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Nose Bleed and how to Overcome it

Nosebleeds are common, and many of us will experience one at some point in our lives. The manner in which the nosebleed usually occurs may aid in determining whether medical attention is required.

Nosebleed in children is common and usually it is nothing to be alarmed about. It is however, irritating and could be distressing for both the child and parents. Parents are often called by teachers to school when a child’s nosebleeds disrupts the class activities. Fortunately, life threatening nosebleed is usually rare in children.

Causes of a Nosebleed

There are two types of nosebleeds:

  • Anterior, and

  • Posterior.

Anterior Nosebleeds

If you have an anterior nosebleed, the bleeding comes from the lower septum (the wall between the two nose channels), just inside your nose. This part of the nose, which is sometimes known as Littles’ area, has a lot of delicate blood vessels inside it. The blood vessels are supplied with blood from your carotid arteries (the two main arteries in your neck which supply the blood flow to your brain). These delicate blood vessels are easily damaged and if they are knocked, they will begin bleeding. Sometimes, the cause of anterior nosebleeds is unknown. However, the main causes include:

  • 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 deviated septum (a crooked nose in the internal, either present from birth or due to an injury),

  • a cold or flu (influenza),

  • sinusitis (an infection of the small, air-filled cavities inside your cheekbones and forehead),

  • a blocked or stuffy nose that is often caused by an infection,

  • a dry nose that is caused by dry air in a hot climate or heated indoor air,

  • hayfever or other allergies,

  • high altitude,

  • excessive use of nasal decongestants,

Children almost always have anterior nosebleeds. In children, many doctors feel that nasal drying is a common cause of nose bleeds. Nasal drying is common in the winter during cold dry weather and in the summer with air-conditioning.


Treatment for Nosebleed

Medicine

  • Treatment of allergic rhinitis with antihistamines and nasal sprays and environment control measures will often eliminate the nose bleeding. The inflammation from the rhinitis promotes vascularization (blood vessel growth) in the anterior part of the nose. These vessels are usually prominient and bleed easily. If bleeding does not stop, nasal cautery may be required.

Two types of cautery are commonly used –

  • In children who have prominent blood vessels in the Little’s area, treatment with a chemical called silver nitrate is an effective treatment option. Silver nitrate is applied onto the Little’s area (a 1 minute procedure done in our clinic).

  • Larger vessels can be treated with Electrocautery using Radio Frequency. In adults, this form of treatment can be done in the clinic under local anaethesia. For children, electrocautery is usually carried our under sedation (in the day surgery centre).

Posterior Nosebleeds

A posterior nosebleed is where the bleeding is heavy and comes from further back, and higher up your nose. Posterior nosebleeds are more common in adults than in children and they may need medical attention.

During posterior nosebleeds, the bleeding originates from branches of the arteries which supply blood to your nasal cavity (the space inside your nose between the roof of your mouth and your brain).

This type of nosebleed can be more serious. If your nosebleed has resulted from a large blow to your head, or a fall, you should seek medical attention because you may have broken your nose.

Other possible causes of posterior nosebleeds include:

  • a tumour in the nasal cavity (beign or malignant nose cancer)

  • recent nasal surgery,

  • high blood pressure,

  • hardened arteries (from fat, cholesterol, or other substances that build up in your arteries),

  • exposure to irritating chemicals,

  • certain medicines, such as aspirin, medicines for arthritis, anticoagulants (blood-thinning medicines)

In some cases, nosebleeds can be a symptom of another condition such as:

  • a blood clotting abnormality – for example haemophilia (an inherited condition that affects the blood’s ability to clot) or von Willebrand’s disease (an inherited disorder that causes bleeding and bruising) , or

  • leukarmia (although this is rare and you are likely to have other symptoms as well).

First Aid Measures to Stop Nosebleed


1. Stop the Bleeding

  • Have the person sit up straight and lean forward slightly. Don't have the person lie down or tilt the head backward.

  • With thumb and index finger, firmly pinch the nose just below the bone up against the face.

  • Apply pressure for 5 minutes. Time yourself with a clock.

  • If bleeding continues after 5 minutes, repeat the process.

2. Call a Healthcare Provider

See medical help immediately if:

  • Nosebleed doesn't stop after 10 minutes of home treatment.

  • There is so much bleeding that it is hard to breathe.

  • The person is taking blood thinners, such as warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), fondaparinux sodium (Arixtra), or aspirin, or has a bleeding disorder.

  • Nosebleed happens after a severe head injury or a blow to the face.

3. Medical Treatment

  • The healthcare provider may use specialized cotton material, insert a balloon in the nose, or use a special electrical tool to cauterize the blood vessels.

4. Follow Up

  • Broken noses often are not fixed immediately. The healthcare provider will refer the person to a specialist for a consultation once the swelling goes down.

  • The person should avoid strenuous activity; bending over; and blowing, rubbing, or picking the nose until it heals.

  • The nostrils should be kept moist with a water-based lubricant or by increasing the humidity in the home.

References: https://www.webmd.com/first-aid/nosebleeds-treatment https://nosesinus.com/en/service/nose-sinus-services/ https://kidshealth.org/en/parents/nosebleeds-sheet.html

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