Nosebleed (Epistaxis): Causes, Treatment and Prevention

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Doctor who take care of women who suffer from nosebleed

1Overview

The nasal is extremely vascular, which means that it has a very large blood supply.
The blood to the nasal cavity is supplied by many arteries, which includes posterior and anterior ethmoid arteries.

About 5 to 10 percent of all nosebleeds or epistaxis come from the posterior nasal cavity. Having a nosebleed is commonly seen in children and it’s just mild. Sometimes, however, the nosebleed can become severe, which is commonly seen in adults with underlying medical conditions.

Epistaxis or nosebleed is characterized as the bleeding from the nostril, nasopharynx and nasal cavity. Usually, the nosebleed is due to the bursting of a blood vessel in the nasal area. This can happen spontaneously or by trauma.

According to statistics, about 60 percent of the total population can be affected by nosebleed at some point in their lives.  About 6 percent require urgent medical attention.

2Causes

The most common site of a nosebleed is the entrance of the nostrils – the nasal septum.
In this area, the blood vessels are delicate and can easily rupture without any reason.
The most common causes of a nosebleed include:

Deviated septum – The septum is the middle part of the nostrils. If it’s shifted to the other side, the air flow to the nostrils is impeded. When this happens, the narrower side will become cracked and dry, increasing bleeding risk.

Hot and dry climate indoors – Nosebleeds are common in some parts where heaters are used during the winter. The dry and hot indoor air causes the fragile skin in the nasal area to become dry and cracked.

Colds or allergiesFor people with respiratory infections that affect the nasal area, there is noted inflammation in the nose. This can increase bleeding risk and when there is colds or congestion, the blood vessels tend to widen, making them more susceptible to injury and bleeding.

Trauma to the nose – The most common cause of a nosebleed is caused by trauma to the nose.

Irritating chemicals – The exposure to irritating chemicals can cause nose bleeding. One of the main culprits is cigarette smoke or even secondhand smoke. In some cases, those who are exposed to ammonia, gasoline and sulfuric acid at work can lead to epistaxis.

Too much alcohol drinking – Heavy alcohol use may lead to nose bleeding. Alcohol interferes with the normal function of clotting factors and platelets in the blood. This leads to superficial blood vessels to dilate and making them vulnerable to injury and bleeding.

Medications – Some medications may interfere with the platelets, clotting factors and blood clotting, making the person at risk for bleeding. The medicines include anticoagulants and nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and aspirin.

Medical conditions – Some medical conditions may increase the risk of bleeding such as kidney failure, liver disease, high blood pressure, hemophilia, thrombocytopenia and other hereditary bleeding disorders.

Other causes:

  • Picking the nose
  • Cocaine use
  • Vigorous blowing the of the nose
  • Inability of the blood to clot due to blood-thinning drugs like warfarin, aspirin and clopidogrel bisulfate

3How to stop a nosebleed?

The most effective way to stop epistaxis is by applying direct pressure to the front of the nose. For nose bleeding caused by colds and allergies, it’s recommended to take nasal decongestants and antihistamines. For those who are prone to epistaxis because of dry skin in the nostrils, applying Vaseline or another ointment will help moisturize the nose.

Here are the other tips for stopping nosebleeds:

  • Sit down and pinch the soft part of the nose for approximately 10 to 15 minutes.
  • Lean slightly forward and breathe through the mouth to allow the blood to drain in the nose.
  • Apply cold compress on the then nose bridge.
  • Do not lie down to reduce the blood pressure in the blood vessels of the nose, as this will reduce further bleeding.

In worse cases, chemical cauterization with silver nitrate can be used to control nose bleeding. If this fails to stop bleeding, packing is also an option. For complicated cases, one method that can be used is the angiographic embolization of the internal maxillary artery, which has an estimated success rate of 71 to 95 percent. However, the procedure may have a risk of stroke, facial nerve palsy, hematomas, stroke, and ophthalmoplegia.

