Often nose bleeding
Nosebleed | NHS inform
About nosebleeds
Nosebleeds can be frightening, but they aren't usually a sign of anything serious and can often be treated at home.
The medical name for a nosebleed is epistaxis.
During a nosebleed, blood flows from one or both nostrils. It can be heavy or light and last from a few seconds to 15 minutes or more.
What to do
To stop a nosebleed:
- sit down and firmly pinch the soft part of your nose, just above your nostrils, for at least 10 to 15 minutes
- lean forward and breathe through your mouth – this will drain blood into your nose instead of down the back of your throat
- place an ice pack or bag of frozen vegetables covered by a towel on the bridge of your nose
- stay upright, rather than lying down, as this reduces the blood pressure in the blood vessels of your nose and will discourage further bleeding
If the bleeding eventually stops, you won't usually need to seek medical advice. However, in some cases you may need further treatment from your GP or in hospital.
Read more about treating nosebleeds
When to seek medical advice
Non-urgent advice: Contact your GP practice if:
- you're taking a blood-thinning medicine (anticoagulant) such as warfarin or have a clotting disorder such as haemophilia and the bleeding doesn't stop
- you have symptoms of anaemia such as heart palpitations, shortness of breath and a pale complexion
- a child under 2 years of age has a nosebleed
- you have nosebleeds that come and go regularly
If your GP practice is closed, phone 111.
Immediate action required: Go to your nearest accident and emergency (A&E) or phone 999 if:
- the bleeding continues for longer than 20 minutes
- the bleeding is heavy and you've lost a lot of blood
- you're having difficulty breathing
- you swallow a large amount of blood that makes you vomit
- the nosebleed developed after a serious injury, such as a car crash
What causes nosebleeds?
The inside of your nose is full of tiny, delicate blood vessels that can become damaged and bleed relatively easily.
Common causes of nosebleeds include:
- picking your nose
- blowing your nose very hard
- a minor injury to your nose
- changes in humidity or temperature causing the inside of the nose to become dry and cracked
Occasionally, bleeding can come from the blood vessels deeper within the nose. This can be caused by a blow to the head, recent nasal surgery and hardened arteries (atherosclerosis).
Read more about the causes of nosebleeds
Who gets nosebleeds?
Nosebleeds are fairly common and most people will experience them every now and again. Anyone can get a nosebleed, but they most often affect:
- children between 2 and 10 years of age
- elderly people
- pregnant women
- people who take blood thinning medication such as aspirin or anticoagulants, such as warfarin
- people with blood clotting disorders, such as haemophilia
Bleeding may also be heavier or last longer if you take anticoagulants, have a blood clotting disorder, or have high blood pressure (hypertension).
Are nosebleeds serious?
Nosebleeds aren't usually serious. However, frequent or heavy nosebleeds may indicate more serious health problems, such as high blood pressure or a blood clotting disorder, and should be checked.
Excessive bleeding over a prolonged period of time can also lead to further problems such as anaemia.
If your GP suspects a more serious problem is causing your nosebleeds, they may refer you to an ear, nose and throat (ENT) specialist for further tests.
Preventing nosebleeds
There are things you can do to prevent nosebleeds.
Do
- avoid picking your nose and keep your fingernails short
- blow your nose as little as possible and only very gently
- keep your home humidified
- wear a head guard during activities in which your nose or head could get injured
- always follow the instructions that come with nasal decongestants – overusing these can cause nosebleeds
Talk to your GP if you experience nosebleeds frequently and aren't able to prevent them. They may refer you to an ENT specialist for an assessment.
Causes of nosebleeds
Nosebleeds can be caused by a number of different things. It's not always possible to identify the exact reason why one occurs.
Nosebleeds can start just inside your nostrils (anterior) or at the back of your nose (posterior). These different types of nosebleeds tend to have different causes.
Anterior nosebleeds
The vast majority of nosebleeds are anterior nosebleeds, which means the bleeding comes from the wall between the two nose channels (the lower septum), just inside your nose. This part of the nose, known as Little's area, contains many delicate blood vessels that can be easily damaged.
