NOSEBLEEDS

The nose is an area of the body that contains many tiny blood vessels or arterioles that can break easily.  One of every seven people will develop a nosebleed some time in their lifetime. Nosebleeds can occur at any age, but are most common in children aged 2-10 years and adults aged 50-80 years.  Nosebleeds are divided into two types, depending on whether the bleeding is coming from the front or back of the nose.

Most nosebleeds, or epistaxes, begin in the lower part of the septum, the semi-rigid wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose or the edge of a sharp fingernail.  Nosebleed coming from the front of the nose, or anterior nosebleeds, often begin with a flow of blood out one nostril when the patient is sitting or standing.

Anterior nosebleeds are common in dry climates or during the winter months when dry, heated indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding. This can be prevented by placing a light coating of petroleum jelly or an antibiotic ointment on the end of a fingertip and then rub it inside the nose, especially on the middle portion of the nose (the septum).

More rarely, a nosebleed can begin high and deep within the nose and flow down the back of the mouth and throat, even if the patient is sitting or standing.  Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose of face.

What are the causes of recurring nosebleeds?

  • Allergies, infections, or dryness that cause itching and lead to picking of the nose.
  • Vigorous nose blowing that ruptures superficial blood vessels.
  • Clotting disorders that run in families or are due to medications.
  • Drugs (such as anticoagulants or anti-inflammatories).
  • Fractures of the nose or the base of the skull.  Head injuries that cause nosebleeds should be regarded seriously.
  • Heredity hemorrhagic telangiectasia, a disorder involving a blood vessel growth similar to a birthmark in the back of the nose.
  • Tumors, both malignant and nonmalignant, have to be considered, particularly in the older patient or in smokers.
 
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