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Nosebleed

life science Maturity 7-9 Next article →

A nosebleed, known medically as epistaxis, occurs when small blood vessels in the nasal mucosa rupture. The nasal mucosa is the soft lining inside the nose. This lining contains a very rich blood supply. Because these vessels are near the surface, they can break easily. Most nosebleeds are minor and stop on their own. However, some cases can be more severe.

Boxing children - bloody nose
Boxing children - bloody nose

In rare instances, blood may flow down the throat into the stomach. This can cause nausea or vomiting. Very rarely, blood may even travel through the nasolacrimal duct. This is the tube that connects the nose to the eye. If this happens, it can produce bloody tears.

There are two distinct types of epistaxis based on where the bleeding starts. The first type is an anterior nosebleed. This is the most common type. It usually occurs in the front part of the nose at a site called Kiesselbach's plexus. This area is also known as Little's area. The second type is a posterior nosebleed. This type is less common but is more serious. It occurs further back in the nasal cavity. These bleeds often come from the sphenopalatine artery or Woodruff's plexus.

Arteries of the Nose
Arteries of the Nose

Posterior bleeds are often harder to control. They may cause blood to flow out of both nostrils.

Many factors can cause the blood vessels to rupture. Trauma is a very frequent cause. This includes blunt trauma, such as a punch to the face. It also includes digital trauma, which is nose-picking. Children may also insert foreign objects into their noses. Environmental factors play a large role as well. Low humidity or dry weather can dry out the nasal lining. This makes the tissue thin and more likely to bleed. Respiratory infections, such as chronic sinusitis or rhinitis, can also cause inflammation. This inflammation makes the blood vessels more vulnerable to breaking.

Medical conditions and medications can also increase the risk. Some people take blood thinners, also called anticoagulants, like aspirin or warfarin. These drugs make it harder for blood to clot. High blood pressure can also increase the duration of a nosebleed. Certain rare conditions, known as coagulopathies, affect how blood clots. These include Hemophilia and Von Willebrand's disease. Some people may also experience bleeding due to tumors. These are rare and can be found in the sinus area or at the base of the brain. Tumors might also cause other symptoms like vision or hearing problems.

Most people will experience a nosebleed at some point. Statistics show that about 60% of the population has had one. Nosebleeds are most common in children under age 10. They are also common in adults older than age 50. While they can look scary, they are rarely life-threatening. In 1999, nosebleeds accounted for only 4 deaths out of 2.4 million in the U.S. Only about 10% of nosebleeds are considered serious. Because of this, only about 6% of patients actually seek medical attention for epistaxis.

If a nosebleed starts, there are specific ways to treat it. The first step is to apply direct pressure. You should pinch the soft, anterior part of the nose. Do not pinch the bony bridge of the nose. You should hold this pressure for at least five to thirty minutes. It is important to tilt your head forward. Do not tilt your head back. Tilting forward prevents blood from entering the airway or stomach. For mild cases, doctors may use chemical cauterization. This involves using silver nitrate to seal the bleeding vessel. This process causes a small amount of tissue death to close the break.

If pressure does not work, doctors use nasal packing. This involves placing material inside the nose to apply pressure from within. Some materials are dissolvable. These use thrombotic agents to help blood clot. Other materials are non-dissolvable, such as Merocel or the Rapid Rhino. Merocel is a synthetic foam that expands with water. The Rapid Rhino uses a balloon catheter that is inflated with air. If bleeding continues despite packing, surgery may be required. A surgeon can perform an endoscopy to find the bleeding point. They can then ligate, or tie off, the specific blood vessel to stop the flow.

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File:Boxing children - bloody nose.jpg
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File:Arteries of the Nose.jpg
Arteries of the Nose.jpg
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