Nose bleeding and why its occurrence
A nosebleed, also known as epistaxis , is bleeding from the nose . Blood can also flow down into the stomach and cause nausea and vomiting . In more severe cases blood may come out of both
nostrils . Rarely bleeding may be so significant
low blood pressure occurs. Rarely the blood can come up the nasolacrimal duct and out from the eye.
Nosebleeds can occur due to a variety of reasons. Some of the most common causes include trauma from nose picking , blunt trauma (such as a motor vehicle accident), or insertion of a foreign object (more likely in children). Relative humidity (including centrally heated buildings), respiratory tract infections , chronic sinusitis , rhinitis or environmental irritants can cause inflammation and thinning of the tissue in the nose, leading to a greater likelihood of bleeding from the nose.
Most causes of nose bleeding are self-limiting and do not require medical attention. However, if nosebleeds are recurrent or do not respond to home therapies, an underlying cause may need to be investigated.
The nasal mucosa contains a rich blood supply that can be easily ruptured and cause bleeding. Rupture may be spontaneous or initiated by trauma. Nosebleeds are reported in up to 60% of the population with peak incidences in those under the age of ten and over the age of 50 and appear to occur in males more than females. An increase in blood pressure (e.g. due to general hypertension) tends to increase the duration of spontaneous epistaxis. Anticoagulant medication and disorders of blood clotting can promote and prolong bleeding. Spontaneous epistaxis is more common in the elderly as the nasal mucosa (lining) becomes dry and thin and blood pressure tends to be higher. The elderly are also more prone to prolonged nosebleeds as their blood vessels are less able to constrict and control the bleeding.
The vast majority of nosebleeds occur in the
anterior (front) part of the nose from the nasal septum . This area is richly endowed with blood vessels ( Kiesselbach’s plexus ). This region is also known as Little’s area . Bleeding farther back in the nose is known as a posterior bleed and is usually due to bleeding from Woodruff’s plexus , a venous plexus situated in the posterior part of inferior meatus. Posterior bleeds are often prolonged and difficult to control. They can be associated with bleeding from both nostrils and with a greater flow of blood into the mouth.
Sometimes blood flowing from other sources of bleeding passes through the nasal cavity and exits the nostrils. It is thus blood coming from the nose but is not a true nosebleed, that is, not truly originating from the nasal cavity. Such bleeding is called “pseudoepistaxis” ( pseudo + epistaxis ). Examples include blood coughed up through the
airway and ending up in the nasal cavity, then dripping
If pressure and chemical cauterization cannot stop bleeding, nasal packing is the mainstay of treatment. There are several forms of nasal packing that can be contrasted by anterior nasal packing and posterior nasal packing. Traditionally, nasal packing was accomplished by packing gauze into the nose, thereby placing pressure on the vessels in the nose and stopping the bleeding. Traditional gauze packing has been replaced with products such as Merocel and the Rapid Rhino. The Merocel nasal tampon is similar to gauze packing except it is a synthetic foam polymer (made of polyvinyl alcohol and expands in the nose after application of water) that provides a less hospitable medium for bacteria. The Rapid Rhino stops nosebleeds using a balloon catheter, made of
carboxymethylcellulose , which has a cuff that is inflated by air to stop bleeding through extra pressure in the nasal cavity. Systematic review articles have demonstrated that the efficacy in stopping nosebleeds is similar between the Rapid Rhino and Merocel packs; however, the Rapid Rhino has been shown to have greater ease of insertion and reduced discomfort. People who receive nasal packing need to return to a medical professional in 24–72 hours in order to have packing removed. There are also several dissolvable packing materials that stop bleeding through use of thrombotic agents that promote blood clots, such as surgicel . The thrombogenic foams and gels do not require removal and dissolve after a few days. Posterior nasal packing can be achieved by using a Foley catheter , blowing up the balloon when it is in the back of the throat, and applying traction. Complications of nasal packing include abscesses,
septal hematomas , sinusitis , and pressure necrosis. In rare cases toxic shock syndrome can occur with prolonged nasal packing. As a result, many forms of nasal packing involve use of topical antistaphylococcal antibiotic ointme