The cause of anterior nosebleeds is sometimes unknown, but they can be caused by a number of things, including:
- picking your nose, particularly if you scratch the inside of your nose with a sharp fingernail
- blowing your nose very hard
- a minor injury to your nose
- a blocked or stuffy nose often caused by an infection such as a cold or flu
- sinusitis – an infection of the small, air-filled cavities inside your cheekbones and forehead
- dry air or an increase in temperature drying out the inside of your nose
- hay fever or other allergies
- high altitude
- excessive use of nasal decongestants
- a crooked nasal septum that's either present from birth (congenital) or the result of an injury (a deviated septum)
Anterior nosebleeds are more common in children and are not usually a sign of anything serious. They can often be treated easily at home.
Read more about treating nosebleeds
Posterior nosebleeds
A small number of nosebleeds are posterior nosebleeds, which means the bleeding originates from branches of arteries that supply blood to the space inside your nose between the roof of your mouth and your brain (nasal cavity).
These nosebleeds are more common in adults than children. They can be more serious than anterior nosebleeds and bleed more heavily. Medical attention may be required.
Causes of posterior nosebleeds include:
- a blow to your head, or a fall
- a broken nose
- recent nasal surgery
- hardened arteries (atherosclerosis)
- medicines that cause you to bleed more easily, including aspirin and anticoagulants such as warfarin and heparin
- a tumour in the nasal cavity
- a blood clotting abnormality – such as haemophilia or von Willebrand disease
- hereditary haemorrhagic telangiectasia (HHT) – an inherited genetic condition that affects the blood vessels
- leukaemia (although this is rare and you're likely to have other symptoms as well)
High blood pressure (hypertension) is also more common in people with nosebleeds and may make it harder to stop the bleeding, but it's not clear whether this directly causes nosebleeds.
Treating nosebleeds
Most nosebleeds can be stopped without the need for medical attention, but occasionally further treatment may be required.
What to do
To stop a nosebleed:
- sit down and firmly pinch the soft part of your nose, just above your nostrils, for at least 10-15 minutes
- lean forward and breathe through your mouth – this will drain blood into your nose instead of down the back of your throat
- place an ice pack or bag of frozen vegetables covered by a towel on the bridge of your nose
- stay upright, rather than lying down as this reduces the blood pressure in the blood vessels of your nose and will discourage further bleeding
If the bleeding eventually stops, you won't usually need to seek medical advice. However, you should still follow our recovery advice.
Non-urgent advice: Contact your GP practice if:
- you're taking a blood-thinning medicine (anticoagulant) such as warfarin or have a clotting disorder such as haemophilia and the bleeding doesn't stop
- you have symptoms of anaemia such as heart palpitations, shortness of breath and a pale complexion
- a child under 2 years of age has a nosebleed
- you have nosebleeds that come and go regularly
If your GP practice is closed, phone 111.
Immediate action required: Go to your nearest accident and emergency (A&E) or phone 999 if:
- the bleeding continues for longer than 20 minutes
- the bleeding is heavy and you've lost a lot of blood
- you're having difficulty breathing
- you swallow a large amount of blood that makes you vomit
- the nosebleed developed after a serious injury, such as a car crash
Find your nearest A&E department
Medical treatment
If you see your GP or go to hospital with a nosebleed, you will be assessed to determine how serious your condition is and what's likely to have caused it. This may involve looking inside your nose, measuring your pulse and blood pressure, carrying out blood tests and asking about any other symptoms you have.
These are the main treatments that your GP or hospital doctor may use to stop your nose bleeding.
Antibiotic ointment
Your doctor may prescribe an antibiotic ointment. This should be applied by squeezing a pea-sized amount onto the front of the nasal septum (wall between the nostrils).
This can reduce the inflammation and crusting in the nose and reduce the severity and frequency of nosebleeds.
Antibiotic ointment is particularly effective in children.
Cautery
If your doctor is able to identify exactly where the bleeding is coming from, they may carry out a minor procedure to seal the bleeding blood vessel by cauterising (burning) it.
This is normally done using a stick of a chemical called silver nitrate. A local anaesthetic will be sprayed into your nose to numb it and the silver nitrate stick will be held against the bleeding point for up to 10 seconds.
