Nosebleed
A nosebleed, also known medically as epistaxis, is bleeding from the nasal cavity caused by rupture of small blood vessels in the nasal mucosa. Most cases are minor and stop spontaneously with simple first-aid or medical care. In some cases, blood may flow down into the stomach, and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significant that low blood pressure occurs. Blood may also be forced to flow up and through the nasolacrimal duct and out of the eye, producing bloody tears.
There are two types: anterior, which is more common; and posterior, which is less common but more serious. Anterior nosebleeds generally occur from Kiesselbach's plexus while posterior bleeds generally occur from the sphenopalatine artery or Woodruff's plexus. The vast majority of nosebleeds occur in the front anterior part of the nose from the nasal septum. This area is richly endowed with blood vessels (Kiesselbach's plexus). This region is also known as Little's area.
Risk factors include trauma; especially from nosepicking, blood thinners, high blood pressure, alcoholism, seasonal allergies, dry weather, and inhaled corticosteroids. Nosebleeds can occur due to a variety of reasons. Some of the most common causes include trauma from nose picking, blunt trauma such as a motor vehicle accident, or insertion of a foreign object. Low relative humidity such as in centrally heated buildings, respiratory tract infections, chronic sinusitis, rhinitis or environmental irritants can cause inflammation and thinning of the tissue in the nose.
Medications play a significant role in triggering these events. Anticoagulation drugs like warfarin, heparin, and aspirin increase the risk. Insufflated drugs particularly cocaine are also listed as causes. Nasal sprays used for prolonged periods or improper use of nasal steroids contribute to the problem. Dietary factors include sulfur dioxide E220 used as a food preservative in wines and dried fruits. Salicylates naturally occurring in some fruits and vegetables may also be involved.
The nasal mucosa contains a rich blood supply that can be easily ruptured and cause bleeding. Rupture may be spontaneous or initiated by trauma. Anatomical deformities such as septal spurs can disrupt normal nasal airflow, leading to mucosal drying and crusting that predisposes to anterior epistaxis. Epidemiologic studies have shown an association between nasal septal deviation and recurrent epistaxis in adults.
Bleeding farther back in the nose is known as a posterior bleed and is usually due to bleeding from Woodruff's plexus, a venous plexus situated in the posterior part of inferior meatus. Posterior bleeds are often prolonged and difficult to control. They can be associated with bleeding from both nostrils and with a greater flow of blood into the mouth. An increase in blood pressure tends to increase the duration of spontaneous epistaxis. The elderly are more prone to prolonged nosebleeds as their blood vessels are less able to constrict and control the bleeding.
People with uncomplicated nosebleeds can use conservative methods to prevent future nosebleeds such as sleeping in a humidified environment or applying petroleum jelly to the nasal nares. Individuals who suffer from nosebleeds regularly especially children are encouraged to use over-the-counter nasal saline sprays and avoid vigorous nose-blowing as preventative measures.
In Indonesian traditional medicine betel leaf is used to stop nosebleeds as it contains tannin which causes blood to coagulate thus stopping active bleeding. Some state that applying ice to the nose or forehead is not useful while others feel it may promote vasoconstriction of the nasal blood vessels and thus be useful. The utility of local cooling remains controversial among medical professionals.
Those who have a nosebleed should apply pressure to the soft anterior part of the nose by pinching the nasal ala for at least five minutes and up to 30 minutes. Pressure should be firm and tilting the head forward helps decrease the chance of nausea and airway obstruction due to blood dripping into the airway. When attempting to stop a nosebleed at home the head should not be tilted back.
Swallowing excess blood can irritate the stomach and cause vomiting. Vasoconstrictive medications such as oxymetazoline Afrin or phenylephrine are widely available over the counter for treatment of allergic rhinitis and may also be used to control benign cases of epistaxis. A few sprays of oxymetazoline may be applied into the bleeding side of the nose followed by application of direct pressure. Those with nosebleeds that last longer than 30 minutes despite use of direct pressure and vasoconstrictive medications should seek medical attention.
About 60% of people have a nosebleed at some point in their life. About 10% of nosebleeds are serious. Approximately 6% of patients will seek medical attention for epistaxis. Nosebleeds are rarely fatal accounting for only 4 of the 2.4 million deaths in the U.S. in 1999. Nosebleeds most commonly affect those younger than 10 and older than 50.
Nosebleeds appear to occur in males more than females. Spontaneous epistaxis is more common in the elderly as the nasal mucosa becomes dry and thin and blood pressure tends to be higher. The vast majority of nosebleeds occur in the front anterior part of the nose from the nasal septum. This area is richly endowed with blood vessels known as Kiesselbach's plexus.
In the visual language of Japanese manga and anime nosebleeding often indicates that the bleeding person is sexually aroused. In Western fiction nosebleeds often signify intense mental focus or effort particularly during the use of psychic powers. The oral history of the Native American Sioux tribe includes reference to women who experience nosebleeds as a result of a lover's playing of music implying sexual arousal.
In American and Canadian usage nosebleed section and nosebleed seats are common slang for seating at sporting or other spectator events that are the highest up and farthest away from the event. The reference alludes to the propensity for nasal hemorrhage at high altitudes usually owing to lower barometric pressure. In the Finnish language picking blood from one's nose and begging for a nosebleed are commonly used in abstract meaning to describe self-destructive behaviour.
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Common questions
What is the medical term for a nosebleed?
The medical term for a nosebleed is epistaxis. This condition involves bleeding from the nasal cavity caused by the rupture of small blood vessels in the nasal mucosa.
Which part of the nose is most likely to bleed during an anterior nosebleed?
Anterior nosebleeds generally occur from Kiesselbach's plexus located in the front anterior part of the nose on the nasal septum. This area is also known as Little's area and contains a rich supply of blood vessels.
How long should you apply pressure to stop a nosebleed at home?
You should apply firm pressure to the soft anterior part of the nose by pinching the nasal ala for at least five minutes and up to 30 minutes. Tilting the head forward helps decrease nausea and airway obstruction while applying this pressure.
Who is most commonly affected by nosebleeds based on age groups?
Nosebleeds most commonly affect those younger than 10 years old and older than 50 years old. Spontaneous epistaxis is more common in the elderly because their nasal mucosa becomes dry and thin and their blood pressure tends to be higher.
What causes bloody tears when someone has a severe nosebleed?
Blood may be forced to flow up through the nasolacrimal duct and out of the eye producing bloody tears. This occurs rarely when bleeding is so significant that it follows an abnormal path through the facial anatomy.