Definition, Description, Causes and symptoms, Treatment, Alternative treatment, Prevention
A nosebleed is bleeding from the nose called epistaxis.
Unexpected bleeding from anywhere is cause for alarm. Persistent bleeding should always be investigated because it may be the earliest sign of cancer. Fortunately, nosebleeds are rarely a sign of cancer. A much more common cause of nosebleeds is injury from picking or blowing or fisticuffs. People with hay fever have swollen membranes that are fragile and more likely to bleed.
Nosebleeds most often come from the front of the septum, that plane of cartilage that separates the nostrils. It has a mass of blood vessels on either side called Kiesselbach's plexus that is easy to injure. Nosebleeds from the more remote reaches of the nose are less common and much harder to manage.
Causes and symptoms
Cancers are an uncommon cause of nosebleeds, but by far the most serious. Injury from fists, fingers, and over zealous nose blowing leads the list. Tumors from the front of the brain may break through into the sinuses or the back of the nose. Bleeding may be a trickle or a flood.
The first treatment is to pinch the nostrils together, sit forward and stay that way for 5-10 minutes. Bleeding that continues will be from the back of the nose and will flow down the throat. If that happens, emergency intervention is needed.
As an emergency procedure, the nose will be packed front and/or back with cotton cloth and a rubber balloon. This is not comfortable. Having no place to flow, the blood should clot, giving the ear, nose and throat specialists (otorhinolaryngologists) a chance to find the source and permanently repair it. If the packing has to remain for any length of time, antibiotics and pain medication will be necessary—antibiotics because the sinuses will be plugged up and prone to infection. Nose packing may so interfere with breathing that the patient will need supplemental oxygen.
Many bleeds are from small exposed blood vessels with no other disease. They can be destroyed by cautery (burning with electricity or chemicals). Larger vessels may not respond to cautery. The surgeon may have to tie them off.
Estrogen cream, the same preparation used to revitalize vaginal tissue, can toughen fragile blood vessels in the anterior septum and forestall the need for cauterization. Botanical medicines known as stiptics, which slow down and can stop bleeding, may be taken internally or applied topically. Some of the plants used are achillea (yarrow), trillium, geranium, and shepard's purse (capsella-bursa). Homeopathic remedies can be one of the quickest and most effective treatments for epistaxis. One well known remedy for nosebleeds is phosphorus.
Both before and after a nosebleed, blow gently and do not pick. Treatment of hay fever helps reduce the fragility of the tissues.
Ballenger, John Jacob. Disorders Of The Nose, Throat, Ear, Head, and Neck. Philadelphia: Lea & Febiger, 1991.
Jackler, Robert K., and Michael J. Kaplan. "Ear, Nose And Throat." In Current Medical Diagnosis and Treatment, 1996. 35th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1995.
J. Ricker Polsdorfer, MD
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