Nasal packing
If cautery is ineffective or your doctor is unable to identify a specific bleeding point, they may recommend packing your nose with gauze or special nasal sponges to stop the flow of blood by applying pressure to the source of the bleeding.
Packing will usually be carried out after local anaesthetic has been sprayed into your nose. The gauze or sponges often need to be left in place for 24-48 hours before being removed by a health professional. You'll usually need to be admitted to hospital to be monitored during this time.
Further treatment
If the treatments above don't help, you may be referred to a hospital specialist such as an ear, nose and throat (ENT) doctor for further treatment.
Additional treatments that may be used in hospital include:
- electrocautery – an electric current running through a wire is used to cauterise the blood vessel where the bleeding is coming from
- blood transfusions – a procedure to replace the blood you've lost
- tranexamic acid – medication that can reduce bleeding by helping your blood to clot
- packing under anaesthetic – your nose is carefully packed with gauze while you are unconscious from general anaesthetic
- ligation – an operation using small instruments to tie off bleeding blood vessels in the back of your nose
Recovery
Once your nose has stopped bleeding, you should follow the advice below to reduce the risk of your nose bleeding again and to stop you picking up an infection:
- avoid blowing or picking your nose, heavy lifting, strenuous exercise, lying flat, and drinking alcohol or hot drinks for 24 hours
- don't remove any crusts that form inside your nose – these may be unpleasant, but they're a useful part of the healing process
- if you need to sneeze, try to sneeze with your mouth open to reduce the pressure in your nose
- avoid people with coughs and colds
If you see a GP or a hospital doctor about your nosebleed, they may give you a prescription for an antiseptic nasal cream once the bleeding stops. This should be applied to the inside of your nostrils several times a day for up to two weeks to help prevent further bleeding.
If your nose does start to bleed again, follow the first aid advice above and seek medical advice if the bleeding doesn't stop.
Nosebleeds (for Teens) - Nemours KidsHealth
Nosebleeds are usually harmless and easily controlled, but they can look scary. Try not to worry — most nosebleeds are easy to stop.
How Can I Stop a Nosebleed?Try these simple tips to stop a nosebleed:
- Get some tissues or a damp cloth to catch the blood.
- Sit up or stand.
- Tilt your head forward and pinch your nostrils together just below the bony center part of your nose. Applying pressure helps stop the blood flow and the nosebleed will usually stop with 10 minutes of steady pressure. Don't stop applying pressure to keep checking if the bleeding has stopped.
If you get a nosebleed, don't blow your nose. This can cause more bleeding. Also, don't tilt your head back. This common practice will cause blood to run into your throat. This can make you cough or choke, and if you swallow a lot of blood, you might vomit.
If you've tried the steps above twice and the bleeding continues after the second attempt, you'll need to see your school nurse or a doctor.
After you've stopped the initial nosebleed, don't lift heavy objects or do other activities that cause you to strain, and try not to blow your nose for 24 hours.
Now that your nosebleed is over, let's take a look at what a nosebleed is and what can cause it.
Different Kinds of Nosebleeds
The most common kind of nosebleed is an anterior nosebleed, which comes from the front of the nose. Capillaries, or very small blood vessels, that are inside the nose may break and bleed, causing this type of nosebleed.
Another kind of nosebleed is a posterior nosebleed, which comes from the deepest part of the nose. Blood from a posterior nosebleed flows down the back of the throat even if the person is sitting or standing. Teens rarely have posterior nosebleeds. They're more common in older people, people who have high blood pressure, and people who have had nose or face injuries.
What Causes Nosebleeds?
The most common cause of anterior nosebleeds is dry air. A dry climate or heated indoor air irritates and dries out nasal membranes, causing crusts that may itch and then bleed when scratched or picked. Colds may also irritate the lining of the nose. Bleeding may happen after repeated nose-blowing. When you combine a cold with dry winter air, you have the perfect formula for nosebleeds.
Allergies can also cause problems, and a doctor may prescribe medicine such as antihistamines or decongestants to control an itchy, runny, or stuffy nose. The medicine can also dry out the nasal membranes and contribute to nosebleeds.
