Do you also get nosebleeds? (Epistaxis) Don't panic, let's find out about this!

Have you suddenly started bleeding from your nose? It's normal to feel a little scared at such times. But most of the time, this is not something serious. Today, let's talk about this nosebleed, or medically known as `(Epistaxis)`, in detail.

What is nosebleed (Epistaxis)?

Simply put, `(Epistaxis)` is bleeding from the tissues inside your nose. This can happen from one nostril, sometimes from both. But most of the time, the bleeding comes from one nostril.

You know, inside our noses, there are lots of tiny blood vessels. These are what help warm the air we breathe, add moisture, and send it to our bodies. But these blood vessels are very close to the skin inside the nose. So, when air goes through the nose, these blood vessels dry out and are more likely to get injured. That's when the bleeding starts.

Just think, about six out of ten people have had a nosebleed at least once in their lives. Most of the time, these are minor things that can be treated at home. However, if the bleeding is very heavy , or if you are vomiting or having other symptoms, such as difficulty breathing, it is definitely best to go to the hospital immediately .

What are the main types of nosebleeds?

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

Anterior Nosebleed

This is the most common type . The bleeding starts at the front of the nose, at the bottom of the wall that separates the two nostrils (also called the `(septum)`). The small blood vessels in this area are very delicate, so they can easily break and bleed. This is usually not a serious condition and can be treated at home.

Posterior Nosebleed

This bleeding occurs deep inside the nose. The blood comes from the large blood vessels near the throat. This can be heavy bleeding, and the blood can also flow down the throat. In such a situation, it is very important to seek medical advice immediately .

What are the symptoms of this?

Most of the time, there are no symptoms other than a nosebleed. However, if you have a posterior nosebleed, some of the blood can travel down your throat and into your stomach. This can cause a strange taste in the back of your throat and make you feel nauseous.

Important: If you have other symptoms (e.g. extreme fatigue , shortness of breath , bruising) along with your nosebleed, it could be a sign of another underlying medical condition.

Why does blood come from only one nostril? Or from both?

Most of the time, bleeding comes from one nostril, but sometimes it can come from both at once. There are many reasons why nosebleeds happen. Fortunately, most of them are not serious.

Common reasons

• Dry air: This is the main cause . In particular,
• In areas with warm, humid climates.
• In areas far above sea level.
• In heated indoor environments.

Dry air can cause the delicate membrane inside the nose to dry out, crust over, and crack. This can cause bleeding when you pick your nose or swim.

• Other common causes:
• Picking the nose (especially in young children).
• An injury to the nose and/or face.
• Having a deviated septum in the nose.
• Frequent sneezing , coughing, and nosebleeds due to upper respiratory tract infections or sinus infections.
• Allergic rhinitis or nonallergic rhinitis.
• Frequent use of nasal sprays (e.g. antihistamines , decongestants). These can dry out the nasal membranes.
• Taking blood-thinning medications (e.g. aspirin , NSAIDs ( painkillers ), warfarin ).
• Inhaling chemicals from cleaning products, workplace fumes, or other strong odors.
• Use of snorted drugs (e.g. cocaine).

Reasons for seeing a little less

• Alcohol use.
• Bleeding disorders (e.g. hemophilia, von Willebrand disease).
• High blood pressure.
• Thickening of the artery walls (Atherosclerosis).
• Facial and nose surgery.
• Nasal tumors.
• Nasal polyps.
• Decreased platelet count due to immune system weakness (Immune thrombocytopenia).
• Blood cancer `(Leukemia)`.
• Hereditary hemorrhagic telangiectasia is a hereditary blood vessel disease.
• Pregnancy.

Why do I get nosebleeds while sleeping?

The causes of nosebleeds while sleeping are the same as those during the day. Things like dry air, allergies, and upper respiratory infections can damage the delicate lining of the nose. Also, sleeping with your head turned to the side can put direct pressure on the nasal cavity, causing nosebleeds at night.

