Home / Treatment / Causes of nasal bleeding, first aid and treatment

Causes of nasal bleeding, first aid and treatment

Bleeding from the nose (scientifically – epistaxis) is very frequently encountered in human pathology. When it is observed the discharge of blood from the nose occurring due to rupture of blood vessels. In some cases, epistaxis leads to a large blood loss and even life threatening. 20% of such bleeding requires immediate medical help. Nasal mucosa characterized by the presence of a significant number of small blood vessels. The damaged blood flows from the nostrils to the outside, but in severe cases it can flow into the larynx and obstruct breathing. Most often, the vascular injury is accidental in the injury of the nose.

According to statistics, epistaxis observed in 60% of people. Usually nosebleeds occur in children up to 10 years and in adults after 50 years. It is noteworthy that this pathology is more typical for men.

After 40-50 years, nosebleeds often appear as Mature people the mucous membrane is much drier and thinner than in young age. The ability of blood vessels to reduce reduced, and there is a tendency to progression of hypertension. In 80% of cases with unclear reasons often repeated nasal bleeding in a patient identify the problems in the system of hemostasis (hemostatic system).

Experts distinguish between two types of this kind of bleeding, depending on which departments the nasal cavity they occur:

  • Front that occurs most often. When the blood flows from the nostrils to the outside;
  • The back, which is rare, but poses significant health risks and require medical help. When the blood flows down the throat inside.

The content of the article:


Causes of nasal bleeding

This pathological condition is caused by various reasons, but there are two groups of factors leading to nosebleeds.

  1. Local damage, which are the most frequent cause of bleeding from the nose:

    • Nose injury during sports or accident;
    • surgery, for example rhinoplasty;
    • The intervention of foreign objects, including fingers;

    • Disease: allergic and atrophic rhinitis, sinusitis, sinusitis. With such pathologies blood vessels of the nose are vulnerable and often damaged, especially if the mucous membrane is regularly dry nasal preparations;

    • Anatomical deformity of the nasal cavity;
    • Ulceration in the area of the vascular plexus of Kisselbach;
    • The use of drugs by inhalation through the nose;

    • Tumors in the nasal cavity or paranasal sinuses: nasopharyngeal carcinoma, bleeding polypus;

    • Lower air humidity (especially in winter), leading to dryness of the nasal mucosa;
    • Barotrauma;
    • The use of oxygen catheter.

  2. Systemic causes that are less common, but require careful attention of the doctor:

    • Allergies;

    • Various infectious diseases: acute respiratory infections, SARS, influenza, diphtheria, sepsis, accompanied by intoxication of the organism. Toxins, viruses and bacteria can lead to the dilation of blood vessels, which become thin and fragile. On the background of infections, there is a weakening of the processes of blood clotting and increased permeability of its elements;

    • Hypertension (high blood pressure);

    • Vascular disease, including atherosclerosis;

    • Heart failure;

    • Increased intracranial pressure;

    • Blood diseases: leukemia, kapilliarotoxicos, leukemia, anemia, hemophilia, hemorrhagic vasculitis, disease Rendu-Osler, idiopathic thrombocytopenic purpura, von Willebrand factor;

    • Lack of vitamin K, C;
    • The pathological state of the liver: hepatitis and cirrhosis, which lead to the decrease of synthesis of components, affecting the normal operation krovoostanavlivayuschee system. This changes the structure of liver tissue, which causes the slow blood flow and increase blood pressure in those vesselsresponsible for the renal circulation;
    • The abuse of alcohol, causing vasodilation;
    • Angiofibroma, which is a formation localized in the nasopharynx or skull base. It is characterized by frequent nosebleeds;
    • Kidney disease are on the increase blood pressure;
    • Hypothyroidism, manifested in violation of thyroid function, in which decreased production of platelets;
    • Side effects of drugs.
In 90-95% of cases of epistaxis its source – the division of the anteroinferior nasal septum, called by Disselboom plexus. In other cases, the bleeding develops in the middle and the posterior nasal cavity. Most threatening are epistaxis characterized by sudden onset, large blood loss and a short duration. Experts call them "signal" epistaxis. They can be caused by damage to the large vessels in the nasal cavity or rupture of the aneurysm. Epistaxis may provoke cancer.

Pulmonary hemorrhage, which is characterized by the appearance of scarlet frothy blood, also can occur through the nose. When bleeding occurs in the upper gastrointestinal tract, from the nose can stand out of dark clotted blood. Blood disorders and treatment with anticoagulants often cause this condition and increase its duration. Epistaxis is also one their characteristics skull fracture. Often, blood observed white blotches cerebrospinal fluid. Heat or sun stroke can also cause flow of blood from the nose. It is accompanied by headache, dizziness, nausea, fainting. This state can be affected by even healthy people.

