Nasal bleed in medical terminology is called as epistaxis. Bleeding from nose can be caused due to various reasons.
- Local Causes
- Nasal bleeds due to inflammation
- Systemic Causes
Local Causes For A Bleeding Nose
- Trauma: Trauma to nose, para nasal sinuses or head may result in bleed which usually stops in a short time. It may be associated with CSF (cerebro-spinal fluid) if there is a fracture through the base of the skull.
- Post operative: After any operative procedure of nose and para nasal sinuses, primary or reactionary bleeding may be seen.
- Picking the nose: Especially Litttle’s area accounts for almost 90% cases. This is area where arteries unite to form a plexus hence a little stretching or picking may cause bleed.
Inflammatory Causes For A Bleeding Nose
Acute inflammation leading to blood in your nose:
- Nasal diphtheria is characterized by blood stained discharge from nostril in children. A membrane forms in the nose due to presence of corny bacterium diphtheria which confirms the diagnosis.
- Acute rhinitis and sinusitis may sometimes results in bleeding.
- Adenoids may cause inflammation and congestion in the nose leading to bleeding.
Chronic Inflammation Causing Nasal Bleeds
Chronic rhinitis and chronic sinusitis are the cause of chronic inflammation.
- Rhinitis sicca: In this condition, vestibules of the nose dry up leading to the formation of scabs. If the person picks the nose to remove the scabs it may result in bleeding.
- Rhinosporidiosis: There is mulberry like red polypoid swelling which may bleed profusely.
- Tuberculosis, syphilis, leprosy may produce granulomas with scanty bleeding.
- Neoplasms: Angiomas from nasal septum may bleed profusely. Malignancy’s commonest areas are maxillary sinus, ethmoidal sinus. An elderly person with unilateral epistaxis should be investigated for malignancy.
- Foreign bodies may cause bleeding. Unilateral blood stained discharge with foul smell in a child should arouse suspicion of foreign body.
Nasal Bleeding Due To Systemic Causes
- Bleeding disorders like leukemia, hemophilia and purpura.
- Increased pressure in SVC (superior vena cava) due to mitral stenosis or superior mediastinal tumors.
- Environmental causes due to reduced atmospheric pressure and dryness. Bleeding may also occur at high altitudes.
- Infections may cause bleeding due to dryness and congestion of nose e.g. viral fever, enteric fever and rheumatic fever.
- Drugs like salicyclate and anti-coagulants may cause bleeding in nostrils.
Treatment For A Bleeding Nose
Treatment of specific causes should be done immediately.
First Aid For Nasal Bleeds
- Ice or cold pack application on the bridge of the nose. It may arrest bleeding by reflux vasoconstriction.
- Pinching the nose for a minute keeps pressure on Little’s area. It may stop bleeding from that area in some cases.
- Trotter’s procedure may be used in hypertensive persons if bleeding happens. In this person sits up, slightly inclined forward with open mouth and breaths quietly. Do not swallow the blood, spit it out. Avoid Forceful cleaning of the nose.
Home Remedies For A Bleeding Nose
- If the bleeding is due to crusting in vestibule as in rhinitis sicca; application of lubricants like oil, Vaseline or clarified butter prevents crust formation.
- Packing of nose: If bleeding persists nose is packed with ribbon gauze dipped in Vaseline or liquid paraffin and packed is removed after 48 hrs. This is anterior packing.
- Juice of flower of pomegranate should be used for deep inhalation.
- Juice of fresh green grass 5 to 10 drops in each nostrils gives immediate result.