Severe nosebleed causes

Nosebleed causes & treatments | NHS inform

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 the recovery advice outlined below.

When to seek medical advice

Contact your GP or call the NHS 111 service 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 two years of age has a nosebleed (this is rare and there's a chance it's caused by something serious)
you have nosebleeds that come and go regularly

Ask someone to drive you to your nearest accident and emergency (A&E) department or call 999 for an ambulance 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.

The main treatments that your GP or hospital doctor may use to stop your nose bleeding are described below.

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.

9 Causes of Anterior & Posterior Nosebleeds

Written by WebMD Editorial Contributors

Medically Reviewed by Jennifer Robinson, MD on September 17, 2022

Types of Nosebleeds

A nosebleed comes from the front of your nose (anterior) or the back of it (posterior).

Anterior nosebleeds. The wall that separates your nostrils is called the septum. It has a lot of blood vessels that can break from a hit in the face or even a scratch of your fingernail. Most nosebleeds start in the lower part of the septum, meaning close to your nostrils.
Posterior nosebleeds. These are more rare. They start deeper in the back of your nose. Posterior nosebleeds are more likely to happen in older people, those with high blood pressure, or those who have had a face injury.

It can be hard to tell if you have a posterior or anterior nosebleed. Both can make blood flow toward the back of your throat if you’re lying on your back. But posterior nosebleeds can be much more serious. You’re more likely to need emergency help.

Nosebleed Causes

Most are spontaneous, meaning they happen unexpectedly and don’t have a known cause. But if you get nosebleeds a lot, there may be a reason you can pinpoint:

Dry climates or dry, heated air that dries out the inside of your nose
Picking your nose or rubbing it too hard
An upper respiratory infection like a cold
Repeated nose-blowing
An injury to your nose or a foreign object in your nose
A deviated septum
Allergies or allergy medicines that can dry out your nose, like antihistamines and decongestants
Certain blood thinners
Taking aspirin regularly
Nasal sprays
A sinus infection
Chemicals that irritate your airways, like ammonia
Pregnancy
Alcohol use

Nosebleeds can also be caused by bleeding disorders, but it’s rare. If your nosebleed doesn’t stop, or you have a lot of bleeding from your gums or when you get minor cuts, see a doctor. Bleeding disorders can be serious because platelets in your blood that help it clot are missing or aren’t working.

Another rare cause of nosebleeds can be a tumor in the nose or sinuses. It may be noncancerous, also called benign, or cancerous. Only about 2,000 cases of cancerous tumors in the nose or sinuses are diagnosed in the U.S. each year.

In some cases, nosebleeds can be caused by genes passed down in families. A rare condition called hereditary hemorrhagic telangiectasia (HHT) affects the blood vessels. The main symptom is repeated nosebleeds that seem to come out of nowhere and get worse over time.

If you have HHT, you might wake up at night with your pillow soaked in blood, and you may develop red spots on your face or hands. If one or both of your parents has this condition and you’re having nosebleeds, ask your doctor about being tested for it. Treatments can help improve your symptoms.

Frequent nosebleeds: what are the causes and what to do?

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.

If the bleeding does not occur due to injuries 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.
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 mucous membrane.
Vascular problems. Even infectious diseases such as chickenpox, measles, influenza, etc. can lead to them.
Polyps, adenoids, tumors. In addition to occasional bleeding, they simply make breathing difficult.
Foreign body - can damage the 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 head forward
Place a cold compress on the bridge of the nose for a few minutes
Cover nose with hand or insert swab pre-soaked in hydrogen peroxide
Drops for vasoconstriction 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 skull fracture)
If vomiting of blood occurs (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.

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. It is better to exclude all the most terrible causes of such a phenomenon as soon as possible and then it is already calmer to engage in further treatment.

Make an appointment with an otolaryngologist

Be sure to consult a qualified specialist in the field of nose diseases at the Semeynaya clinic.

For prices for pediatric appointments or other questions, follow the link below

Tags OtolaryngologistTherapist

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.

During epistaxis, blood can flow from the nostrils, congeal in the lumen of the nasal passages and in the vestibule of the nose, and drain 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.
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.
Arteries of the ethmoid labyrinth. True, they rarely bleed spontaneously.

It should be understood that the discharge of blood 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.
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.
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.
Deterioration of the gastrointestinal tract, which is associated with the negative effect of the blood swallowed 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.

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.

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 techniques 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).

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
Epistaxis

Laser coagulation of blood vessels is one of the most sparing and at the same time effective methods of treating nosebleeds.

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.
The physical discomfort experienced by the patient does not require the use of general anesthesia (narcosis). 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.

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