EPISTAXIS is the medical term for nosebleed, which is a common occurrence.
Our noses have a large amount of blood vessels and nosebleed occurs when these vessels break. The severity can vary from a mild bleed which is most common, to a life-threatening condition which requires urgent attention.
Nosebleed can be divided into anterior bleeding and posterior bleeding.
Anterior bleeding which is common in children occurs when the blood vessels in the front of the nose break. The bleeding is usually minimal and easy to stop.
A posterior bleed occurs when the vessels at the back or deep inside the nose break. It is more common in adults and can be dangerous because it can cause more severe bleeding.
There are many causes of nosebleed. Nose allergies, especially in children, are a common cause of nosebleed. Children with nose allergies tend to repetitively rub and pick their nose because of itchiness, which can break blood vessels and cause a nosebleed.
Dry air is another cause of nosebleed. Sleeping in an air-conditioned room without a humidifier can dry out the skin lining in the nose, which can cause crusting and lead to nose rubbing, picking and frequent sneezing. The high velocity airflow against the dried and crusted nose lining while sneezing will cause nosebleed.
Other causes include trauma to the nose, an infection, a foreign body in the nose, nose cancers, abnormal blood vessels, bleeding disorders, high blood pressure and blood thinning medications such as aspirin.
Anterior nosebleed, which is less serious, can be treated at home. To do so, pinch the soft part of the nose between the thumb and index finger while sitting up. Lean forward and breathe through your mouth. Then apply an ice pack to the nasal bridge. Do not panic because it will cause palpitations and worsen the bleed.
Avoid leaning back or tilting the head back as this causes the blood to flow into the throat. After 15 to 20 minutes, the nosebleed should subside. However, if the bleeding persists, you should immediately seek medical help.
To help prevent future nosebleed, keep the interior lining of the nose moist, which can be done by applying petroleum jelly inside the nose using a cotton swab twice a day. A saline nasal spray can also help moisten the dried nasal lining.
The environment also plays a role in preventing nosebleed. Use a humidifier and an air-conditioner to humidify air in the house. You should also regularly clean bedspreads and blankets regularly to minimise contact with house dust and dust mites, which are the most common cause of nose allergies.
Frequent and intermittent mild anterior nosebleed requires further evaluation from a ear nose and throat (ENT) doctor. If needed, the doctor will cauterise bleeding blood vessels in the nose using chemical solutions such as silver nitrate and trichloacetic acid.
Rapid bleeding with severe blood loss as in posterior nosebleed and severe nose trauma require urgent medical attention. The nose will be packed with nasal packing for between 24 and 72 hours, while the patient’s blood will be investigated to identify any bleeding disorder.
If the nosebleed persists despite nasal packing, the patient may require surgical intervention or a procedure to plug up the bleeding vessels, called embolisation.
Dr Abdul Fattah Abdul Wahab is a consultant ENT surgeon at Ara Damansara Medical Centre.