Epistaxis is the medical term for bleeding from the nose. It is believed that nosebleeds are caused by a broken fragile blood vessel in the nose, which could be caused by a minor injury or an infection.
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Epistaxis is the medical term for bleeding from the nose. It is believed that nosebleeds are caused by a broken fragile blood vessel in the nose, which could be caused by a minor injury or an infection.
Anyone can have a nosebleed, but they are slightly more common in men than women. They tend to affect the elderly and are also very common in children, with over half of children between the ages of 6 and 15 years old having regular nosebleeds.
They can happen anytime – usually unexpectedly – but are more likely to occur in the morning or late evening.
It is believed that nosebleeds are caused by a broken fragile blood vessel in the nose, which could be caused by a minor injury or an infection.
The risk of nosebleeds is also increased by:
Drinking a lot of alcohol
Antithrombotic medication such as aspirin, warfarin, clopidogrel and apixaban. These are often prescribed to patients with heart disease and affect the way blood clots. If you are taking one of these medications, speak to your doctor if you start to have nosebleeds.
Blood clotting problems – if you find you bleed for a long time after minor cuts or if your skin bruises easily, you should speak to your doctor as you may need blood tests to investigate how long your blood takes to clot.
In children, a minor skin infection called Staphylococcus Aureus can cause crusting inside the nose. This may be transferred to the inside of the nose by the child’s finger when they pick their nose, a common childhood habit, which can damage the nose lining and lead to nosebleeds.
Nosebleeds are particularly common in childhood, but adults aged 45 and over are also more likely to experience them, as are pregnant women and people with high blood pressure.
Between the ages of 45 and 80, blood may take longer to clot, resulting in excessive bleeding when a blood vessel in the nose is damaged.
Anyone who uses anticoagulant medications for heart conditions (i.e. aspirin and warfarin) is at a greater risk of frequent epistaxis (aka recurring nosebleeds).
Many women experience nosebleeds during pregnancy due to hormonal changes and increased blood flow – placing greater pressure on the delicate blood vessels in the lining of the nose.
A condition called pregnancy rhinitis usually affects women in the first trimester. This is where the mucous membranes in the nose swell and become inflamed, causing congestion, stuffiness, and sometimes nosebleeds.
Hereditary haemorrhagic telangiectasia (HHT) is a genetic disorder that affects how blood vessels form.
Adults with HHT have some blood vessels that haven’t developed properly – causing frequent nose bleeding or arteriovenous malformations (AVMs).
People with high blood pressure who consume excessive amounts of alcohol are more likely to suffer from nose bleeds.
Alcohol is a natural blood thinner. Excessive amounts can cause dehydration and, in turn, dry the nasal passages out – increasing the risk of epistaxis.
Patients who have recently undergone surgery on their nose (i.e. rhinoplasty, septoplasty, or septorhinoplasty) may experience bleeding – usually as a result of the incisions made, use of blood thinners, or outside impacts.
Other possible nosebleed causes in adults include:
A deviated septum
Colds and infections that cause repeated coughing, sneezing, and nose-blowing
Rhinosinusitis and allergies cause the inflammation of the nasal lining
Recreational drugs, such as cocaine, that are inhaled through the nose
High altitudes and changes in temperature and humidity
Frequent use of nasal sprays containing decongestants and antihistamines can dry out the nasal membranes
Nosebleeds are not usually a cause for concern – unless you’re having them frequently!
If nosebleeds are a regular occurrence, it could be a sign of an underlying medical issue – so you need to see a doctor or an ear, nose, and throat (ENT) specialist as soon as possible.
In most cases, frequent epistaxis (the medical term for recurring nosebleeds) is caused by the rupture of the blood vessels in the nose or an abnormal growth (tumour or polyp) in the nose or sinuses.
When nosebleeds can’t be treated at home, an ENT specialist can rule out diagnoses by examining you and checking your medical history, including any medication you’re on.
They can also assess your symptoms (e.g. anaemia) and look into your family history for conditions, such as hereditary haemorrhagic telangiectasia (HHT) which causes abnormal blood vessel formation, resulting in your blood not clotting properly.
