Nosebleed (Epistaxis)
Epistaxis, commonly known as nosebleeds, occurs when blood vessels within the nasal cavity rupture and bleed. Common causes include dry air, nasal injury, allergies, infections, high blood pressure, or blood clotting disorders.
Nosebleeds are generally categorised into anterior (front of the nose) and posterior (back of the nose) types, with anterior nosebleeds being more common and less severe. While most episodes are minor and can be treated at home by pinching the nostrils and leaning forward, frequent or heavy nosebleeds may require medical attention to address potential underlying causes.
Epistaxis can result from various factors affecting the nose's delicate blood vessels. Common causes include:
- Trauma or Injury – Physical impact to the nose or habitual nose picking can damage nasal blood vessels, leading to bleeding.
- Clotting Disorders – Conditions like haemophilia or using blood-thinning medications can impair the blood's ability to clot, increasing the likelihood of nosebleeds.
- Rhinitis and Sinusitis – Inflammation from nasal infections can irritate the lining of the nose, causing blood vessels to rupture.
- Nasal Tumours – Benign and malignant growths in the nasal passages can disrupt normal blood flow and lead to bleeding.
- Deviated Nasal Septum – A misaligned nasal septum can cause uneven airflow and dryness, which may result in nosebleeds.
- Nasal Polyps – Soft, painless growths inside the nasal passages can cause irritation and frequent nosebleeds.
- Leukaemia – Certain diseases, like leukaemia, affect blood cell production and clotting mechanisms, making nosebleeds more common.
Epistaxis primarily presents via a visible nosebleed. This may range from a light trickle to a heavier flow. Other accompanying symptoms may include:
- A Feeling of Liquid Dripping Behind the Throat – Blood may flow down the back of the throat, causing a sensation of liquid dripping, which might lead to coughing or swallowing blood.
- Dizziness and Light-headedness – Significant or prolonged blood loss from a nosebleed can result in dizziness or light-headedness due to a temporary decrease in blood pressure.
Depending on the cause and severity of the nosebleed, treatment options can range from home remedies to medical intervention. These include:
- First Aid Measures – Sit upright and lean forward slightly to prevent swallowing blood. Pinch the soft part of your nose just below the bridge for 10 to 15 minutes while breathing through your mouth. Avoid lying down or tilting your head back.
- Topical Vasoconstrictors – Applying certain nasal decongestant sprays can help constrict blood vessels and reduce bleeding.
- Cauterisation – If the bleeding vessel's source is identifiable, a doctor may attempt to cauterise and seal the source of the bleed.
- Nasal Packing – In cases where bleeding does not stop with direct pressure, nasal packing with gauze may be used to apply pressure from inside the nose.
- Treating Underlying Conditions – Managing factors such as high blood pressure, infections, or clotting disorders can help prevent recurrent nosebleeds.
- Surgical Intervention – For severe or recurrent cases, procedures like arterial ligation or endoscopic cauterisation may be performed to control bleeding.
- Humidification and Lubrication – A humidifier can moisten dry air, and saline nasal sprays or gels can keep the nasal passages moist and reduce the risk of bleeding.
Are nosebleeds painful?
- Nosebleeds are generally not painful, although the experience can be uncomfortable or distressing. The bleeding originates from the delicate blood vessels in the nasal lining, which do not have pain receptors, so individuals typically do not feel pain during the bleeding. However, discomfort may be present if there is associated trauma or irritation to the nasal passages.
How do you know if a nosebleed is serious?
- A nosebleed may be concerning if it lasts longer than 20 minutes despite applying direct pressure or occurs after an injury (direct trauma) to the head or face. Other warning signs include dizziness, light-headedness, or a rapid heartbeat, which may indicate significant blood loss. In such cases, seek medical attention immediately.
Should I go to ENT for nosebleeds?
- Visiting an ear, nose, and throat (ENT) specialist is advisable if you experience frequent or severe nosebleeds that do not respond to the typical first aid measures. An ENT doctor can evaluate for potential underlying causes, such as anatomical issues, clotting disorders, or nasal tumours that may require further treatment.
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