An injury to the nose may cause bleeding and isn't usually cause for alarm. If you ever have a facial injury, use the tips outlined earlier to stop the nosebleed. If you can't stop the bleeding after 10 minutes or you are concerned about other facial injuries, see a medical professional right away.
Nosebleeds are rarely cause for alarm, but frequent nosebleeds might indicate a more serious problem. If you get nosebleeds more than once a week, you should see your doctor. Most cases of frequent nosebleeds are easily treated. Sometimes tiny blood vessels inside the nose become irritated and don't heal. This happens more frequently in teens who have ongoing allergies or frequent colds. A doctor may have a solution if you have this problem.
If your doctor rules out a sinus infection, allergies, or irritated blood vessels, he or she may order other tests to see why you're getting frequent nosebleeds. Rarely, a bleeding disorder or abnormally formed blood vessels could be a possibility.
Cocaine (or other drugs that are snorted through the nose) can also cause nosebleeds. If you suspect a friend is using cocaine, try talking about it and get help from a trusted adult.
Can I 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.
- Keep the inside of your nose moist with saline (saltwater) nasal spray or gel, or dab petroleum jelly or antibiotic ointment gently around the opening of the nostrils.
- Wear protective athletic equipment when playing sports that could cause injury to the nose.
An occasional nosebleed may make you worry, but there's no need to panic — now you know what to do!
Reviewed by: Michelle P. Tellado, MD
Date reviewed: September 2019
Frequent nosebleeds in adults and children causes, treatment
Many people face the problem of spontaneous nosebleeds. In most cases, these are single and self-limiting episodes. But recurrent (recurring) frequent nosebleeds are also possible, and in people of almost any age.
In this case, it is recommended to consult a doctor to identify their cause and select the optimal treatment tactics.
Nosebleeds or epistaxis (epistaxis) is the outflow of blood from the vessels located under the mucous membrane of the nasal cavity, paranasal sinuses and nasopharynx. It can be different in duration and volume, one- and two-sided. nine0003
During epistaxis, blood can be discharged from the nostrils, congeal in the lumen of the nasal passages and in the vestibule of the nose, and flow down the back of the throat. In the latter case, they speak of posterior nosebleeds. Often it is accompanied by ingestion of blood, followed by vomiting or the release of tarry stools (melena).
The source of recurrent epistaxis can be:
- The choroid plexus, located in the anterior-lower part of the nasal septum, is the most common source of bleeding. This region is called the Kisselbach-Little zone. The vessels here are superficial, multiple, and the mucous membrane is prone to thinning. nine0014
- The posterolateral region of the nasal cavity (the so-called Woodruff's plexus). It is also a fairly likely source of frequent nosebleeds, because the vessels in this area are devoid of a muscle layer and therefore are not able to contract when damaged.
- Posterior septal arterioles. They are branches of the sphenopalatine artery, which is sometimes even called the "epistaxis artery". After all, it is this vessel that is the source of abundant recurrent nosebleeds of the posterior type. nine0014
- Arteries of the ethmoid labyrinth. True, they rarely bleed spontaneously.
It should be understood that bleeding from the nostrils is not always nasal bleeding (that is, originating from the nasal cavity). Its source can be the pharynx, esophagus and stomach, damaged fairly large vessels in fractures of the bones of the skull. In such cases, it is more competent to talk about bleeding from the nose.
Why nosebleeds occur
Frequent nosebleeds are not an independent disease and are not always caused by ENT pathology. They can be caused by:
- Mechanical damage to the nasal mucosa - for example, due to bad habits, improper nasal rinsing.
- Atrophic changes in the nasal mucosa against the background of chronic rhinitis, rhinosinusitis of various origins, deviated nasal septum.
- Congenital anomalies of the vascular plexuses of the nasal cavity. nine0014
- Polyposis of the nose and paranasal sinuses and other neoplasms of this area.
- Systemic disorders in the blood coagulation system. Often, increased bleeding occurs with infectious diseases, vitamin K and C deficiency, taking a number of drugs (especially anticoagulants, antiplatelet agents, non-steroidal anti-inflammatory drugs), leukemia. Congenital disorders of hemostasis are also possible.