In cases where not established the exact cause of epistaxis, it is usually associated with diseases of the blood. Moreover, it could be a number of serious diseases. These include disorders of function and structure of platelets, reducing clotting factors and a decrease in prothrombin level. The causes of nasal bleeding include high physical load, fast running, overheating of the body, sharp bends and getting up with high blood pressure, rarefaction of the surrounding air.

To determine the cause of chronic nasal bleeding canneed the following hardware laboratory and research:

  • Analysis of blood and urine, which will show the overall health;
  • Coagulation characterizing the work of the blood coagulation system;

  • A blood test for the presence of prothrombin and determination of pathologies of the liver ALAT, ASAT;

  • Electroencephalogram, reflecting the nature of biological currents of the brain;
  • Ultrasound of the head and internal organs;
  • Electrocardiogram, indicating disorders in the circulatory system;
  • Echocardiography, aims to study changes in the heart and its valves;
  • Radiograph of the nasal cavity and the cranium;
  • Computed tomography of the sinuses;
  • Magnetic resonance imaging of the sinuses and skull.

For diagnosis the patient may need examination by the following doctors: ENT, hematologist, surgeon, neurologist, cardiologist, ophthalmologist.

Bleeding from the nose at high pressure

High blood pressure is one of the common causes of epistaxis. Its first signs are:

Frequent cases of bleeding nose, accompanied by the above signs indicate hypertension. In this case, the appearance of blood from the nose is a compensatory process that prevents the overloading of the blood vessels of the brain. Nosebleeds that occur in arterial hypertension, are characterized by long duration. Profuse bleeding from the nose at high pressure can lead to its rapid fall, which can cause congestive heart failure (collapse).


What is the cause of frequent nose bleeding?

Recurring nosebleeds are often associated with the peculiarities of the anatomical structure of the nasal cavity. The appearance of droplets or trickles of blood when coughing, sneezing, or runny under normal health points to weak walls of blood vessels plexus of Kisselbach. Such bleeding from nose is almost always observed from an early age.

Another reason for frequent spontaneous bleeding from the nose is atrophic rhinitis. In this disease the mucous membrane of the nosebecomes thin and parched. This condition contributes to the violation of the integrity of blood vessels at the slightest touch.

Frequent epistaxis observed in the change of hormonal background. They can occur in adolescence and in pregnant women. In girls from 11 years sometimes marked allocation of blood from the nose. They can for some time to accompany the first menstruation. During pregnancy occurs in the body global hormonal, structural and functional changes. Greatly increases the level of sex hormones such as estrogen and progesterone. They have a direct impact on increasing the blood supply in the area of the mucous membranes. While women with fragile vessels or thin the lining of the nose, greatly increases the risk of frequent epistaxis. Sometimes pregnant women have bleeding from the nose indicate an increase in blood pressure, which is a sign of the development of such hazardous conditions such as preeclampsia and eclampsia. The emergence of epistaxis may indicate exacerbation of a pregnant woman, diseases of the kidneys and liver.

Regardless of the reasons private epistaxis are a significant cause for consulting a doctor and conducting a comprehensive diagnostic of human health.


What to do with nosebleeds?

Most people before the start of epistaxis are the following typical feelings: a growing headache, pulsating noise in the ears, a sensation of tickling or itching in the nose. Actions for this pathology is directly dependent on the factors that caused it. This should also take into account the severity of the pathogenesis.

Experts identify the following typical signs of bleeding from the nose:

  • The secretion from the nostrils or into the throat after a red blood indicates that its source is the front or posterior part of the nasal cavity;
  • After the foam of blood from the nose is a sign of pathology in the lower divisions of the respiratory system, namely, the bronchi and the lungs;
  • Minor bleeding, characterized by the selection of drops and trickles of blood. As a rule, their volume does not exceed a few milliliters. It usually stops on their own and can be very short. To stop this epistaxis you just need to press the wings of the nose. Most frequently this pathology is formed in the region of the plexus of Kisselbach;
  • Moderate bleeding, which leads to the loss of up to 300 ml of blood. Despite this, pathological changes in the cardiovascular system often does not occur. It is advisable to consult a doctorstudy of the causes of epistaxis;
  • Massive blood loss (300-500 ml), causing pale skin, low blood pressure to 11070 mm RT. article, General weakness, significant increased heart rate (90 beats/min), dizziness. In the most severe cases, the patient loses up to 1 l blood. After such blood loss after 1-2 days often decreases the level of hemoglobin in the blood. Hematocrite number in this epistaxis reduced to 30-35 UNITS. A copious epistaxis is a serious threat to human health, therefore, should immediately consult the doctor.

