Nose bleed, bleeding from nose.

There may be two causes for nose bleed local cause and systemic cause, however, most of the times the nose bleed takes place without any cause.

The local factors may be blunt trauma, foreign body in the nose, environmental irritants, inflammation due to infection, allergic reaction, acute RTI, chronic sinusitis, intranasal tumors, inappropriate use of nasal steroids, otic barotraumas (sudden ascent or descent in an aircraft or scuba diving), insufflated drugs (cocaine), upper respiratory tract infection, Surgeries (septal or sinus surgery), anatomical deformities and low relative humidity of inhaled air.

Systemic factors are allergies, hypertension, anemia, blood dyscrasias, envenomation by snakes, hematological malignancies, heart failure, vascular disorders, connective tissue disorders, pregnancy, vitamin C and vitamin K deficiency, coagulation abnormalities (von Willebrand Disease) and drug induced like aspirin, warfarin, ibuprofen, clopidogrel and also ginseng.

There may be drying or irritation of nasal lining due to dry weather, allergens, sinusitis or colds. Nose bleed is caused due to burst of blood vessel in the richly perfused nasal mucosa. The rupture may be due to spontaneous action or some injury.

Nose bleed is more prevalent in children and in people above the age of 50 years and it is more prevalent in males than in females.

Due to increased blood pressure or increased nasal blood flow as in cold or infection nose bleed can occur. It may be due to anticoagulant medications or disorder related to blood clotting, these factors may prolong the bleeding.

In elderly people the nasal mucosa is dry and hypertension may be there so there are increased chances of nose bleed. Also if there is nose bleed in them it is for prolonged period of time as their blood vessels have less constriction abilities to control the bleeding.

There may be anterior bleed in which there is a bleeding from the anterior part of the nostrils the nasal septum. The blood from the back of nose is called as posterior bleed. In this type of bleeding, it is from both the nostrils and has larger flow of blood into the mouth.

Nose bleed can be diagnosed by physical examination and some tests. The tests are blood test (complete blood count), partial thromboplastin time, prothrombin, nasal endoscopy and X-ray of the skull.

The nose bleed stops when there is a clot formation. This can be achieved by applying direct pressure, by pinching the soft fleshy part of the nose. Due to this there is pressure on the anterior part of the nose which is a common source of nose bleed. Pressure should be applied in head tilted in forward position for five to twenty minutes. This reduces the chance of airways obstruction and nausea. Nausea can be due to swallowing of excess blood.

Local vasoconstrictive agents can be used for control of nose bleed. The drugs oxymetazoline and phenylphrine are available over the counter in the form of nasal sprays can be used for controlling nasal bleed.

In case of chronic epistaxis due to dry nasal mucosa, application of saline thrice a day, keeping the nose lubricated with creams or ointments and installing a humidifier are all helpful practices.

One should not lie down with nose bleed. Nose picking, blowing or bending down should be avoided for long time after the bleed.

If nose bleed continues then doctor may close the blood vessel using heat or silver nitrate sticks. Doctor may do nasal packing. Treatment may be given to remove foreign body (if present), stopping blood thinners or reducing their use and to reduce blood pressure.

The prognosis of epistaxis is excellent. Death due to epistaxis is rare.

Recurrent nose bleeds can cause anemia due iron deficiency. Posterior nose bleeds along with other co-morbidities in the elderly needs to be closely monitored for signs of shock.

If nose bleed is due to nose injury or head injury or it does not stop by simple procedures then one should go to an ENT doctor.

Measures to keep the atmosphere humid helps in preventing nose bleed. Saline spray in the nose, application of moisturizing ointments like petroleum jelly on the nose mucosa can help in preventing nose bleed.