Help, my nose is bleeding! Epistaxis is a fairly common and generally benign disorder, yet it is as frightening every time as any other blood loss. “In most cases, the bleeding is caused by fragility of capillaries present in the front part of the nose: running a lot on the surface, they can be affected by numerous factors that lead to the loss of the normal state of health of the nasal mucosa “, explains Dr. Giovanni Ciavarrootolaryngologist at the Lazzaro Spallanzani Medical Center in Reggio Emilia and the Piccole Figlie Hospital in Parma.
“Most commonly, nosebleeds can indicate the dryness of the nasal mucosaoften favored by anatomical variants such as the deviation of the nasal septum, as well as sometimes nasal infections, trauma, rhinological surgeries and general health conditions, such as sudden changes in blood pressure, drug therapies, coagulation alterations and, much more rarely, nasal or systemic pathologies of greater severity “.
Because the nose is bleeding suddenly
The nose is a richly organ vascularized which receives blood from different branches of the carotid artery, one of the main arterial vessels that supply the head and neck area. The internal nasal structures are dynamic, in continuous movement and take care of filtering, humidifying, heating and purifying the air before it reaches the lungs: having to manage about fifteen thousand liters a day, it can happen that mucous membranes undergo dryness and breakagepaving the way for bleeding.
Normally we do not notice anything, because platelets and fibrin immediately seal the damaged areas, but sometimes it can happen that the blood does not stop immediately and leaks outside. «Bleeding often has a sudden naturelinked to the sudden vasodilationwhich is known to be correlated to the temperature of the environment in which we find ourselves », specifies the expert.
What are the main causes of epistaxis
In children, the most common cause of nosebleeds is represented by the classics “Picking your nose” (which cause the formation of scabs due to infection by germs such as Staphylococcus), while in adolescents it can be linked to hormonal changes typical of puberty and in adults instead it can be due to trauma (trivial, such as blowing the nose too violently, or more serious, such as bruises to the face caused by falls or accidents), infections (including colds,), inhalation of excessively dry air (especially in winter when the domestic heating leads to a lowering of the relative humidity of the air we breathe) or, at a later age, a hypertensive spikes and the weakening of the vascular walls.
“Even some medications they can promote epistaxis, such as prolonged nasal therapies with cortisone sprays or antiplatelet and anticoagulants taken to thin the blood for curative or preventive purposes “, warns Dr. Ciavarro. “In rare cases there are more serious pathologies at the base of the epistaxis, such as tumors of the nasal cavities, the incidence of which, however, is quite rare, so it is good not to be alarmed”.
How long does the nosebleed on average and when to worry
Normally, with the right maneuvers, the epistaxis recurs within few minutes. If, on the other hand, it persists or when the episodes are very frequent, it is advisable to contact an otolaryngologist to perform an evaluation of the nasal cavities. “Sometimes a small varice may be discovered, that is, the dilation of a venous or arterial vessel, which in some cases may require cauterization. It is a intervention that is performed on an outpatient basis under local anesthesia, of short duration and not painful, which consists in “burning” the vessel responsible for the bleeding », explains Dr. Ciavarro.
“Frequently, however, a particularly dry mucosa is observed, so the patient is advised to apply emollient creams on the inner walls of the nostrils to restore suitable protection of the capillaries”. Epistaxis is usually an isolated symptom, but it is better investigate if it is associated with an alteration of nasal function (difficulty breathing, especially if only one nostril is involved), abnormal secretions or a feeling of heaviness and soreness around the eyes and at the base of the forehead.
The exams to do
In general, a careful medical history is essential in order to collect all useful information on the frequency, duration and periodicity of bleeding, lifestyle habits, any systemic pathologies and therapies taken by the patient. As part of the ENT assessment, it is often essential to perform a fibroscopic examination of the nasal cavity: “In the nasal cavity a thin and flexible tube is introduced, made up of optical fibers, which allows to observe in an enlarged and detailed version on a monitor both the anterior and the posterior portion of the nose”, explains the expert.
In old age, blood pressure monitoring may also be useful in order to rule out hypertensive states or sudden hypertensive spikes. “According to the data collected, the doctor will then evaluate the opportunity to perform further clinical tests, such as blood tests, arterial blood pressure Holter or radiological investigations such as CT scan or magnetic resonance of the facial massif”, explains Dr. Ciavarro.
How to handle the situation
What to do when it happens? «It is important to get in a quiet, isolated and not too hot environment, flexing the head down and compressing the wings of the nose with two fingers, like pliers. Breathing with the mouth, you have to remain still for at least 5-10 minutes, avoiding compulsively checking the bleeding status », Dr. Ciavarro recommends.
«It is necessary dispel a myth. There is no need to introduce hemostatic cotton, toilet paper or gauze into the nostrils: occluding the nostrils does not promote clottingbut on the contrary it risks hindering it, as well as favoring a new bleeding when we remove the foreign material ».
In the case of abundant nosebleeds, it may happen to detect a few more blood drops once 5-10 minutes have elapsed and perhaps to feel a clot that occupies the entire nasal cavity: “In a gentle way, we blow our nose to eliminate the obstruction and then we repeat the compression for another 5-10 minutes », concludes the expert. “In conclusion, in the face of the epistaxis we keep calm, we manage the episode in a serene way and we talk about it as soon as possible with the trusted doctor”.