Treatment of nasal bleeding

Not always bleeding from the nose can be stopped independently. In this case, can be applied drug treatment. It somehow prevent disease or to prescribe the patient drugs intravenously/intramuscularly or inside. Choose them depending on the severity of the bleeding. With a slight to moderate epistaxis should take 1-2 teaspoons of 10% calcium chloride. It enhances the action krovoostanavlivajushchim drugs, improves the contractility of vascular walls and reduces their permeability.

Doctors to stop epistaxis prescribed the following medications:

  • Solution etamzilata sodium is 12.5% (dicynone), which enhances platelet function and helps stop bleeding. It does not affect blood clotting, so it is prescribed for a long time. It is used for oral or intravenous;
  • Menadione, which enhances the effect krovoostanavlivajushchim drugs, but it cannot be used more than 3-4 days. This drug is administered intramuscularly;
  • Aminocaproic acid reduces the processes leading to thinning of the blood. It is administered intravenously (over 60 drops per minute). It is contraindicated DIC (violation of intravascular coagulation) because it increases blood clotting.

The patient should also take vitamins C and K. In case of severe nasal bleeding used the transfusion of blood components. The patient is administered at least 500 ml of fresh plasma, has a hemostatic effect.

If ongoing for a long period of time, bleeding from the nose can be used surgical methods of treatment.

Front tamponade

Front tamponade, which stopsbleeding from the anterior nasal cavity is as follows:

  1. During the procedure, the nose area numb spray 10% lidocaine or instillation of 2% tetracaine.

  2. Neck injected gauze (turundas) length 20 cm and width up to 1.5 cm.

  3. Before the introduction of the nose turundas moistened with 3% hydrogen peroxide, accelerating the formation of a thrombus, or a 5% solution of aminocaproic acid, which has hemostatic effect.

  4. You can also turundas moistened with thrombin or hemophobia.

  5. After the introduction of the tampon in the nose impose sling bandage.

  6. Turundas in the nose leave on for 1-2 days, daily injecting swab with aminocaproic acid. In severe cases turundy nose leave it for 6-7 days.

  7. Before you remove a tampon it inject 3% hydrogen peroxide to become moist and easier removed.

Rear tamponade

Rear tamponade required in case of excessive bleeding from the posterior nasal cavity, as follows:

  1. For this procedure, prepare sterile swabs of folded gauze. Their size should be 2,5x2 cm

  2. Tampon tie the two silk threads of length 20 cm crosswise. One of the four ends of the threads cut off.

  3. Before the procedure, intramuscular analgesia produce lytic mixture consisting of aqueous solution 1 ml of 1% promedol, 2 ml 50% analgin, 1 ml of 2% diphenhydramine.

  4. Start the procedure with the introduction of the bleeding nostril a thin rubber catheter. It is administered as long as he does not come out through the nasopharynx into the throat.

  5. Then using pliers or tweezers pull the catheter out through the mouth.

  6. By the end of the catheter is tied swab and tighten it inside the nasal cavity until it stops at the Hoan (internal nasal openings).

  7. The tampon is held in place by two tensioned threads coming out of their nose.

  8. The third thread displays of his mouth. Glue one to the cheek by adhesive plaster.

  9. Rear tamponade of reliability to complement the front.

  10. Tampons leavenose for 1-2 days. In severe cases, for 6-7 days. The patient should take antibiotics and sulfa drugs for the prevention of infectious diseases and rhinogenous sepsis.

  11. Remove tampons with silk threads.

Surgical treatment

Surgery apply in 5-17 % of cases of permanent extensive nasal bleeding.

With the possible effects on the nasal cavity by the following methods:

  • Moxibustion a round swab of cotton wool soaked with 40% solution of silver nitrate (silver nitrate) or trichloroacetic acid. This is the most simple method of treatment of epistaxis. After this procedure, a scab that stops the bleeding;
  • The introduction of drugs (procaine, lidocaine) in the submucosal shell of the nasal cavity. This method of therapy is used for local bleeding;
  • Submucous resection of cartilage located in the nasal septum, detachment of the nasal mucosa, and local intervention is recommended with frequent relapses of the pathology;
  • Electrocoagulation (cauterization current) that should be performed only in a medical facility. The procedure is performed under local anesthesia. Electrocoagulation helps in the damage of small vessels in the anterior part of the nasal septum and recurrent bleeding;
  • Radio wave impact of the device Surgitron, which is characterized by its efficiency and safety. This surgery has almost no side effects and complications;
  • Cryosurgery, during which the damaged area of the mucous membrane treated with liquid nitrogen. After this therapy on the nasal mucosa does not occur scar tissue. In this case the mucous membrane is completely restored rather quickly. The procedure lasts about half an hour;
  • Laser photocoagulation, which is characterized by high efficiency and safety. The only drawback is a rather high price for a therapy session. In this procedure, the damaged mucous membrane is exposed to high-intensity laser. Operation different minimum injury of tissues, high precision and anti-bacterial effect of laser, which reduces the risk of infections;
  • Remove ridges and spikes of the nasal septum using surgical instruments.