Who is more likely to develop this? (Risk factors)

Anyone can get a nosebleed. Most people have experienced it at least once in their lives. But some people are more likely to get it.

• Children between the ages of 2 and 10: Dry air, colds, allergies, and putting fingers and other objects in their noses can cause frequent nosebleeds in children.
• Adults between the ages of 45 and 80: As you approach age 50, your blood clotting time may increase. You are also more likely to have high blood pressure, hardening of the arteries (atherosclerosis), or blood clotting disorders at this age.
• Pregnant women: During pregnancy, the blood vessels in the nose dilate, putting more pressure on the delicate blood vessels inside the nose.
• People taking blood-thinning medications: This includes medications like aspirin and warfarin.
• People with blood clotting disorders: For example, hemophilia and von Willebrand disease.

When should you be concerned about nosebleeds?

It's normal to feel a little worried when you see blood coming from your nose, but most of the time it's not serious. You can manage it at home. However, you should see a doctor if :

• If you have frequent nosebleeds.
• If you have symptoms of anemia (weakness, dizziness, extreme fatigue, feeling cold, difficulty breathing, pale skin).
• If you start getting nosebleeds after starting a new medication .
• If you have nosebleeds and unusual bruising all over your body – both together – it could be a sign of a serious condition, such as a blood clotting disorder (hemophilia or von Willebrand disease), blood cancer (leukemia), or a nasal tumor.

If your child is under 2 years old and has a nosebleed, it's a good idea to talk to a pediatrician. Regardless of your child's age, it's wise to mention the nosebleed at their next medical checkup.

How do doctors find this?

A doctor will ask you a few questions about your nosebleed:

• How long (in minutes) did the bleeding last?
• Approximately how much blood was lost?
• How often do you get nosebleeds?
• Did the blood come from one nostril or both?

Also, this is also heard:

• The types of medications you take (including blood thinners like aspirin, cold/allergy medications, etc.)
• Does anyone in your family have blood-related diseases?
• Use of alcohol and/or inhalants.

Then, the doctor will examine your nose to see where the bleeding is coming from and what is causing it. They will use a small instrument called a ``speculum`` to open the nostril and look inside the nose using different light sources or an ``endoscope`` (a thin tube with a camera).

The doctor may inject medicine into the nose to numb the inside of the nose and constrict the blood vessels. He or she may also remove any blood clots and crusts inside the nose. This may be a little uncomfortable, but it is not painful.

Rarely, X-rays, a CT scan, or blood tests may be ordered to check for blood clotting disorders, blood vessel abnormalities, or tumors in the nose.

What is the treatment for this?

Treatment for nosebleeds depends on the cause of the bleeding. Your doctor will explain what is needed for your condition. Treatment for `(Epistaxis)` may include:

• Nasal packing: The doctor places gauze, a special nasal sponge or foam, or an inflatable latex balloon in the nose to create pressure where the bleeding is coming from. The doctor may need to remove this for about 24-48 hours.
• Cauterization: This procedure uses a chemical (silver nitrate) or heat (electrocautery) to seal off the blood vessel. Before this, the doctor sprays a numbing medicine inside the nose.
• Changing/re-prescribing medications: Reducing the amount of blood thinners you take – or stopping them – may help. You may also need medication to control your blood pressure. Your doctor may also prescribe a medication, such as tranexamic acid (Lysteda®), which helps your blood clot.
• Removing a foreign object: If the nosebleed is caused by something lodged inside the nose, the doctor will remove it.
• Surgery: Surgery can be performed to repair a broken nose or correct a deviated septum (septoplasty).
• Ligation: In this procedure, the doctor ties off the blood vessel that is causing the bleeding to stop.

How to stop nosebleeds at home?

Follow these steps to stop a nosebleed:

• Stay calm, breathe through your mouth.
• Sit up straight, tilt your head slightly forward (don't tilt your head back, as this can cause blood to flow down your throat).
• Use your thumb and index finger to pinch the soft part of your nose (just above the nostrils).
• Wait until the bleeding stops. Use a tissue or a damp cloth to wipe away the blood.

