In medical terms, it is known as epistaxis.
The nose is a part of the body:

  • Rich in blood vessels,
  • In a vulnerable position, protruding from the face.

A facial trauma can cause nasal lesions and bleeding.
Nasal hemorrhage is caused by the rupture of a blood vessel within the nasal mucosa.

Epistaxis can occur spontaneously when the nasal mucosa becomes dry and ruptures.
This situation is frequent:

  • In dry climates,
  • During the winter months due to domestic heating.

The chances of bleeding increase when taking anticoagulant medicines, for example:

  • Aspirin,
  • Coumadin.

In addition, the most frequent causes of nasal bleeding change with age.

Usually blood  comes out of just one nostril , but it can come out of both.

Classification of epistaxis

  • The epistaxis former is the most common. The bleeding originates in a blood vessel in the nasal septum, to where a network of vessels (Kiesselbach’s plexus) converge. Generally, previous bleeding is easy to control even without physician intervention.
  • The posterior epistaxis is very rare in young people, most common in the elderly. Bleeding usually originates in an artery at the back of the nose (Woodruff area). This disorder is difficult to manage and hospitalization and the intervention of an otolaryngologist are usually necessary.


Causes of bleeding in the nose

The most frequent cause of occasional nasal bleeding is  trauma  that can be caused by a violent blow or slap, for example by practicing boxing.

Sometimes it is possible to cause an injury by putting your fingers in the nosewhen the mucus becomes:

  • Dry,
  • Hard.

The heating during the winter may be responsible for nosebleeds because heat causes dryness of the internal membranes of the nose become more prone to rupture and then to bleeding.
Among the causes of bleeding of the nose are:

Among the diseases that cause nosebleeds are:

1. Leukemia ,
2. Disease of Rendu-Osler-Weber
3. Some types of infection  of the upper respiratory system, for example, sinusitis ,
4. Tumor in benign or malignant nose,
5. Von Willebrand disease,
6. Hemophilia ,
7. Atherosclerosis is a disease of the arteries in which plaques are formed mainly of fatty deposits (atheromas).

Most of the time, children have a habit of taking a cold shower immediately after they have played outdoors, especially under the hot sun.
In some cases, abrupt changes in body temperature may cause nosebleeds.
When the body reaches a high temperature due to physical activity, it needs time to reduce the temperature.
However, if the body is suddenly exposed to cold (such as a cold bath), the mechanism is unbalanced and this can cause bleeding and other disorders.

Bleeding in the nose and high blood pressure
There are two types of bleeding in the nose, anterior and posterior. One of the reasons for posterior nose bleeding is hypertension, defined as the pressure exerted by the blood against the wall of the arteries. Epistaxis may occur if systolic (maximum) blood pressure exceeds at least 160 mmHg.

Bleeding in the nose and vitamin deficiency

Lack of vitamins B-9 and B-12
Lack of vitamins B-9 and B-12 can cause nosebleeds because it causes elevated levels of homocysteine ​​in the blood that damages the walls of blood vessels and increases the risk of aneurysm and rupture of capillaries .

Vitamin A Deficiency
According to an article from the University of Maryland Medical Center, vitamin A is necessary for the moisture and health of the mucous membranes of the nose, paranasal sinuses, mouth, eyes and digestive system.
The deficiency can cause dryness and inflammation in the nasal cavity and therefore increases the risk of injury and bleeding.
In addition, the dry mucosa is also a risk factor for infection that can cause nosebleeds.

Vitamin K Deficiency
Vitamin K acts as a cofactor for an enzyme that converts glutamic acid to gamma-carboxyglutamic acid, which is necessary for blood clotting.
Coagulation is the process that prevents blood from leaving, forming a clot in the artery.
This process is essential to heal damaged blood vessels.
The lack of vitamin K causes an uncontrollable hemorrhage in case of rupture of a blood vessel.

Vitamin C Deficiency
Vitamin C is necessary for the development of collagen which is the main component of connective tissue.
The collagen is:

  • In the skin,
  • We blood vessels.

Vitamin C deficiency weakens the blood vessels and can cause capillary fragility.
The fragility of the vessels and capillaries of the nose depends mainly on the collagen used to prevent injury and loss of blood.


