two nostrils with your fingers for approximately ten or fifteen minutes, to promote the formation of a clot that clogs the bleeding area and stops bleeding.
If after these measures, which anyone can take if they are in this situation, the bleeding has not subsided, or if it subsided but reoccurs in a short period of time, you should consult your doctor, who will carry out a check on the bleeding. blood pressure.
Local measures (on the bleeding area)
- Cleansing the nasal passages from clots.
- Attempt to locate the bleeding point to perform a cauterization with silver nitrate , if it is light bleeding.
- If the hemorrhage does not subside after cauterization or the bleeding is more abundant, an anterior tamponade must be performed, through the nostrils, which consists of the introduction of a gauze inside the nostrils, so that pressure is applied direct to the bleeding area or areas, preventing further bleeding. Plugging can cause headache, dry mouth and throat, watery eyes, and pain that travels to the ear.
- If after a certain time (to be established by the doctor) the bleeding continues, it will be necessary to consider consulting a specialist in otorhinolaryngology, because the next measure would be a posterior tamponade, which sometimes requires admission and general anesthesia: it consists of the introduction of a tube or catheter that ends in a balloon that swells in the area of the nostril that communicates with the throat (posterior area). When the balloon is inflated, the area is compressed, preventing the bleeding from continuing.
- If the bleeding continues despite having taken the previous measures, a ligation of the blood vessel to which the bleeding vessel belongs should be considered, depending on the location of the bleeding.
- In blood diseases or coagulation disorders it is necessary, sometimes, transfusions of various elements of the blood: whole blood, vitamin K , corticosteroids …
How to avoid a nosebleed?
In cases where the cause is in the environment (dryness, low humidity, heating or air conditioning) or in the scratching of the nose, it is easy to prevent its appearance by eliminating the cause.
In hypertensive patients, good blood pressure control will prevent epistaxis from appearing.
When the cause is not known, especially in children, where it is usually trivial or due to weak blood vessels, complications of excessive bleeding or alarm and urgency can be prevented by visiting a doctor, being informed about the measures immediate doses to be taken, with which a significant percentage of nosebleeds cease.
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.