Nose Bleeding

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By peace | October 1, 2006

Nosebleeds(epistaxis) are very common. Most nosebleeds are mere nuisances. But some are quite frightening, and a few are even life threatening. Physicians classify nosebleeds into two different types.

Anterior nosebleed: Most nosebleeds begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail. This type of nosebleed comes from the front of the nose and begins with a flow of blood out one nostril when the patient is sitting or standing.

Posterior nosebleed: More rarely, a nosebleed can begin high and deep within the nose and flow down the back of the mouth and throat even if the patient is sitting or standing.

Types Of Nosebleeds

Obviously, when the patient is lying down, even anterior (front of nasal cavity) nosebleeds may seem to flow posteriorly, especially if the patient is coughing or blowing his nose.

It is important to try to make the distinction since posterior (back of nasal cavity) nosebleeds are often more severe and almost always require a physician’s care. Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face.

Anterior nosebleeds are common in dry climates or during the winter months when heated, dry indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented if you place a bit of lubricating cream or ointment about the size of a pea on the end of your fingertip and then rub it inside the nose, especially on the middle portion of the nose (the septum).

Causes Of Nose Bleeds

Most nosebleeds occur because of minor irritations or colds. The nose has an abundant supply of tiny blood vessels, which makes it easy for the nose to bleed. Air moving through the nose can dry and irritate the membranes lining the inside of the nose. The lining develops crusts that bleed when irritated by rubbing, picking, or blowing the nose.

The lining of the nose is more likley to become dry and irritated from low humidity and dry environment, allergic rhinitis, colds or sinusitis. A deviated septum, foreign objects in the nose, or other nasal obstruction may cause also cause nosebleeds. A direct impact to the nose can also cause a nosebleed.

Most nosebleeds occur on the tip of the nasal septum, which contains many fragile, easily damaged blood vessels. More rarely, nosebleeds may occur higher on the septum or deeper in the nose. These higher or deeper nosebleeds may be harder to control.

Occasionally, nosebleeds may indicate other disorders such as bleeding disorders, hypertension or arteriosclerosis. Hereditary hemorrhagic telangiectasia (also called HHT or Osler-Weber-Rendu syndrome, a disorder involving a vascular growth similar to a birthmark in the back of the nose) may be evidenced by nosebleeds.

Sometimes blood thinners such as Coumadin or aspirin may cause or worsen nosebleeds. Most nosebleeds begin on the septum — the midline, vertical cartilage that separates the nasal chambers and is lined with fragile blood vessels. This form of nosebleed is not serious, and is usually easy to stop.

Additional Causes Of Nosebleeds:

Allergies, infections, or dryness that cause itching and lead to picking of the nose.
Vigorous nose blowing that ruptures superficial blood vessels in the elderly and in the young.
Clotting disorders that run in families or are due to medications.
Fractures of the nose or of the base of the skull that can cause bleeding and should be regarded seriously when the bleeding follows a head injury.
Rarely, tumors (both malignant and nonmalignant) have to be considered, particularly in the older patient or in smokers.

Treatment For Nosebleeds

Many physicians suggest any of the following lubricating creams or ointments. They can all be purchased without a prescription: Bacitracin, A and D Ointment, Eucerin, Polysporin, and Vaseline. Up to three applications a day may be needed, but usually every night at bedtime is enough. A saline nasal spray will also moisten dry nasal membranes.

If the nosebleeds persist, you should see your doctor. Using an endoscope, a tube with a light for seeing inside the nose, your physician may find a problem within the nose that can be fixed. He or she may recommend cauterization (sealing) of the blood vessel that is causing the trouble.