Nosebleed or Epistaxis – Risk factors and Home Remedies.

How can nosebleeds occur?

A nosebleed, in its simplest form, is the loss of blood from the tissue lining your nose.

Nosebleeds, also known as epistaxis, are frequent.

Some 60% of people will have at least one nosebleed in their lifetime. The nose is a common site for damage and nosebleeds due to its central location on the face and the significant number of blood vessels that are close to the surface in its lining.

 

Types of nosebleeds

Nosebleeds are described by the site of the bleed

One is more serious than the other of the two main categories.

An anterior nosebleed begins on the bottom portion of the wall dividing the two sides of the nose, in the front of the nose (called the septum).

This front part of the nose has delicate capillaries and tiny blood vessels that are prone to breaking and bleeding.

The most typical and often non-serious type of nosebleed is this one.

Children are more likely to get these nosebleeds, which may typically be managed at home.

 

Deep inside the nose, there is a posterior nosebleed.

The larger blood vessels in the back of the nose, close to the throat, are bleeding, which is the source of this nosebleed.

Compared to an anterior nosebleed, this one may be more dangerous.

It may cause significant bleeding that runs down the back of the throat.

For a nosebleed of this nature, you could require immediate medical assistance.

Adults are more likely to get this kind of nosebleed.

 

Pathophysiology

Usually, bleeding happens when the mucosa erodes, exposing the arteries, which then break.

The Kiesselbach plexus originates on the septum in Little's region, where more than 90% of bleeding originate anteriorly.

The ICA (anterior and posterior ethmoidal arteries) and the ECA (sphenopalatine and branches of the internal maxillary arteries) meet in the Kiesselbach plexus.

Instead of the profuse blood pumping seen from an arterial origin, these capillary or venous bleeds generate a steady oozing.

Additionally, anterior bleeding can begin anterior to the inferior turbinate.

In the nasal cavity, posterior bleeding develop further back, are typically more severe, and are frequently arterial in origin (eg, from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx).

A posterior source carries a higher risk of airway impairment, blood aspiration, and more challenging bleeding control.

 

What Causes Nosebleed?

The majority of nosebleeds lack an obvious reason.

However, nosebleeds are frequently brought on by trauma to the nose.

Both external nose damage from a blow to the face and internal nasal trauma from nose-picking can result in nosebleeds.

 

The following conditions also increase a person's risk of nosebleeds:

Exposure to warm, dry air for prolonged periods of time,

Sinus and nasal infections,

Allergies, a foreign body in the nose (object stuck in the nose),

Nasal surgery, a deviated or ruptured nasal septum, and cocaine usage are all signs of nasal irritation.

Less commonly, an underlying disease process or taking certain medications may cause a nosebleed or make it more difficult to control.

Blood-thinning pharmaceuticals such aspirin, clopidogrel bisulfate, warfarin (Coumadin), and nonsteroidal anti-inflammatory drugs (NSAIDs) frequently cause the blood's inability to clot.

Antihistamines and corticosteroids used topically to the nose can occasionally cause nosebleeds.

Other conditions that might affect blood clotting and increase the risk of nosebleeds include liver illness, persistent alcohol use, renal disease, platelet problems, and genetic blood clotting disorders.

Rare causes of nosebleeds include nasal tumors and vascular abnormalities.

Even if it's not always the case, high blood pressure might cause bleeding.

The anxiety brought on by the nosebleed is frequently what causes the blood pressure to rise.

 

Which Children  are most likely to experience a nosebleed?

Children may be more susceptible to nosebleeds if they:

    Lives in a dry climate

    Picks his or her nose

    Has allergies

    Has a cold

 

Warning signs and symptoms

Some symptoms and traits in people who have a nosebleed are cause for concern.

