Nosebleeds: causes, prevention, and wrong practices

According to the American Family Physician’s website, 60% of people experience nosebleeds, with more men than women. The causes of nosebleeds are very diverse; blunt force, infection, mechanical irritation, allergies, dry air, colds, etc.

Why do people have nosebleeds?

1、Nasal injury 

• Mechanical trauma: such as car accidents, bruises, boxing injuries and nose digging, etc. are common causes of nosebleeds. 
• Pneumatic injury: During high-altitude flight and diving, if the difference in air pressure inside and outside the sinuses suddenly changes too much, it will cause the mucosal vessels in the nasal cavity and sinuses to expand and rupture and bleed. 
• Radiotherapy injury: during and after radiotherapy of the head and neck, the nasal mucosa becomes congested and edematous, or the epithelium falls off, and nosebleeds can also occur. 

2、Inflammation of the nose 

• Non-specific inflammation of the nose: acute rhinosinusitis, dry rhinitis, atrophic rhinitis, etc. are likely to cause nosebleeds, and the amount of bleeding is usually not much. 
• Specific infection of the nose: specific infections such as tuberculosis, lupus, syphilis, leprosy and diphtheria can cause nosebleeds due to mucosal erosion, ulceration, granulation and nasal septal perforation. 

3、Nasal cavity, sinus and nasopharynx tumors 

The most prone to epistaxis are nasal septal hemangioma, nasopharyngeal fibrovascular tumor, bleeding nasal polyp and malignant tumor of nasal cavity and sinus. A small amount of nasal bleeding or blood in the snot is one of the main symptoms of malignant tumors in the early stage. 

4、Foreign body in nasal cavity 

It is common in children, mostly unilateral nasal bleeding, because the nasal foreign body stays in the nasal cavity for a long time, which can cause the nasal mucosa to erode and bleed. Animal nasal foreign bodies, such as leeches, can cause repeated massive nasal bleeding.

5、Acute febrile infectious diseases 

Such as epiglottitis, influenza, hemorrhagic fever, scarlet fever, malaria, measles and typhoid fever.Mostly due to high fever, toxic damage to blood vessels, nasal mucosa congestion, swelling and dryness, resulting in capillary rupture and bleeding. In general, the amount of bleeding is small, mostly occurs in the fever period, and the bleeding site is mostly located in the anterior part of the nasal cavity. 

6、Cardiovascular system diseases 

• Hypertension and arteriosclerosis: Hypertension and arteriosclerosis are important causes of rhinorrhea in middle-aged and elderly people, and vascular sclerosis is its pathological basis.Increased blood pressure, especially when constipation, excessive force or emotional excitement, can rupture the nasal blood vessels and cause nasal bleeding. In addition, sneezing, forceful coughing, violent transnasal breathing or nasal massage are also factors that make nasal bleeding recurrent and difficult to control. 
• Increased venous pressure: emphysema, pulmonary heart disease, mitral stenosis, neck or mediastinal occupying lesions and other diseases can cause superior vena cava hypertension, the nasal cavity and nasopharyngeal veins of these patients are often angry stasis, when the patient coughs violently or other triggers, the blood vessels can rupture and bleed, and the bleeding site is mostly located in the nasopharyngeal veins at the posterior nostril from the distribution area. 

7、Other diseases 

Pregnancy, premenopause and menopause can cause epistaxis, which may be related to increased capillary fragility. Patients with severe liver disease can have epistaxis caused by impaired synthesis of coagulation factors by the liver. Uremia can also cause epistaxis. Nosebleeds can be one of the early manifestations of rheumatic fever. 
Note that nosebleeds are a relatively common disease in clinical practice, so many people feel indifferent to nosebleeds. If nosebleeds are prolonged, you need to pay attention to them and seek medical attention promptly.

How can I prevent nosebleeds?

Nosebleeds sometimes occur repeatedly, and more attention should be paid to prevention in general.

• The diet should eat more fresh vegetables and fruits to replenish sufficient amount of vitamins, and keep the bowels unobstructed.
• Quit bad smoking and drinking habits, and during the dry season, apply some antibiotic ointment or drops of peppermint paraffin oil in the nose to keep the nasal mucosa moist.
• If you have high blood pressure, heart disease and other chronic diseases, you should actively treat them to avoid recurrent nasal bleeding.
• Prohibit nose picking. Washing face with hot water is forbidden when bleeding. The head position should not be lower than the waist, and the pillow should be higher when sleeping. Avoid chewing hard objects.
• People who have a history of rhinorrhea, especially those with seasonal attacks, should pay attention to the working and living environment, which should not be too dry, hot and dusty.
• Exposure to harmful gases should take effective health precautions. When bleeding, pay attention to quiet and rest, diet to increase nutrition. When bleeding a lot, take a semi-recumbent position. In case of heavy bleeding, use cold towel to wet compress the forehead. Try to control sneezing and try to control coughing. If you can’t control it, pinch your nose tightly when coughing.

The wrong thing to do after a nosebleed

1. Tilting your head when bleeding can prevent blood from flowing out?

Correct: Because the rear of the nose is the same as the pharynx in terms of anatomical structure, tilting the head can prevent blood from flowing out of the nasal cavity on the surface, but this blood will flow into the pharynx from the rear and can be easily swallowed, causing nausea and other discomfort. In order to avoid the discomfort caused by swallowing blood, the nasal bleeding should maintain a slightly forward leaning body posture.

2、When bleeding, block the nasal cavity with toilet paper to stop the bleeding?

Correct approach: This method can actually stop the bleeding, the principle is to compress the nasal blood vessels through physical action to achieve pressure to stop bleeding, but toilet paper, cotton balls and other items do not guarantee sterility, plus the bleeding point in the nasal cavity when nasal bleeding often has damage, bacteria can easily enter the wound, leading to local infection. What is more dangerous is that the nose is within the “danger triangle” of the face, and infection in this area may lead to serious infectious cranial sinus thrombosis, and even life-threatening.

3, Nosebleeds are just a common phenomenon, no need to seek medical attention?

Correct: Although up to 85% of nosebleeds are idiopathic nosebleeds with no specific cause, for a significant number of patients with recurrent, severe nosebleeds, the possibility of a combination of other moderate to severe nasal diseases is still not uncommon. For example, some hematologic diseases (e.g., aplastic anemia, leukemia) and nasopharyngeal tumors may have recurrent nasal bleeding as the first manifestation. Therefore, those who bleed continuously or frequently should seek prompt medical attention.