Usually, nosebleeds are harmless and can be easily stopped.

The medical name is Epistaxis.

The nose is a part of the body and:

  • Contains many blood vessels,
  • Is in a vulnerable position as it protrudes from the face.

A facial injury can cause injuries to the nose and nosebleeds.

Nosebleeds are caused by rupture of a blood vessel inside the nasal mucosa.

Epistaxis can occur spontaneously when the nasal mucosa is dry and tears.

This situation is common:

  • In dry climates,
  • In the winter months due to the heating in the house.

The possibility of nosebleeds increases when taking anticoagulant drugs such as:

  • Aspirin
  • Coumadin.

In addition, the frequency of nosebleeds changes depending on age.

Usually it bleeds only from one nostril, but the bleeding can also occur on both sides.


Classification of epistaxis

  • Anterior epistaxis is the most common form. The blood comes from a blood vessel of the nasal septum, where a network of blood vessels converges (Kiesselbach plexus). Usually, the anterior bleeding can be easily controlled without medical intervention.
  • Posterior epistaxis is rare in adolescents, more often it occurs in the elderly. The bleeding originates from an artery in the back of the nose (Woodruff’s plexus). This disorder is difficult to treat and requires inpatient treatment by an otolaryngologist.

Causes of nosebleeds

The most common cause of nosebleeds is trauma caused by a hard punch or a slap, for example, when boxing.

Sometimes an injury can occur if you reach your nose with your finger and the nasal mucosa is dry and:

  • Hard
  • Rough.

Heating in winter can also be responsible for nosebleeds, because the heat leads to dryness of the inner nasal mucosa, which then becomes more susceptible to tears and bleeding.

Causes of nosebleeds include:

  • High blood pressure, it also causes headaches, dizziness, nausea, blurred vision and fatigue.
  • stay at high altitudes,
  • Allergic rhinitis or non-allergic rhinitis (inflammation of the nasal mucosa),
  • Cold
  • some medications, for example, non-steroidal anti-inflammatory drugs (such as brufen), aspirin, anticoagulants (such as heparin), antihistamines and some decongestant nasal remedies,
  • sniffing cocaine,

Diseases that cause epistaxis are:

  1. Leukaemia
  2. Rendu-Osler-Weber disease,
  3. Some types of upper respiratory tract infections, for example, sinusitis,
  4. Benign or malignant tumors of the nose,
  5. Von Willebrand disease,
  6. Haemophilia
  7. Atherosclerosis, which is a disease of the arteries in which plaques form mainly due to fatty deposits (atheroma),

Most often, children have a tendency to take a cold shower after playing outdoors and in the hot sun.

In some cases, the sudden change in temperature can cause nosebleeds for the body.

Once the body has reached a higher temperature during physical activity, it needs time to return to its initial temperature.

When the body is exposed to sudden cold (such as a cold bath or shower), the mechanism becomes unbalanced and this can cause bleeding and other disturbances.

Nosebleeds and high blood pressure

There are two types of nosebleeds, from the anterior and posterior section of the nose. One of the reasons for bleeding from the back of the nose is high blood pressure, called arterial blood pressure. Epistaxis may occur when arterial systolic blood pressure (upper blood pressure) exceeds 160 mm Hg.

Nosebleeds and vitamin deficiencies

Lack of vitamin B-9 and B-12

Deficiency of vitamins B-9 and B-12 can cause nosebleeds because due to an increased concentration of homocysteine in the blood, the vascular walls are damaged and the risk of forming aneurysms and capillary injuries is increased.

Lack of vitamin A

According to an article from the University of Maryland Medical Center, vitamin A is important for moisturizing and for the health of the nasal mucosa, sinuses, mouth, eyes, and digestive system.

A deficiency can cause dryness and inflammation in the nasal cavities, thus increasing the risk of lesions and bleeding.

In addition, dry mucous membranes are a risk for infections that lead to nosebleeds.

Lack of vitamin K

Vitamin K serves as a cofactor for an enzyme that converts glutamic acid into gamma-carboxyglutamic acid, which is required for blood clotting.

Blood clotting is a process that stops blood leakage by forming a coagel in the artery.

This process is essential for healing damaged blood vessels.

The lack of vitamin K leads to uncontrollable bleeding after a blood vessel has burst.

Lack of vitamin C

Vitamin C is important for the development of collagen, which is the main component of connective tissue.

Collagen is located:

  • In the skin,
  • In the blood vessels.

Lack of vitamin C weakens blood vessels and can lead to a condition called capillary fragility.

The fragility of blood vessels and capillaries in the nose depends mainly on collagen, which prevents vascular rupture and nosebleeds.

Nosebleeds in children

Causes of epistaxis in children

Nosebleeds from the front of the nose are most common in dry climates or in winter. In this weather, the air dries out the nasal mucous membranes, which can form a crust, burst and bleed.