Bleeding nose in children

Causes of bleeding in the nose in children
Previous epistaxis is more common in dry climates or during the winter. At this time, the air dries out the nasal membranes that can create a crust, cause a rupture and bleeding.
Children may suffer from nosebleeds due to:

  • Trauma: An accident can cause nosebleeds that can cause bleeding . This is one of the most common causes of nose bleeds in children.
  • Children shove  foreign bodies, such as : food, small toys, other items, etc., in the nose. Foreign bodies can rot, irritate and corrode mucous membranes, causing nasal bleeding.
  • Scratching: Scraping dry mucus, scratching the mucosa of the nose or causing abrasion of the wall with your fingers or fingernails can cause nosebleeds in children.
  • Allergies and infections: Infections of the upper respiratory tract and paranasal sinuses can cause inflammation that can increase the chances of having blood in the nose.
    The allergies can cause rhinitis and epistaxis.
  • Seasonal Factors: In winter, when the weather is dry, home heating can cause dryness in the nasal passages, causing the lesions and bleeding of the tissues.
    In summer or spring, pollen in the air causes allergies in children, which can be a cause of bleeding from the nose.
  • Structural abnormalities: An abnormal structure in the nose, such as nasal polyps or a deviated nasal septum , may be another cause of nosebleeds.
  • Blowing the nose energetically : Since children’s tissues and mucosa are very soft and thin, blowing the nose vigorously can cause mucosal rupture that can cause nosebleeds.
  • Medications: The process of blood clotting can be prevented by medications such as ibuprofen, aspirin, etc.
    These medications do not cause nosebleeds but may aggravate the condition and cause blood clotting problems.


Bleeding in the nose during pregnancy

Bleeding through the nose during pregnancy is common, especially from the second trimester.
About one in five pregnant women have nosebleeds, while only one in 16 women does not have this disease.

Bleeding often occurs because pregnancy hormones (estrogen and progesterone) dilate the larger blood vessels.
At the same time, increased blood flow increases pressure on the delicate veinsof the nose.
The inner (mucous) walls inside the nose may:

  • Swell up,
  • Dry.

This can get worse in the winter, a season where the person can catch colds and home heating makes the house hot and dry.
All this can easily cause the rupture of blood vessels, causing mild bleeding.


Causes of nasal bleeding at night and in the morning

Hot, cold, dry weather
The most common causes of nose bleeds, especially at night, are:

  • The dryness caused by heat,
  • Breathing excessively the nose,
  • Scraping the nose,
  • Allergies.

The dry air causes the mucus embedded in the nose and the consequence is the desquamation and the hemorrhage.

The nose is filled with small, sensitive blood vessels that bleed easily, especially when the person itches, scrubs or blows the nose.

Other possible causes are:
1. Chills,
2. Smoking ,
3. Upper respiratory tract infection,
4. A foreign body in the nose,
5. Hypertension ,
6. Cancer,
7. Facial injury,
8. Blood clotting disorders,
9. The side effect of an anticoagulant drug or aspirin and drug.

Allergy, infection and colds
Sometimes when the person has a cold or allergy, the nasal mucous membranes become inflamed and this can cause epistaxis morning and night.
In addition, the cold causes congestion of the nasal cavities and the person resorts to the use of nasal decongestants that can irritate and dry the nose.
This can cause nosebleeds.
Even blowing your nose excessively can cause:

  • The lesion of the mucosa,
  • Nasal bleeding.

According to the American Academy of Otolaryngology, allergies and infections can cause itching .
Thus, the patient scratches the nose and can cause bleeding.

Septum Deviation
septum deviation occurs when the wall between the two nostrils becomes crooked.
According to an article on the Mayo Clinic website , this problem may predispose to bleeding because the free nostril has a greater exposure to the dehydrating effect of airflow.
The consequence may be the formation of scabs or bleeding.

A deviated septum can cause:

  • Nasal obstruction,
  • Infections and injuries.

Bleeding in the nose can occur during the morning or at night during sleep.


How to stop a nose bleed?

When blood leaves the nose, it is necessary to:

  • Sit up straight,
  • Tighten your nose between your thumb and forefinger for at least 10-15 minutes.

Do not tilt your head back  (or up) because you run the risk of bringing the blood into the airway.
If bleeding is caused by dryness, rubbing the membranes with a dense lubricant ( Vaseline ) prevents other bleeding.
In some cases, applying a cold compress of ice between the forehead and the nose helps stop the bleeding.


Natural Remedies for Bleeding in the Nose

When the bleeding stops, keep your head higher than the heart:

  • You gain time for blood clotting,
  • Will prevent further bleeding.

Do not blow your nose and do not put anything inside because this can remove the clot (the crust that closed the lesion).
If you can not avoid the sneezing, keep your mouth open so that the air comes out through it instead of coming out through the nose.

Salt Water
Salt is an excellent disinfectant and reduces repair time of skin or mucosal damage.

  • Pour one tablespoon of salt into a glass of water and mix well.
  • When the salt is dissolved, put a cotton ball in the glass.
  • When cotton is soaked in water, gently insert it into the nostril.

You can also spray a few drops of nasal spray with salt sold in pharmacies or online.


Medications and Treatment for Bleeding in the Nose

There are some remedies that can be taken in pill form or intravenously, for example tranexamic acid .

When to worry? 
Medical intervention is necessary if the nose does not stop bleeding even after following the instructions above or if it continues to bleed for more than 15-20 minutes.

Persistent bleeding may indicate other serious undiagnosed body conditions. Therefore, call an ambulance as soon as possible, especially if:

  • The person concerned is a newborn, a child or an elderly person,
  • The loss of blood is significant.

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