Nosebleed during pregnancy

Pregnancy can make the blood vessels in various parts of the body dilate. Also, there is an increase in blood volume. The increased blood supply places more pressure on the fragile vessels in the nose, making them rupture faster and more easily. Hence, epistaxis or nose bleeding is very common during pregnancy.

Nosebleeds are common in pregnancy because of some hormonal changes. These nosebleeds are usually short but in some cases, they can be a little heavy. Though it’s frightening, as long as you don’t lose too much blood, it’s harmless.

When a pregnant woman experiences a nosebleed, it can be light or heavy and may last for about a few seconds to many minutes. Also, during pregnancy, you will experience more colds than usual, further increasing the risk of bleeding.

In fact, about 20 percent of pregnant women experience nose bleeding compared to just 6 percent in women who are not pregnant. For most pregnant women, however, the occasional nosebleeds are just normal and harmless.

The risk of nose bleeding will increase when the pregnant woman has colds, high blood pressure, a sinus infection or allergies. The reason behind nose bleeding during pregnancy is swelling. Pregnant women are prone to feeling stuffy sue to pregnancy edema. The female hormones, particularly progesterone and estrogen, increase the flow of blood to the mucous membranes of the body, including the nose. The mucous membranes in your nose will soften and swell, which will make the area delicate. When the woman will sneeze or there is even a slight trauma, it will lead to nose bleeding.

How to stop a nosebleed during pregnancy

Here are the ways to stop a nosebleed in a pregnant woman:

  • Sit down and lean forward a little. However, keep the head higher than the heart.
  • Just like in nose bleeding in non-pregnant women, pinch the soft lower part of the nose with your thumb and index finger. Squeeze it for about 10 to 15 minutes.
  • Apply ice on the nose bridge.

You can seek medical attention of the nose bleeding happens when you have high blood pressure if it continues even after you did all the steps earlier and the blood flow is severe.

4Nosebleed prevention

  • Hydrate by drinking plenty of fluids. This will help keep the mucous membranes moisturized, reducing the risk of epistaxis.
  • When you have colds, never blow your nose vigorously. Blowing too hard may lead to a nosebleed. Blow the nose gently. Also, keep the mouth open when sneezing to allow the pressure to be distributed.
  • If the climate is warm and dry, use a humidifier to prevent dryness of the skin in the nose. Vaseline or petroleum jelly is also effective.
  • If the doctor prescribes a medical nose spray, make sure you follow the instructions to prevent using it improperly. These drugs can dry and irritate the nasal area.
  • Use saline or saltwater nose drops to spray to keep the area moisture.
  • Do not pick your nose or put anything inside the nasal area.
  • Do not lift heavy objects or strain after an episode of nose bleeding.
  • Use prescription medicines like blood thinners such as warfarin, enoxaparin, and clopidogrel properly and as prescribed.
  • Limit the use of aspirin and NSAIDs, since they increase the risk of bleeding. You can take paracetamol and acetaminophen for pain.
  • If you have high blood pressure, keep it maintained and under control. This will help reduce the risk of nosebleeds.
  • Avoid smoking because it can slow down healing and can irritate the nasal passages.
  • Avoid illicit drugs like amphetamines and cocaine.
  • When blowing the nose, use the right blow technique. Use the thumb to close one nostril and gently blow out one side. Repeat the procedure with the other side.
  • Ask your doctor about the medications you can use for your colds and stuffiness. Make sure you will consult with a doctor before taking any medications because some drugs can harm the baby.
  • Try using a humidifier to moisten the air. This can be used specifically during the winter season when the air is dry and warm indoors due to heaters and heating systems.
  • Boost your intake of vitamin C. Talk with your doctor about taking an extra dose of vitamin C during pregnancy to make the capillaries and arteries stronger. This will help reduce the risk nose bleeding. Pregnant women can also increase their daily dosage of vitamin C by eating more fruits and vegetables rich in the vitamin-like tomatoes, bell pepper, and kiwi.
  • Lean forward during a nosebleed and do not lean back. This will promote the drainage of blood out of the nostrils and not into the back of the throat. If bleeding continues, make sure you seek medical attention right away.