Nosebleed? Don't be afraid! Let's talk about this (Epistaxis)

It's a little scary when you suddenly start bleeding from your nose, isn't it? Maybe you're doing something, or your little one is playing, and suddenly you see a drop or two of blood coming out of your nose. Sometimes it just stops, but sometimes when the bleeding continues, you can't figure out what's going on. Is this really serious? Why is this happening? Let's talk about everything in detail and simply today.

What does this nosebleed mean? (Epistaxis)

Simply put, bleeding from the nose is called `(Epistaxis)` in medical science. This can happen from one nostril, sometimes from both. But most of the time, bleeding comes from only one nostril.

Now let's see why this happens. Imagine, inside our nose there are many tiny blood vessels, spread out like a small mesh. These blood vessels have an important function. That is, to warm the air we breathe and provide it with the necessary moisture before sending it to our lungs. But the problem is, these tiny blood vessels are located very superficially, or very close to the skin inside the nose.

So when the air we breathe becomes very dry, for example when we spend a lot of time in an AC room, or when we live in an area with a dry, cold climate like Nuwara Eliya, the inside of the nose becomes dry and small crusts form. At this time, when we blow our nose a little hard, put our finger in it, or even just for a moment, these tiny blood vessels burst and start bleeding.

There are two main ways nosebleeds occur.

Doctors divide nosebleeds into two main types, depending on where the bleeding comes from.

1. Anterior Nosebleed

This is the most common type of nosebleed. The bleeding starts at the front of the nose, at the bottom of the septum, the wall that separates the two nostrils. The blood vessels in this area are very delicate, so even a small injury can cause bleeding. This is usually not a serious condition. Most of the time, it can be controlled at home with the first aid we've discussed.

2. Posterior Nosebleed

This is a type that requires a little bit of attention. This bleeding occurs from the larger blood vessels deep inside the nose, near the throat. The bleeding can be a little heavier, and the blood is more likely to go down the throat than forward from the nose. When this blood goes into the stomach, it can cause nausea and vomiting.

Bleeding from the back like this is usually difficult to stop with home first aid.In such a situation, it is best to see a doctor immediately or go to the hospital's Emergency Treatment Unit (ETU).

Why do we get nosebleeds? Let's look at some of the reasons

There can be a variety of reasons for nosebleeds. Fortunately, most of these causes are not serious.

Commonly seen reasons

• Dry air: This is the main cause. Weather with high heat and low humidity, staying in AC rooms all day, and the dryness of the air in mountainous areas can cause the inside of the nose to dry out and bleed.
• Nose picking: This is especially common among young children. The nails can get stuck and injure delicate blood vessels.
• Nose pinching: When we have a cold or sinus infection, we pinch our nose very hard. That pressure can also cause blood vessels to burst.
• Allergies: People who are allergic to things like dust and pollen may experience frequent itchy noses and sneezing, which can damage the delicate membranes inside the nose.
• Nasal Sprays: Some sprays used for allergies or nasal congestion can dry out the inside of the nose when used for a long time.
• Injuries to the nose or face: Bleeding can occur due to a fall, accident, or a blow while playing sports.
• Blood thinners: People taking blood-thinning medications like aspirin and warfarin may experience increased bleeding even from a minor injury.
• Deviated Septum: When the wall that separates the inside of the nose is deviated to one side, the airflow is altered, and one side can become constantly dry and bleed.

Less common causes

• Excessive alcohol use
• Blood clotting conditions (e.g., hemophilia or von Willebrand disease)
• High blood pressure
• Thickening of blood vessel walls (Atherosclerosis)
• Surgeries performed on the nose or face
• Nasal tumors or polyps
• Diseases such as blood cancer (Leukemia)
• Pregnancy (during this time, the blood vessels in the body dilate, putting more pressure on the delicate veins in the nose)

Should you be worried about a nosebleed? When should you see a doctor?

Most of the time, nosebleeds are not serious. However, in some cases, they can be a symptom of another condition. Therefore, it is important to seek medical advice in the following cases:

How to stop a nosebleed at home (first aid)

Okay, now let's see what exactly to do when you start to get nosebleeds, without panicking.

1. Calm down: Don't panic at first. Stay calm and breathe through your mouth.

2. Sit up straight: Sit up straight in a chair and tilt your head slightly forward. Never tilt your head back. Doing so can cause blood to go down your throat, causing coughing and vomiting. This can also increase bleeding.

3. Pinch your nose: Use your thumb and index finger to pinch the soft part just above your nostrils. Don't pinch the bony part of your nose, just the soft part.

4. Wait 10-15 minutes: at least 10 minutes at a timeKeep pressing. Do not release your hand while checking to see if the bleeding has stopped. Doing so will break the blood clot that is forming and the bleeding will start again. Release your hand after 10 minutes. If the bleeding is still coming, keep pressing for another 10 minutes.

5. Wipe away the blood: Use a tissue or a damp cloth to wipe away the blood that comes out. Never try to press cotton balls or rolled tissue paper into your nose.

At a time like this, go to ETU immediately!

Usually, the above first aid measures will stop the bleeding. However, in the following cases, do not stay at home and immediately go with someone to the nearest hospital's Emergency Department (ETU).

• If the bleeding doesn't stop after holding your nose tightly for 15-20 minutes.
• If a very large amount of blood is lost (e.g. more than a cup).
• If you are taking blood-thinning medications (aspirin, warfarin), or if you have a blood clotting disorder (hemophilia) and your bleeding does not stop.
• If you feel difficulty breathing .
• If you are vomiting blood continuously.
• If you start bleeding after a hard blow to the head or face (a fall, a car accident).

What kind of treatment does a doctor give for this?

When you go to the hospital, the doctor may use different treatments depending on the cause of the bleeding and its severity.

• Nasal Packing: To apply pressure to the bleeding area, you can place something like gauze soaked in medicine, special sponges, or an inflatable balloon inside the nose. This is left in place for about 24-48 hours and then removed.
• Cauterization: This involves cauterizing and 'sealing' the tiny blood vessel that is bleeding, either using a chemical (silver nitrate) or a small electrical device (electrocautery). The inside of the nose is numbed before this, so there is no pain.
• Medication changes: You may be advised to change the dosage or temporarily stop taking things like blood thinners.
• Surgery: If the nose is broken or has a deviated septum, it can be corrected with surgery (septoplasty).

What can be done to prevent nosebleeds from recurring?

If you suffer from frequent nosebleeds, following these habits can go a long way in controlling the condition.

• Keep your nose moist: Use a saline nasal spray, available from pharmacies, two to three times a day. It's also a good idea to use a humidifier in your bedroom at night.
• Apply a coating:Apply a small amount of Vaseline to a cotton ball and apply it to the inside of the nostrils. But don't put the cotton ball too deep.
• Don't blow your nose forcefully: Be very gentle when blowing your nose. Open your mouth when sneezing.
• Don't pick your nose: Avoid this habit. Teach young children about this and keep their nails short.
• Avoid smoking: Smoking dries out the inside of the nose and damages the delicate membranes.
• Wear protective helmets: If you play sports that can cause injuries to your face and nose, be sure to wear protective helmets.