- Arterial hypertension (increased blood pressure). It can be caused by hypertension, chronic renal pathology, tumors of the adrenal glands. nine0014
- Chronic liver disease.
In women, a significant hormonal imbalance often becomes a predisposing factor for the development of nosebleeds. This is possible during pregnancy, against the background of taking therapeutic hormonal drugs and oral contraceptives, in menopause. Epistaxis is also described during the period of abnormal formation of the menstrual cycle in adolescent girls, it is called vicarious.
Are nosebleeds dangerous?
A single and quickly stopped nosebleed is not life-threatening. But repeated and prolonged episodes of epistaxis can cause quite serious complications.
Possible consequences of frequent nosebleeds include:
- Development of chronic post-hemorrhagic iron deficiency anemia. It is accompanied by general weakness, fatigue, decreased concentration, deterioration of the skin and its appendages. And long-term anemia causes hypoxia (lack of oxygen) of tissues with the development of not always reversible changes in the heart and other organs. nine0014
- Deterioration of the gastrointestinal tract, which is associated with the negative effect of swallowed blood during epistaxis.
- With heavy bleeding - the development of hemorrhagic shock. In severe cases, epistaxis can even cause death from severe blood loss, several such cases are described in the medical literature.
Recurrent epistaxis should not be ignored, even if there are no well-defined complaints between bleeding episodes. It is recommended to contact an ENT doctor and undergo an examination prescribed by him. If necessary, the patient can be referred to specialists of a different profile. nine0003
Treatment of nosebleeds: how to do it right
If a patient visits a doctor during a nosebleed, treatment should first of all be aimed at stopping it as soon as possible. For this, various techniques can be used. Their choice is determined by the location and caliber of the bleeding vessel, the volume of blood loss, the nature of changes in the mucous membrane and the general condition of the patient.
After that, a decision is made on further tactics. The basic treatment regimen for frequent nosebleeds is determined by the doctor based on the results of a comprehensive examination. The main efforts should be aimed at preventing the recurrence of episodes of epistaxis. And this often requires a complex impact using conservative and surgical measures, including with the participation of several specialists. nine0003
Treatment for frequent nosebleeds may include:
- Drug therapy to correct blood pressure levels.
- Measures to normalize the state of the blood coagulation system.
- If possible, eliminate local causes of frequent nosebleeds. Such treatment is carried out by an ENT doctor, and conservative and surgical methods are often combined.
Influencing the source of frequent nosebleeds is one of the most important preventive measures. Such treatment may include removal of tumor-like formations, complex therapy of chronic rhinitis and sinusitis, and other measures. The best result in the long term is the elimination of the bleeding vessel (or its radical exclusion from the bloodstream). nine0003
Various surgical techniques have been widely used in the past. Subsequently, more gentle methods were actively introduced - sclerotherapy, electrocoagulation, local cryotherapy. Currently, in the treatment of nosebleeds, preference is given to laser coagulation of blood vessels.
Laser coagulation of blood vessels is really effective
See also
Treatment of ENT diseases
Nosebleeds
Laser coagulation of blood vessels is one of the most gentle and at the same time effective methods of treating nosebleeds. nine0003
Its advantages include:
- The impact is aimed, without the formation of extensive damage to the mucous membrane and soft tissues.
- It is possible to coagulate submucosal vessels of any localization, if necessary, removing detected telangiectasias and hemangiomas.
- The vessel is vaporized by the high temperature of a narrowly focused laser beam, instantly and irreversibly switched off from the bloodstream.
- Laser coagulation does not provoke massive thrombosis and does not lead to the formation of extensive edema. nine0014
- The physical discomfort experienced by the patient does not require the use of general anesthesia (anesthesia). Therefore, laser coagulation of vessels with frequent nosebleeds can be performed on an outpatient basis, even if the patient has concomitant somatic diseases. There is also no long-term disability.
In St. Petersburg, laser coagulation of blood vessels for the treatment of recurrent epistaxis is successfully used in the Clinic of Dr. Korenchenko, if necessary, supplementing it with other methods. nine0003
Our doctors recommend not postponing a visit to specialists until the development of difficult-to-stop nosebleeds. Even a single and supposedly causeless episode of spotting is an alarming sign. And recurring bleeding requires a mandatory and prompt visit to the doctor, even if the amount of blood loss is small. This will avoid the development of severe complications and carry out the necessary full-fledged treatment using the most sparing effective methods. nine0110Frequent nosebleeds: what are the causes and what to do?