When it comes to epistaxis management, there are a few things an ENT specialist will advise patients do to stop the bleeding.
Sit up. This will prevent the blood from running down the back of your throat – causing nausea, vomiting, and diarrhoea.
Lean forward. This decreases blood flow through the nasopharynx, allowing you to spit out any blood in your mouth – preventing you from swallowing it.
Pinch the soft part of your nose. Using your thumb and index finger, firmly pinch either side of the nostrils for 10-15 minutes without releasing pressure to help stop the bleeding.
Apply a cold compress or ice pack. Holding an ice pack against the bridge of the nose can help narrow blood vessels and slow the bleeding.
Avoid lying down. Staying in an upright position will reduce the blood pressure in the blood vessels, helping to reduce further bleeding.
If bleeding persists, your ENT doctor may suggest further epistaxis management, such as inserting a nasal pack into the nasal capacity to apply pressure to the septum to stem the bleeding. A contralateral nasal pack may also need to be inserted.
One thing to note about epistaxis management is that nasal packs must be left in the nose for at least 24-hours to ensure the bleeding vessel has stopped and coagulated. After removing the pack, your ENT doctor will inspect the nasal cavity to determine whether cauterisation is required.
If nasal packing doesn’t stop the nosebleed, the blood vessels can be ligated surgically or embellished radiologically.
For more information about epistaxis management, contact us today.
Stress affects us all in different ways.
Some people bite their nails while others grind their teeth or crack their knuckles when they feel anxious about something.
You may feel the need to blow your nose incessantly, or you might find yourself picking your nose more often when you’re stressed out. This can cause irritation and ultimately lead to a nosebleed.
The stress hormone, cortisol, can help in various scenarios – triggering the ‘fight or flight’ response and sharpening senses when under pressure. However, this constricts blood vessels and causes the blood flow to redirect to the muscles.
When the blood vessels in the nose constrict, they can rupture – causing a stress-related nosebleed.
Stress is a part of daily life.
But, to prevent your nose from bleeding every time you feel tense, try to reduce your stress levels by keeping hydrated, drinking less caffeine, spending time outdoors, taking time to relax, and practising breathing exercises – in and out slowly through the mouth.
Do you often wake up to find blood on your pillow?
Many people have nosebleeds at night while they’re sleeping and the causes are often the same as nosebleeds that occur during the daytime.
For example, if the humidity levels are low in your bedroom, it can dry out the membranes on the inside of your nose. At night, when you’re not drinking water or breathing through your mouth, the blood vessels can rupture and cause bleeding.
Another reason why you might have a nosebleed when sleeping is that you’re suffering from a cold or you have allergies – especially if you’ve been blowing your nose non-stop during the day.
To prevent a nosebleed at night, consider using a humidifier, especially during the winter, to stop the air from drying out and causing irritation in the nose.
Most nosebleeds are minor and can be treated without the need to see a doctor.
With careful epistaxis management, bleeding should stop following application of pressure by pinching the fleshy part of the nose for 15 minutes. If it does stop then no further treatment is necessary, although you should avoid strenuous exercise or straining on the toilet for a few days after nosebleeds.
If you have minor bleeding that you can stop by applying pressure, but it occurs regularly, then you should consult your doctor for advice.
If bleeding does not stop after 15 minutes of applying pressure and is severe, you should see an ENT doctor immediately.
There are several ways epistaxis can be treated.
If the cause of your nosebleeds is crusting and infection inside the nose, then your doctor can prescribe an antiseptic cream. One such cream (Naseptin) contains peanut oil so a different option (Bactroban) is used for patients with a peanut or soy allergy. These creams are effective in treating nosebleeds, particularly in children, but may need repeated treatments for several weeks at a time.
In specific circumstances, e.g. if you are taking warfarin, your nose bleed may be treated using packing, which involves putting packs of sponge or material into the nose to stop the bleeding. You may need to be admitted and stay in hospital for a few days with the packs in place, after which your doctor will discuss your warfarin prescription with you.