Children may suffer from nosebleeds for the following reasons:

  • Trauma: An accident can cause injuries to the nose that lead to hemorrhage. This is one of the most common causes of nosebleeds in children.
  • Toddlers put foreign objects in the nose such as: food, small toys, other objects, etc.
  • Foreign bodies can decompose, irritate and injure the mucous membrane, thus causing nosebleeds.
  • Scratching: Scraping out dried nasal secretions, scratching the nasal mucosa or popping the inner walls of the nose with your fingers and nails can cause nosebleeds in children.
  • Allergies and infections: Infections of the upper respiratory tract and sinuses can lead to inflammation, which increases the likelihood of nosebleeds.
  • Allergies can lead to rhinitis and epistaxis.
  • Seasonal factors: In winter, when the climate is cold and dry, heating can make the nasal passages brittle, causing rupture of blood vessels in the tissues.
  • In summer or spring, the pollen flight in the air can trigger allergies in children, which are then a reason for nosebleeds.
  • Structural malformations: Structural malformations of the nose, such as nasal polyps or a curvature of the nasal septum, can be another cause of nosebleeds.
  • Too much blowing of the nose: Since the tissue and mucous membrane are tender and soft in young children, blowing the nose too hard can cause the tissue to tear and lead to nosebleeds.
  • Medications: The blood clotting process can be blocked by drugs such as ibuprofen, aspirin, etc.
  • These drugs don’t cause bleeding, but they can make a disease worse and cause problems with blood clotting.

Nosebleeds during pregnancy

Nosebleeds are common in pregnancy, especially in the second trimester.

About one in five pregnant women have nosebleeds, while only one in 16 non-pregnant women have these symptoms.

The bleeding usually occurs because the hormones in pregnancy (progesterone and estrogen) put the blood vessels as far as possible.

At the same time, the blood flow is increased and exerts pressure on the tender venous vessels in the nose.

The moist inner walls (mucous membranes) of the nose can:

  • Swell
  • Dry out.

This can get worse in winter, when colds become more common and a heater makes the apartment warm and dry.

All of this together can quickly lead to rupture of blood vessels and light bleeding.

Causes of nosebleeds at night and in the morning

Warm, cold and dry climate

The most common causes of nocturnal nosebleeds are:

  • dryness due to ambient heat,
  • Heavy nose blowing,
  • nasal popping,
  • Nosebleed.

Dry air causes crusting of the nasal mucosa. The result is a flaking of the crusts and bleeding.

The nasal mucosa is full of small and sensitive blood vessels that bleed easily, especially when scratching, abrasion, and nose blowing.

Other possible causes include:

  1. Cold
  2. Smoke
  3. upper respiratory tract infection,
  4. A foreign body in the nose,
  5. Hypertension
  6. Tumour
  7. Facial injury
  8. blood clotting disorder,
  9. Side effects of anticoagulant drugs or aspirin and drugs.

Allergy, infection and colds

Sometimes, with a cold or allergy, the nasal mucous membranes become inflamed, which can trigger nosebleeds both in the morning and at night.

In addition, a cold closes the nasal cavities and you use nasal sprays, which can irritate and dry out the nose.

This can lead to nosebleeds.

Also strong blowing can cause:

  • mucosal cracks,
  • Nosebleed.

According to the American Academy of Otolaryngology, allergies and infections can cause itching.

The patient therefore scratches his nose and nosebleeds occur.

Septal deviation

Septal deviation occurs when the septum between the two nasal cavities is curved.

According to an article on the Mayo Clinic website, this disorder can favor nosebleeds because the free nostril is exposed to greater dehydration from the airflow. The result may be crusting or bleeding.

Septal deviation can cause:

  • A stuffy nose,
  • Infections.

Nosebleeds can occur in the morning and during the night during sleep.

How to treat nosebleeds?

If the nose bleeds, you should:

  • Sit upright,
  • Squeeze the nostrils between thumb and forefinger for at least 10 – 15 minutes.

Do not tilt your head backwards (or downwards), because you risk the blood flowing into the respiratory tract.

If the bleeding happens due to dryness, rub the mucous membranes with a lubricant (petroleum jelly) to avoid further bleeding.

In some cases, an ice pack placed between the forehead and nose helps to stop the bleeding.

Natural remedies for nosebleeds

As soon as the bleeding stops, keep your head above heart level:

  • This saves time for blood clotting,
  • Further bleeding is prevented.

Do not blow your nose and do not tampone because this can loosen the blood clot (the crust that closed the lesion).

If the sneezing cannot be suppressed, open the mouth to allow the air to come out through the mouth instead of through the nose.

Salt water

Salt is an excellent disinfectant and shortens the healing time of lesions on the skin or mucous membrane.

  • Put a tablespoon of salt in a cup of water and mix well.
  • Once the salt has dissolved, place a cotton ball in the cup.
  • Once the cotton ball has soaked up, carefully insert it into the nostril.

In addition, you can use a few salty nasal drops using nasal spray, which is available in a pharmacy or online.

Drug therapy for nosebleeds

There are medicines that are taken in tablet form or given intravenously, for example, tranexamic acid (Ugurol).

When to worry?

Medical intervention is required if the nasal bleeding does not stop, even if the applications described above have previously taken place or the bleeding persists after more than 15 – 20 minutes.

Continued bleeding may indicate other serious physical conditions that may not yet have been diagnosed.

Therefore, you should call for help as soon as possible, especially if:

  • the data subject is a newborn, a child or an elderly person,
  • The blood loss remains constant.

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