In recent years the most popular method of stoppingepistaxis manipulations are produced on patanasal (maxillary, ethmoid) sinuses. In the process of this treatments are ligation or clipping of the damaged vessel. In some cases, surgery may be needed for mechanical destruction of cells of the ethmoid sinus. Then perform tamponade of the nasal cavity.

In severe cases, by the physician carry out the ligation of the main vessels such as the external carotid and internal maxillary artery. Such an operation is carried out in cases where other therapies have been ineffective. It often does not cause complications and effectively stops the bleeding.

In severe nasal bleeding caused by damage to the internal carotid artery, and perform angiography and embolization of the bleeding vessel inside the skull. This is a very promising method of treating severe pathologies. This operation provides the ability to accurately block the damaged portion of the vessel from which the bleeding occurs. The procedure is quite complicated and not possible without expensive special equipment and experience of the surgeon. Unfortunately, this complex operation can sometimes lead to paralysis and bleeding of large areas of the brain.

Current high-tech methods microinsurance and endoscopic surgery are characterized by undue complexity and are not always effective. However, they can also lead to various complications.


First aid for nosebleeds

If you experience nosebleeds one must clearly define what he will be able to cope on their own or with loved ones, and that requires immediate medical intervention.

When bleeding from the nose, you must do the following:

  • To reassure the patient. To do this, it needs slow and deep breathing. This step reduces emotional arousal and prevents the increases in heart rate and increase blood pressure, which only increase the blood loss;
  • Seat patient in a comfortable position raise his head, not throwing it back. The head should be slightly tilted forward. With his head thrown back, the blood dripping down the nose and throat, can cause vomiting and getting blood clots in the airway, leading to respiratory distress functions. Under the nose of the patient fills the collecting tankflowing blood, which allow to determine accurately the volume of blood loss;
  • To take measures to stop the bleeding. For this the wings of the nose pressed against the septum with your fingers. Also the patient can gently release the nasal cavity from the accumulated blood in it clots. In the cleared nose buried nasal drops (Galazolin, Nazivin, Sanorin, Glycine). They have a vasoconstrictor effect. Is instilled into each nostril 5-6 drops of the drug. After that, the nose is instilled 10 drops of 3% hydrogen peroxide. A very effective method of stopping bleeding from the nose is irrigation of the cavity with cold 5% aminocaproic acid. Also for these purposes can be used drugs such as Thromboplastin or Thrombin. The above procedures are complex: mechanical compressed blood vessels, the accumulated blood coagulates faster and dries, creating a kind of tube, nasal drops constrict blood vessels, hydrogen peroxide and other drugs accelerate the formation of a blood clot, stopping the blood;
  • Applying a cold compress to the nose. It may be an ice pack wrapped in cloth or a cold towel. Every 15 minutes remove compress for a few minutes. Due to exposure to cold constricts blood vessels, rapidly reducing the amount of bleeding. Dip hands in cold water and feet warm also contributes to a more rapid stop of blood;
  • Put in the nostrils with a cotton swabdipped in a solution of vasoconstrictor drugs (3% hydrogen peroxide, 5% aminocaproic acid). The wings of the nose should be pressed against the septum for 5 to 15 minutes. During removal of the tampon should be very careful again not to damage the blood vessels and removing the crust formed;
  • Give the patient to drink salted water (1 teaspoon/200 ml).

Sometimes measures first aid may not be enough. Immediately contact doctor in case of:

  • Injuries of the nose and of the skull;
  • Ongoing bleeding for a long time;
  • Too abundant loss of blood (to more than 200 milliliters);

  • Exacerbation of chronic diseases of the kidneys and liver;

  • The availability of infectious diseases;

  • Sudden worsening of health, General weakness, vomiting, pale skin, dizziness, loss of consciousness.

In the prevention of epistaxis canrecommend:

  • Strengthening of walls of vessels by regular intake of vitamin C or Askorutin;
  • Maintaining normal blood pressure;
  • Exercise of blood vessels using contrast showers, baths, tempering dousing;
  • The coagulability of the blood by the intake of vitamin K and calcium;
  • Ensure the moisture of the nasal mucosa by using ointments or oils;
  • Refusal of Smoking and alcohol;

  • Timely therapy of chronic diseases of the kidneys, liver, heart, and vascular system;

  • Moderate exercise;
  • A healthy diet that includes protein foods like cheese, liver, chicken, Turkey.

Because the epistaxis is not only a small local pathology, but also a sign of various dangerous to human health diseases, with frequent relapses or excessive discharge of blood must undergo a comprehensive examination to establish an accurate diagnosis and appropriate therapy.