They comprise

Excessive blood loss warning signs (such as weakness, fainting, or dizziness when standing up)

Use of substances that prevent blood from clotting

Symptoms of bleeding disorders or bleeding disorders that are known to exist (such as hemophilia)

Recent nosebleed occurrences, particularly those without a known reason

Aspirin, clopidogrel, warfarin, and more recent medications taken orally (known as novel oral anticoagulant medicines), like rivaroxiban and apixaban, are the most frequently used medications that interfere with blood clotting.

 

Signs of a bleeding disorder include

    Numerous small, purplish spots on the skin (petechiae)

    Many large bruises

    Easily bleeding gums

    Bloody or tarry stools

    Coughing up blood

    Blood in the urine

    Excess bleeding while brushing the teeth, having blood tests, or suffering minor cuts

    Heavy menstrual periods in women

 

Complications

Epistaxis complications can include the following:

Sinusitis

Hematoma/perforation of the septum

Nasal malformation on the outside

Pressure necrosis of the mucosa

Vasovagal incident

Migration of balloons

Aspiration

 

Diagnosing a Nosebleed

Your doctor will perform a physical examination if you go to the hospital with a nosebleed to identify the cause.

They'll look for evidence of a foreign item in your nose.

Your medical background and current medications will also be discussed.

Inform your doctor of any additional symptoms you experience as well as any recent wounds.

The reason of a nosebleed cannot be identified by a single test.

To determine the cause, your doctor may carry out diagnostic procedures.

These tests consist of:

A blood test called a complete blood count (CBC) is used to look for blood diseases.

A blood test called the partial thromboplastin time (PTT) measures how long it takes for your blood to clot.

The nasal endoscopy

Face and nose X-rays and a CT scan of the nose

 

What are the treatments for Nosebleed?

Depending on the cause, treatments could include:

Nasal packing . Gauze, special nasal sponges or foam or an inflatable latex balloon is inserted into your nose to create pressure at the site of the bleed. The material is often left in place for 24 to 48 hours before being removed by a healthcare professional. 

Cauterization. In this procedure, the leaking blood vessel is sealed by using either a chemical (silver nitrate) or thermal energy (electrocautery).

To first numb the inside of your nose, a local anesthetic is shot inside the nostril.

Fresh or modified prescriptions for medications.

Cutting back on or stopping blood thinner use can be beneficial.

Additionally, blood pressure medicines can be required.

A blood clotting aid called Tranexamic (Lystedaâ) may be prescribed.

If a foreign object is what's causing the nosebleed, have it removed.

Surgical repair of a broken nose or correction of a deviated septum if this is the cause of the nosebleed.

Ligation.

In this procedure, the blood vessel that is causing the bleeding is tied up to stop it.

 

Home remedies

Stopping the bleeding is the first thing to do.

Sit down and pinch the soft parts of the nose firmly, breathe through the mouth.

 Lean forward (not backward) to prevent blood from draining into the sinuses and throat, which can result in inhaling the blood or gagging.

 Sit upright so that the head is higher than the heart; this reduces blood pressure and slows further bleeding.

 Continue putting pressure on the nose, leaning forward, and sitting upright for a minimum of 5 minutes and up to 20 minutes, so that the blood clots. If bleeding persists for more than 20 minutes, medical attention is required.

 Apply an ice pack to the nose and cheek to soothe the area and avoid strenuous activity for the next few days.

People are advised to get medical help if they frequently get nosebleeds (which could be a sign of an underlying issue), have suffered a head injury, take anticoagulants (medications that thin the blood), or have had an injury to the head and the bleeding does not stop.

How to prevent nosebleeds?

When you blow your nose (especially when you have a cold), do so gently into a soft tissue. Don’t blow forcefully or pick your nose.

 Your doctor may recommend a cool-mist humidifier to moisten your indoor air.

Saline nasal spray or gel, petroleum jelly, or antibiotic ointment can be gently applied around the nostril openings to keep the interior of the nose wet.

When participating in sports that can harm the nose, wear protective sporting gear.

There's no need to panic if you occasionally experience a nosebleed because you now know what to do.