In most other circumstances, ‘direct’ treatment can be used, which is a very effective and non-painful procedure. An example of this is to use modern technology to find the location of the bleeding in your nose and stop it by ‘sealing it off’ using a chemical called silver nitrate. This is applied to the lining of the nose, usually after applying local anaesthetic solution.
Diathermy is another example of ‘direct’ treatment that is successful for treating nosebleeds and involves passing a very weak electric current across the affected blood vessel. This is performed using a small telescope, which allows your consultant to find the damaged blood vessel and stop the bleeding and is usually carried out under local anaesthetic.
In uncommon cases, the above may not be successful and rhinoplasty surgery may be required. Many different options are available, and they are quite complicated. Your consultant will explain these in detail and help you to decide which is the best procedure for you. Some examples include:
Using telescopes and diathermy to stop bleeding from deep within your nose
Sphenopalatine artery ligation – sealing off the main blood vessel in your nose which is located behind your cheek. This, again, uses telescopes and avoids the need to cut the skin around your nose.
Embolisation – passing small guidewires along a blood vessel from your leg up into your nose and using fine mesh or glue to seal the blood vessels.
The team at OneWelbeck has extensive knowledge and experience when it comes to epistaxis management.
Booking an appointment with our specialists will enable us to find out more about your nosebleeds and why you might be having them, before offering a suitable solution to manage them.
To find out more about the treatments we offer for patients with frequent epistaxis, get in touch today.
Nosebleeds can happen at any time – causing embarrassment and inconvenience.
Although they can be caused by various factors, it’s important to monitor how often they occur.
If you experience more than 3-4 nosebleeds a week (or 6 or more in a month), we highly recommend booking an appointment at our ENT clinic, so our specialists can rule out any underlying medical conditions.
Our ENT doctors will discuss the treatment options for epistaxis management, taking into consideration your health, lifestyle, and budget requirements.
Sad but true, frequent epistaxis can be a symptom of cancer.
Leukaemia is a type of blood cancer that affects the bone marrow and its ability to produce normal blood cells. Symptoms often include fatigue, a pale complexion, shortness of breath, bruising, and bleeding from the nose, gums, and stools.
Nasopharyngeal cancer develops in the nasopharyngeal which connects the back of the nose to the back of the mouth. Symptoms include a lump or growth in the neck area (lasting more than 3 weeks), hearing loss and ringing in the ears (tinnitus), headaches, difficulty swallowing, stuffy nose, double vision, facial numbness, and nosebleeds.
Nosebleeds are also common symptoms of nasal and sinus cancer, along with a persistent stuffy nose affecting one nostril, a lack of smell, bloody mucus running from the nose, and mucus draining to the back of the nose and throat.
To determine if your epistaxis is a sign of cancer or any other medical condition, contact our ENT consultants today.
Nosebleeds can happen at night for exactly the same reasons as nosebleeds in the day.
This includes:
Dry air – the blood vessels in the nose are sensitive to dryness. While you’re breathing through your mouth when you sleep, the membranes are more likely to crack and the blood vessels bleed.
Allergies – if you suffer from allergies or hay fever, you might have spent the most part of the day sneezing, irritating the nasal passages and making them more prone to bleeding (especially when you lie down).
Medications – anyone who takes blood thinners or aspirin is at a greater risk of epistaxis, as these are designed to prevent blood clots – making you bleed more easily and taking longer to stop.
If you sleep with your head to one side, this can also put pressure on the nasal cavity – much like a cold, allergies, and changes in pressure, humidity, and temperature – causing your nose to bleed.
To stop your nose from pumping out with blood, you need to firmly pinch the soft part of your nose (also known as the alae).
This is just below the bony nasal bridge and above the nostrils.
You’ll need to use your thumb and index finger and squeeze them against the septum – applying pressure for at least 10-15 minutes.
Make sure you remain in an upright position, tipping your head forward slightly to stop blood draining down your throat.
If you get any blood in your mouth, simply spit it out.
For more tips on epistaxis management, contact our specialists.
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