Frequent nosebleeds

Nose bleeding often looks scary. It should be noted that in most cases nasal bleeding is not serious and can be stopped quite easily. There are two types of nosebleed: anterior nosebleeds (from a blood vessel at the front of the nose) and posterior nosebleeds (from the back of the nose).

More than 90% of all nosebleeds are of the first type. They are called ‘anterior’ as the bleeding is from the blood vessels located in the front part of the nose. Generally, these nosebleeds are easily managed and can be treated at home.

Less common – about 10% of all cases – are the posterior nosebleeds. They tend to affect elderly people. The source of bleeding are larger blood vessels located in the back of the nose.

Stopping this type of bleeding can be difficult for which reason they can pose a threat to life and usually require hospitalization and treatment by an otolaryngologist.

Nosebleeds occur more often in winter, especially in dry air and cold weather. The problem can appear at any age, but more often in pre-school and junior school.

Causes of nosebleeds

• One of the main causes is nose injury. The traumatic cause can be both external, for example when punched in the face, and internal, like damaging the vessels inside of the nose (with a nail, cotton swab, etc.);
• Another frequent cause is recurrent external adverse factors, such as cold. It leads to vascular spasm and dryness of the mucosa, thus increasing the risk of damaging the walls of the blood vessels;
• Deflection of the nasal septum, congenital or acquired. It often encourages the development of hypertrophic changes in the mucous membrane of the nose, the increase of vascular plexus areas, blood vessel fragility and the risk of damaging;
• Chronic rhinitis and sinusitis – inflammation of the nasal mucosa and sinuses and frequent nasal colds can result from allergy, chronic infection, or anatomical defects in the structure of the nose (congenital or post-traumatic);
• Less commonly, nose bleeding can be caused by an underlying disease, for example, different forms of coagulopathies (disorders in the process of blood coagulation and formation of blood clot);
• The inability of blood to form clots in time is often associated with blood thinning drugs such as warfarin or aspirin;
• Liver diseases can also impair blood clotting;
• Rare causes of nose bleeding are abnormalities in the blood vessels wall structure and oncological diseases of the nose;
• High blood pressure is another contributing factor; however, hypertension is rarely if ever the only cause of nose bleed.

How to treat nosebleed at home

In some cases, nosebleeds may occur due to minor external causes like violently blowing your nose while suffering from rhinitis or sinusitis. The strain and local pressure increase provoke the onset of bleeding. This is why people affected by this problem should avoid frequent or forced sneezing or blowing their nose.

To stop the bleeding, follow the below recommendations:

• Keep calm. Panic and stress can raise your blood pressure and increase the bleeding.
• Keep the vertical position.
• Tilt your head forward (this will prevent swallowing of blood which may happen if you tilt your head back).
• Pinch your nostrils with your thumb and index finger for 10 minutes (ask someone to time you).
• Spit out blood, as swallowing blood can provoke vomiting.

When the bleeding stops, remember the following important points:

• Avoid doing things that cause additional irritation of the nose, like sneezing or blowing your nose, within 24 hours.
• Do not use ice packs - this will not help if bleeding is not associated with fresh injury.
• Dry air can aggravate the problem. Increasing air humidity with a humidifier or evaporator will help prevent the drying of the nasal mucosa and heavier bleeding. If you do not have special appliances to increase the humidity in the room, it is enough to place a pot filled with water next to a heat source, for example, a radiator: the water will evaporate and saturate the air with additional moisture.

Drug treatment of nosebleeds

Anterior nosebleeds

Minor nosebleeds stop by themselves and do not require any treatment. If the bleeding source is a superficial blood vessel, the doctor can cauterize it with a special chemical compound.

In more complicated cases, a special procedure called anterior nasal packing may be required to stop the bleeding. The idea is to create pressure inside the nostrils to stop the bleeding. There are various types of dressings, from gauze balls impregnated with Vaseline to special polymeric materials called synthetic sponges, which expand when moistened. The decision on which material should be used is taken by the doctor.

The nasal packing procedure is performed both in hospitals and in outpatient clinics, after which the patient goes home with the pack. As the pack blocks outflow from the nasal sinuses, a prophylactic dose of antibiotics is administered to prevent infection. The packs are usually left in the nasal cavities for 24-72 hours. 

Posterior nosebleed

Posterior nose bleeding usually does not stop by itself and requires hospitalization. The doctor performs posterior nasal packing, which can be very uncomfortable. To eliminate discomfort, sedative and anaesthetic drugs are administered. The posterior nasal packing lasts for 48-72 hours. If bleeding does not stop, surgical procedures are used.

Bleeding after rhinoplasty

Nosebleeds can occur within the first few days after nose surgery. A sign of excessive bleeding is rapid (every few minutes) impregnation with blood of napkins placed in the nose. Severe bleeding when blood gushes from the nose or pours down the throat is a very rare phenomenon associated with an impairment of the blood coagulation system. Bleeding usually occurs within the first two days or the first weeks after surgery. If blood loss continues, the patient should seek help from a specialist. Chronic nosebleeds are a consequence of improperly performed rhinoplasty. Therefore, it is important to seek help from a skilled plastic surgeon.

Other treatments against frequent nosebleeds

After the cause of nosebleeds is established (after examination by an ENT doctor and additional examinations), a treatment is prescribed, which may include the following methods:

• Drug therapy – drugs improving the blood clotting capacity.
• Vitamin therapy – is prescribed if it is determined that the cause of the fragility of blood vessels and poor coagulation is the lack of particular nutrients.
• Surgical treatment – in case of displacement of the nasal septum and other defects of the nasal cavity, rhinoplasty can be a quick and effective solution.

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