Most of the time, home care is sufficient. However, some nosebleeds require hospital treatment. In these cases, go to the nearest emergency room with someone immediately, or call 1990:

• If you can't stop the bleeding even after holding your nose for 15-20 minutes.
• If there is a lot of blood (more than 1 cup).
• If you are taking blood thinners (such as aspirin or warfarin), or if you have a blood clotting disorder, and the bleeding does not stop.
• If you have difficulty breathing.
• If you swallow blood and can't stop vomiting.
• If your nose starts bleeding after a blow to the head or a serious injury (fall, car accident, hard blow to the face/nose).

Is it okay to drink water after a nosebleed?

Yes, you should drink plenty of fluids after a nosebleed. Water and fruit juice, which are caffeine-free, are good. After a nosebleed, some of the blood can travel down your throat and into your stomach. This can make you feel nauseous. But drinking water will not affect the nosebleed.

Can you die from a nosebleed?

Bleeding from the upper part of the nasal septum or deep inside the nose can be difficult to control. However, death from nosebleeds is rare.

What can be done to prevent nosebleeds?

Here are some things that can help prevent nosebleeds:

• To keep your nasal passages moist, use a saline nasal spray or saline nose drops in each nostril two or three times a day. These can be purchased at a pharmacy or made at home.
• Add moisture to the air by adding a humidifier to your furnace, or by placing a humidifier in your bedroom at night.
• Apply a nasal gel or ointment (such as `Bacitracin®`, `Vaseline®` or `Ayr Gel®`) to the inside of your nostrils with a cotton bud. Do not insert the cotton bud more than 1/4 inch into your nostril. These gels and ointments are available at most pharmacies.
• Don't blow your nose loudly.
• Keep your mouth open when you sneeze. Always sneeze into a tissue or your elbow.
• Do not put anything solid, including your fingers, in your nose.
• Limit the use of medications that can increase bleeding (such as aspirin and ibuprofen). Always talk to your doctor before making any changes to your medications. This is especially important for prescription medications such as warfarin (Coumadin®) and nonsteroidal anti-inflammatory drugs (NSAIDs).
• If your nasal allergy symptoms are not easily controlled with over-the-counter or prescription medications, see a doctor. When using over-the-counter medications, follow the directions on the label exactly. Overuse can cause nosebleeds.
• Stop smoking. Smoking dries out your nose and causes allergies.
• Wear protective headgear if you are doing activities that could injure your face and nose.

Teach your child to avoid nosebleeds and not to put anything in their nose. It's also a good idea to keep their nails short. Your pediatrician can give you more advice.

Is it normal for blood to clot when you have a nosebleed?

Yes. Blood clots are blood clots that form in response to an injured blood vessel. When a blood vessel is damaged, blood clots form to stop excessive bleeding. When you pinch your nose to stop a nosebleed, the blood clot starts to form. It usually stays there until you remove it or blow your nose.

Why do I always get nosebleeds?

There are many reasons why you may have frequent nosebleeds. This can affect one nostril or both. The most common causes are:

• Frequent use of nasal sprays for allergy symptoms or colds/nasal congestion.
• The air where you live is dry.
• Sniffing drugs through the nose.

You may need to stop using the spray for a while or completely. If you are using these products, talk to a doctor.

Rarely, frequent nosebleeds (epistaxis) can be a sign of a blood clotting disorder or other serious condition. If you have frequent nosebleeds, see a doctor.

Finally, things to remember

Epistaxis, or nosebleeds, is a common but somewhat annoying medical condition. Once you learn how to stop a nosebleed quickly, you can quickly get back to doing what you were doing before it started. Most cases of epistaxis are not serious. But if you have frequent nosebleeds or if you have a blood clotting disorder, be sure to see a doctor. Taking care of your health is the most important thing.