Nosebleed: What It Is, Symptoms, Diagnosis, and Treatment

A nosebleed is the loss of blood from the tissue lining the inside of the nose. Nosebleeds are common because of the position of the nose in the center of the face and the presence of numerous blood vessels near the surface of its inner lining, making it an easy target for injury and bleeding. These blood vessels are easily prone to bleeding. The air passing through the nose can dry out and irritate the membranes lining the inside of the nose. However, most nosebleeds are not serious and can be treated at home. Some, however, require medical attention, as in certain cases, nosebleeds can be an early sign of other medical issues. This is especially the case with nosebleeds occurring in the back of the nose. While some nosebleeds can be stopped at home, it should not be forgotten that they can also be a sign of more serious conditions.

What is a Nosebleed?

A nosebleed is the loss of blood from the tissue inside the nose. There are two types of nosebleeds: anterior (front) and posterior (back) nosebleeds. Although posterior nosebleeds are less common, they require medical intervention. Most anterior nosebleeds occur at the entrance of the nasal cavity, as the front of the nose is exposed to extreme temperatures and humidity, making it prone to trauma. The types of nosebleeds are as follows:

• Anterior Nosebleed: Occurs at the front of the nose, and blood flows out of the nostrils. This type is common in the general population but usually does not indicate a serious medical condition.
• Posterior Nosebleed: Occurs near the throat and at the back of the nose. It can cause blood to flow backward and is rare.

Nosebleeds are especially common in children and people over the age of 65. While this can be bothersome for children, it can typically be stopped with first aid and usually does not cause long-term problems. There are several reasons for nosebleeds, but they are rarely alarming. Non-medical causes of nosebleeds can be prevented with the following methods:

• Using a humidifier in dry air
• Keeping the nose moist
• Avoiding touching the inside of the nose
• Preventing children from inserting foreign objects into the nose

What Causes a Nosebleed?

Nosebleeds occur when the blood vessels in the nasal mucosa rupture. In some cases, underlying health conditions and less common factors can contribute to nosebleeds. Common causes of nosebleeds include:

• Trauma to the face
• Liver disease
• Chemotherapy
• Picking the nose
• Blowing the nose forcefully
• Infections in the nose, throat, or sinuses
• Common cold
• Allergies
• Fever-reducing medications
• Blood-thinning medications
• Nasal sprays
• Hot or cold dry air
• Leukemia
• Nasal polyps
• Sinusitis
• Pregnancy

If a nosebleed is caused by a foreign object in the nose, pain or itching, a foul-smelling discharge from one nostril, and bad breath may also accompany the bleeding. If the bleeding is caused by hay fever, symptoms like itchy nose, sneezing, and itchy eyes may accompany the bleeding. Nosebleeds can also occur without external factors. For example, when the mucous membranes inside the nose dry out, crust, or crack, it can cause bleeding. Nosebleeds are also common in individuals with bleeding disorders or those on blood-thinning medications.

Treatment for Nosebleeds

If the bleeding occurs at the front of the nose, certain measures can help stop the bleeding quickly. Particularly in children, crying when they see blood can complicate the situation and cause the bleeding to worsen. Therefore, the first step is to calm the child. Whether the individual is a child or an adult, it is important to sit upright during a nosebleed. While sitting upright, the head should be slightly tilted forward to prevent blood from flowing backward. However, if the bleeding does not stop after a while or recurs after stopping, medical intervention may be required.

If the bleeding is in the back of the nose or if there is recurrent bleeding, medical intervention may be necessary. However, before treatment, it is essential to diagnose the location of the bleeding inside the nose. Nosebleeds are typically diagnosed based on symptoms. The doctor will ask some questions and conduct a brief examination to determine the cause. The inside of the nose is first physically examined. If necessary, the nose may be examined using an endoscope, tomography, or X-ray. If it is suspected that the nosebleed is due to another medical condition, blood tests may be requested. If frequent nosebleeds occur or there are specific risk factors, the doctor may want to conduct further investigations. In addition to blood tests, the person may be referred to an ENT specialist.

After diagnosis, if the bleeding is caused by the rupture of a blood vessel, a procedure called cauterization is used to heat and seal the vessel. In less severe cases, a nasal tampon can be used to stop the bleeding.

When Should You Visit a Healthcare Facility?

Most nosebleeds are usually mild and do not last long. With a little patience and pressure, almost all uncomplicated anterior nosebleeds can be stopped. Even rare nosebleeds that require doctor care can generally be successfully treated with cauterization, tamponing, or other options. Apart from nosebleeds, if there are recurring infections or bruising, it may indicate a blood disorder. Therefore, it is important to see a doctor as soon as possible. However, some individuals with excessive bleeding, multiple medical conditions, or who are on blood-thinning medications may need to be hospitalized for nosebleed treatment. Emergency medical assistance is recommended in the following cases:

• Injury from a blow to the nose
• Very severe bleeding
• Difficulty breathing
• Nosebleed lasting more than 15 minutes
• Occurrence in a child under 2 years old
• Use of blood-thinning medications
• Nosebleed occurring with vomiting of blood

Although nosebleeds can be bothersome, they are usually not something to be concerned about. However, since doctors investigate whether there is an underlying medical condition causing the bleeding, frequent or unusually heavy nosebleeds should always be checked by a doctor.

If the nosebleed does not stop with first aid measures, it is necessary to go to the emergency room. Additionally, if blood continues to leak from the nose, especially if there is persistent nasal congestion or foul-smelling nasal discharge, you should contact a healthcare facility again. In elderly individuals, particularly smokers, these could be signs of a tumor in the nose or sinuses. In a small child, these could indicate that a foreign object is stuck in the nostril. Therefore, nosebleeds are a medical condition that should be carefully monitored.

If a child under 2 years old experiences a nosebleed, if you have frequent nosebleeds, if you develop heart palpitations, if you have symptoms of anemia such as shortness of breath and pale skin, if you are on blood-thinning medications, or if the nosebleed lasts longer than 10 to 15 minutes, or if the bleeding is excessive, or if you are swallowing a large amount of blood that leads to vomiting, or if the bleeding started after a blow to the head, you should seek emergency medical intervention at a healthcare facility as soon as possible.