Nosebleeds (Epistaxis)

Nosebleeds (Epistaxis): Definition and Causes

Nosebleeds (Epistaxis) are characterized by the leakage of blood from the nasal cavity due to damage to the blood vessel walls. This often occurs as a result of nasal injuries, but can also arise due to serious internal conditions. In any case, immediate medical attention is necessary. In cases where nosebleeds do not cause external impact and occur regularly, a comprehensive medical examination is necessary to determine the underlying cause of the condition.

Causes of Nosebleeds:
Nosebleeds are a diagnostic symptom rather than a standalone condition. The causes leading to blood leakage can be divided into local and systemic factors. Local factors involve processes occurring within the nasal cavity itself. The convergence of external and internal carotid artery capillaries to the olfactory nerve of the nose is a point of weakness in the blood vessel system, as vessels in these areas have thin walls, making them susceptible to damage from even minor injuries or increased blood pressure.

Key local and systemic causes of nosebleeds include:

  • Any injuries to the nose or its internal structures, including injuries from facial punches or foreign bodies or medical interventions.
  • Effects of external factors such as sunstroke, overheating, excessive physical exertion, and sudden changes in air pressure.
  • Mucous membrane dryness due to lack of humidity in the air.
  • Adverse changes resulting from nasal septum deviation.
  • Mucous membrane burns due to exposure to sharp irritants.
  • High blood pressure.
  • Acute respiratory viral infections (leading to inflammation of the nasal mucosa, weakening blood vessel walls, and making them more fragile).
  • Malignant and benign tumors in the nose (neoplasms).
  • Autonomic nervous and vascular dysfunction.
  • Arteriosclerosis (leading to loss of blood vessel elasticity).
  • Unmonitored use of medications affecting blood clotting.
  • Excessive use of nasal sprays that dry out the mucous membrane.
  • Deficiency in vitamin C, and more.

Types and Symptoms of Nosebleeds (Epistaxis):

Anterior Nosebleed:

  • Characteristics: Occurs when the integrity of the blood vessel network is violated.
  • Duration and Volume: Usually short-term and not significantly large in volume.
  • Impact: Losing up to 100 ml of blood usually does not cause significant harm to the body.

Posterior Nosebleed:

  • Frequency: Less common but more dangerous, posing a greater threat to an individual’s health.
  • Source: Typically from larger blood vessels.

When a significant amount of blood is lost, the person may experience symptoms such as weakness, dizziness, paleness of the skin, and ringing in the ears. If the bleeding is not stopped promptly, low blood pressure occurs, along with difficulty breathing and blueness in the hands and feet. Losing more than one liter of blood leads to a noticeable increase in heart rate and may cause loss of consciousness.

First Aid for Nosebleeds:
If bleeding from the nose occurs due to injury and is not significantly large in volume, the problem can be self-managed, especially if the person does not suffer from serious health issues.

First and foremost, the affected person should sit in a chair with a backrest. Avoid throwing the head back forcefully or lying down excessively to prevent swallowing blood, which may cause nausea and vomiting. Also, avoid bending forward to avoid increasing blood flow to the nose area.

To stop anterior bleeding, simply place ice or a cloth soaked in cold water on the nose and apply firm pressure to the inside of the nose for 10-15 minutes. For heavy bleeding, cotton pads or cotton soaked in hydrogen peroxide can be cautiously inserted into the nose.

If bleeding does not stop, the person should be transported to a medical facility.

Ways to Stop Nosebleeds:
Nasal Packing:

  • The most common and effective method to stop blood flow from the nose.
  • These medical procedures are performed if bleeding is not stopped within the first 15 minutes.
  • Nasal packing can be anterior (foam inserted through the nose) or posterior (foam inserted through the mouth) depending on the location of the affected blood vessels.
  • The procedure helps to stop heavy bleeding and protects the patient from significant blood loss.

Using Nasal Packing:

  • Narrow strips of cloth or gauze soaked in hemostatic and antibiotic ointments are used.
  • For anterior packing, it is carefully arranged in the affected half of the nose using forceps.
  • To prevent nasal septum deviation, an additional tampon is inserted into the other nostril opening.
  • Packing is secured by placing a tightly shaped cloth.

Coagulation by Laser, Electrical Current, or Liquid Nitrogen:

  • When the cause is a small injury to blood vessels, bleeding can be stopped by coagulating the tissue under the influence of a narrow-beam laser, electric current, or liquid nitrogen.

Posterior Packing:

  • When blood vessels are large and bleeding is difficult to stop, posterior packing is performed.
  • The procedure involves using a special catheter pulled through the nasal cavity to the mouth and secured at the back.
  • The catheter is tied to foam or sponge with a hemostatic agent, then the catheter is removed from the nose and the sponge is inserted into the throat.

To prevent nosebleeds in children and adults, it is advisable to follow some simple guidelines:

  • Avoid head injuries during sports activities.
  • Eliminate the habit of scratching the nose.
  • Avoid rubbing the nose vigorously and repeatedly during colds or allergies.
  • Use vasoconstrictor medications as directed.
  • Use measures to promote mucous membrane reconstruction.
  • Monitor room humidity levels.

Regular check-ups with an ear, nose, and throat (ENT) doctor are also beneficial for prevention.