Nose Bleed (Epistaxis)

When should I seek medical attention for my nosebleeds?

Nosebleed in children is common and usually, it is nothing to be alarmed about. It is, however, irritating and could be distressing for both the child and parents. Parents are often called by teachers to school when a child’s nosebleeds disrupt the class activities. Or more stressful if the nose bleeds take place during an examination. 

Most cases are mild and can be controlled with simple measures such as pinching the nostril together. 

Frequent severe nosebleeds in adults could signal a more serious problem. For example, nosebleeds and bruising can be early signs of leukaemia. Nosebleeds can also be a sign of a blood clotting or blood vessel disorder, or a nasal tumour (both non-cancerous and cancerous).

Causes of a Nosebleed

There are two types of nosebleeds:

• Anterior, and
• Posterior

The type of nosebleeds that you have will depend on where the bleeding originates.

Anterior Nosebleeds

If you have an anterior nosebleed, the bleeding comes from the lower septum (the wall between the two nose channels), just inside your nose. This part of the nose, which is sometimes known as Littles’ area, has a lot of delicate blood vessels inside it.

The blood vessels are supplied with blood from your carotid arteries (the two main arteries in your neck which supply the blood flow to your brain). These delicate blood vessels are easily damaged and if they are knocked, they will begin bleeding.

Sometimes, the cause of anterior nosebleeds is unknown. However, the main causes include:

• picking your nose, particularly if you scratch the inside of your nose with a sharp fingernail,
• blowing your nose very hard,
• a minor injury to your nose,
• a deviated septum (a crooked nose in the internal, either present from birth or due to an injury),
• a cold or flu (influenza),
• sinusitis (an infection of the small, air-filled cavities inside your cheekbones and forehead),
• a blocked or stuffy nose that is often caused by an infection,
• a dry nose that is caused by dry air in a hot climate or heated indoor air,
• hayfever or other allergies,
• high altitude,
• excessive use of nasal decongestants,
• excessive use of the illegal drug – cocaine.

Children almost always have anterior nosebleeds. In children, many doctors feel that nasal drying is a common cause of nose bleeds. Nasal drying is common in the winter during cold dry weather and in the summer with air-conditioning.

Treatment for Nosebleeds

Medicine 

• Treatment of allergic rhinitis with antihistamines and nasal sprays and environment control measures will often eliminate the nose bleeding. The inflammation from rhinitis promotes vascularization (blood vessel growth) in the anterior part of the nose. These vessels are usually prominent and bleed easily. If bleeding does not stop, nasal cautery may be required.

Two types of cautery are commonly used:

• In children who have prominent blood vessels in the Little’s area, treatment with a chemical called silver nitrate is an effective treatment option. Silver nitrate is applied to the Little’s area.
• Larger vessels can be treated with Electrocautery using Radio Frequency.  Electrocautery is usually carried out under sedation (at the day surgery centre of the hospital).

Posterior Nosebleeds

A posterior nosebleed is where the bleeding is heavy and comes from further back and higher up your nose. Posterior nosebleeds are more common in adults than in children and they may need medical attention.

During posterior nosebleeds, the bleeding originates from branches of the arteries which supply blood to your nasal cavity (the space inside your nose between the roof of your mouth and your brain).

This type of nosebleed can be more serious. If your nosebleed has resulted from a large blow to your head or a fall, you should seek medical attention because you may have broken your nose.

Other possible causes of posterior nosebleeds include:

• a tumour in the nasal cavity (benign or malignant nose cancer)
• recent nasal surgery,
• high blood pressure,
• hardened arteries (from fat, cholesterol, or other substances that build up in your arteries),
• exposure to irritating chemicals,
• certain medicines, such as aspirin, medicines for arthritis, anticoagulants (blood-thinning medicines)

In some cases, nosebleeds can be a symptom of another condition such as:

• a blood-clotting abnormality – for example, haemophilia (an inherited condition that affects the blood’s ability to clot) or von Willebrand’s disease (an inherited disorder that causes bleeding and bruising), or
• leukaemia (although this is rare and you are likely to have other symptoms as well).