Nosebleed

Nosebleed is a common problem. Most cases arise spontaneously and in such case it is usually not significant issue. However, sometimes it can be just a symptom of another disease and that is why some information about nosebleed is really helpful.

Causes

Blood usually leaks from major vessels that run within walls of nasal cavity. The location most vulnerable to bleeding is so-called Kiesselbach’s plexus located in frontal part of nasal cavity in the area of nasal septum. Bleeding from back part of nasal cavity is much less common. Causes of blood vessels disruption may be multiple and usually they are combined.

Vessel fragility

This is the reason of more frequent nosebleed in children whose nasal blood vessels are more fragile than by adults. In addition, blood vessels are more fragile by lack of vitamin C. Vitamin C is essential for connective tissue formation that is an important part of blood vessel walls. When there is vitamin C deficiency, blood vessels tend to crack easily.

Injuries

A punch in the nose is usually followed by bleeding. But it is not always the violence, bleeding from the nose normally occurs by picking nose and pushing various objects into nostrils, so typical for small children.

Infections

Infectious processes (common cold, sinusitis) usually result in formation of mucus and by bacterial infections in pus formation. Blood vessels may be damaged by inflammation and then bleeding occurs.

Allergies

Common allergic rhinitis leads to irritation of nasal mucosa. When this condition is chronic, mucosa may get atrophic or, on the contrary, it proliferates by emergence of nasal polyps. In both cases, disturbed mucosa is susceptible to bleeding.

High Blood Pressure

Increased blood pressure can easily cause bleeding from small blood vessels of the nasal cavity. If fluid flows through a pipe under high pressure, the chance is higher that pipe’s wall is going to break.

Certain drug abuse

This includes regular and excessive drinking of alcohol that dilates blood vessels and makes them prone to bleeding. Snorting cocaine typically causes nosebleed. Cocaine damages the lining of nasal cavity including arteries and this leads to nosebleed.

Blood clotting disorders

Some disorders are congenital like Von Willebrand disease and hemophilia. Most disorders are, however, induced by anticoagulant drugs. Coagulation is also disrupted by bone marrow pathologies like aplastic anemia or leukemia.

Nasal cavity tumors

Malignant and benign tumors may grow in nasal cavity as elsewhere in the body. This is, however, a relatively rare cause of nosebleed and there is no need to worry about it much.

Symptoms

The blood flows from one or both nostrils. However, if affected person bends his or her head backward, blood flows into nasopharynx. Out of nasopharynx it can get into mouth (where we feel its taste) and subsequently it can be swallowed or aspirated. Swallowing larger amount of blood is undesirable because it can reflexively activate the vomiting reflex. Chronic blood loss caused by nosebleed could theoretically provoke symptoms of anemic syndrome (fatigue, dizziness, pallor, etc.) but it is very rare.

Diagnostic approach

Simple and uncomplicated bleeding is not a reason to visit a doctor. Frequent, prolonged or poorly stoppable bleeding may suggest pathology and it is advisable to visit an otolaryngologist. The otolaryngologist can look for the source of bleeding. It is also important to measure blood pressure that is a typical cause of nosebleed by older people. When there are frequent and strong nosebleeds it is wise to perform some blood tests to exclude coagulation disorders.

Treatment

As first aid, it is important to press the nose on both sides with your fingers or with a handkerchief soaked in cold water, breathe through your mouth and gently bend your head. We want to prevent blood flowing down to nasopharynx, where it can be swallowed (risk of inducing vomiting), or inhaled (risk of suffocation). Coldness causes reflexive vasoconstriction and eases blood clotting. Doctor should be asked for help if bleeding still persists. An otolaryngologist can find the bleeding site and stop it by various means (thermal cautery, nasal tamponade, etc.).