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Bleeding from the nose due to trauma usually does not raise questions, but if it occurs without any mechanical impact, and even more often, this should alert
What can be the causes of frequent nosebleeds and how they can be cured - tells otorhinolaryngologist of the clinic "Semeynaya" Olga Pavlovna Soloshenko. nine0003
If the bleeding does not occur from trauma and recurs periodically, it is better not to delay the visit to the ENT. After all, bleeding can be anterior and posterior - the second happens less often, but it is much more dangerous. With anterior bleeding, blood only goes out, with posterior bleeding, it flows into the mouth or stomach along the back of the pharynx. Posterior is usually caused by damage to larger vessels that are located deep in the nasal cavity. It is very difficult to stop back bleeding without a doctor.
Causes of nosebleeds:
- Injuries. Injury to the nose is often fraught with cartilage fractures. As a rule, this is accompanied by swelling and pain.
- High blood pressure. Very common cause. Due to a sharp jump, the walls of the capillaries easily burst. Pressure rises due to overload, as well as in the presence of diseases of the cardiovascular system.
- Sunstroke and any sudden increase in body temperature. nine0014
- Overwork.
- Hormonal changes. Bleeding may occur in women during the months of pregnancy or menopause, and in adolescents at puberty.
- Dry air. It causes dryness of the mucous membrane.
- Poor blood clotting.
- ENT diseases. Sinusitis, sinusitis, rhinitis - all of them can cause bleeding, especially with the constant use of drugs that thin the mucosa. nine0014
- Vascular problems. Even infectious diseases such as chicken pox, measles, influenza, etc. can lead to them.
- Polyps, adenoids, tumors. In addition to occasional bleeding, they simply make breathing difficult.
- Foreign body penetration - can damage mucous membranes and blood vessels.
- Deficiency of vitamins K, C and calcium.
First aid rules for nosebleeds:
- Lie down (or position the patient) with legs down
- Tilt your head forward
- Place a cold compress on the bridge of the nose for a few minutes
- Cover nose with hand or insert swab pre-moistened with hydrogen peroxide
- Vasoconstriction drops can be instilled
Attention, this must not be done!
- Throwing the head back (contrary to popular belief) - blood can enter the respiratory tract
- Blow your nose - so as not to increase bleeding without it.
Which cases require an immediate call to a doctor and an ambulance
- In case of loss of consciousness
- For excessive bleeding
- Blood flows with clear fluid (this may occur after trauma and indicate a fracture of the base of the skull)
- If you vomit blood (possibly indicating bleeding in the esophagus or stomach)
- Foamy blood (possible with lung injury)
- In a patient with diabetes mellitus
- If the patient is known to have poor blood clotting
Treatment
Treatment of bleeding is carried out in a complex manner. Often, an otorhinolaryngologist works in conjunction with a general practitioner, neurologist, endocrinologist, and hematologist.
At the first examination, the doctor determines the type of bleeding - anterior or posterior. Also, the patient is required to pass a general blood test and a coagulogram (analysis of blood coagulation indicators). In addition, it is important to measure the pressure, because if it is above the norm (the absolute norm is 120/80 mm Hg, but these figures change depending on age), the blood will not stop until it decreases. nine0003
In case of significant blood loss, the patient may be left in the hospital.
As a treatment for bleeding, it is possible to pack the nasal cavity, cauterize vessels (with drugs, laser, ultrasound, etc.), remove polyps. If there is no result, surgical ligation of vessels in problem areas is performed. In addition, drugs are prescribed that increase blood clotting.
Prevention
- Taking drugs that strengthen the walls of blood vessels
- Nutrition rich in vitamins and minerals
- Air humidification during the heating season
- Injury Prevention
- Monitoring blood pressure and taking medications to lower it
Nosebleeds are not only unpleasant, but also dangerous. Therefore, as soon as it begins to bother you regularly, it is important to see a doctor as soon as possible.