Nosebleeds

and Carola Felchner, science journalist

Marian Grosser studied human medicine in Munich. In addition, the doctor, who was interested in many things, dared to make some exciting detours: studying philosophy and art history, working on the radio and, finally, also for a Netdoctor.

More about the experts

Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

With nosebleeds (medical epistaxis), blood suddenly comes out of one or both nostrils. But that is mostly harmless. However, frequent nosebleeds can also indicate a (serious) illness. Read here about the causes of nosebleeds, how to properly provide first aid and how the doctor treats nosebleeds.

Brief overview

What to do if you have a nosebleed? Sit upright, tilt your head forward and down, cool your neck, if necessary press your nose tightly together
Epistaxis - Causes: e.g. B. irritated or inflamed nasal mucous membrane (e.g. in dry room air, cold, allergies), blow or fall on the nose, foreign bodies in the nose, injuries or malformations of the nasal septum wall, benign or malignant tumors in the nasal region, febrile illnesses such as measles or flu , High blood pressure, various autoimmune and hereditary diseases, drugs
When to the doctor if you have repeated nosebleeds or if the bleeding does not stop

Caution!

When a nosebleed, many people reflexively tilt their head back. But that's not a good idea: the blood then runs down the esophagus into the stomach, which can cause nausea. In addition, it is then not possible to assess how bad the nosebleed is.
For the same reason, do not lie down if you have a nosebleed.
Do not put a handkerchief or cotton wool in the bleeding nose. The reason: the wound can tear open again when it is removed.
Shortly after the nosebleed you shouldn't blow your nose, otherwise it will start to bleed again quickly.

Epistaxis: what to do

Experts recommend the following immediate measures to stop nosebleeds:

Ask the person affected to sit upright. He should bend his head forward so that the blood can flow out through the nostril. If necessary, place a bowl in front of them or give them a cloth to catch the blood.
Have the patient squeeze their nose tightly with their thumb and forefinger for a few minutes (with their mouth open) or ask them if you should do this for them. Then check regularly to see if the nosebleed has stopped. If not, pinch your nose again for a few minutes.
You can also cool the neck or the bridge of the nose. Use a cool, damp cloth or ice cubes wrapped in a cloth. As a result of the cooling, the supplying blood vessels contract - the bleeding subsides.
If an unconscious person has a nosebleed, there is a risk of blood entering the windpipe. In the worst case, the affected person suffocates from it! Therefore, bring him into the stable side position. Then the blood can flow out of the nose.

Nosebleed in child: you can do that

Children sometimes panic when they suddenly have blood dripping from their noses. It is therefore all the more important that you remain calm as a first aider. Talk to the child reassuringly, possibly telling them a story to distract them. Embrace the little patient and explain why they should tilt their head forward.You can help the child by supporting their head for the duration of the nosebleed. You can also pinch the child's nose. The child should spit out any blood that gets into the mouth. Usually the spook is over after a few minutes.

Check especially with small children whether there is an object in the nose that could have triggered the bleeding.

Epistaxis: causes

Nosebleeds occur when the fine vessels of the nasal mucous membrane, which is well supplied with blood, are injured. Most venous vessels are affected. This can be seen from the fact that the blood that escapes is dark red. With arterial injuries, the bleeding tends to be bright red and spurting.

Since several blood vessels converge in the front part of the nose (medical Locus Kiesselbachi), this is where most of the bleeding occurs. These are usually harmless.

Dangerous nosebleeds often originate in the back of the nose. This is due to the fact that the supplying vessels are not yet as finely branched in the back of the nose as they are further forward, so that a leak is simply larger. If you have this type of nosebleed, your ear, nose and throat doctor will often need to intervene to stop the bleeding.

In the case of nosebleeds, one must also differentiate whether the cause is local, i.e. in the nose, or whether there is another disease behind it. The former is often the case.

Epistaxis: Local Causes

Sneezing or vigorously blowing your nose can be enough to burst the small veins in your nose. The likelihood of nosebleeds is also higher if the nasal mucous membrane is irritated, for example from overheated or air-conditioned room air, allergies or decongestant nasal sprays.
A blow or fall on the nose can also cause nosebleeds. The same applies when small children stick a foreign object in their noses, such as a pea or a small Lego brick: if they injure the nasal mucous membrane, blood will leak out. The same thing can happen with nose picking.
In some people, a hole in the septum (medical septum perforation) is responsible for frequent nosebleeds. Such a hole can be the result of a previous operation in the nasal area. However, it can also arise, for example, from a vascular disease, an accident or from inhaling corrosive substances.
Some malformations of the nasal septum can also cause the nose to bleed if protruding spurs or bony ridges injure the nasal mucosa. Such malformations are often accompanied by a curvature of the nasal septum (medical septal deviation).
Rarely is there a benign or malignant tumor in the nasal cavity or paranasal sinuses behind (repeated) nosebleeds.

Epistaxis: Systemic Causes

Nosebleeds can also be a sign of a (serious) illness. For example, the following diseases can cause nosebleeds:

febrile illnesses such as flu or measles (nosebleeds are favored here due to increased blood flow to the mucous membranes)
Colds (an inflamed nasal mucosa can easily start to bleed - especially if the person blows his nose frequently)
Kidney disease
Vascular and circulatory diseases such as hardening of the arteries (arteriosclerosis) and high blood pressure (hypertension)
congenital dysfunction of the blood platelets (thrombocytopathy or thrombopathy)
Various autoimmune and hereditary diseases such as Wegener's disease, Osler's disease, hemophilia (such as hemophilia A and B, von Willebrand-Jürgens syndrome, etc.)
Leukemia ("blood cancer")
In rare cases, severe bleeding of the esophagus (for example in the presence of varicose veins = esophageal varices) can leak from the mouth and nose, so that it looks like a nosebleed, but is not one.

Sometimes nosebleeds are medication-related. This applies, for example, to the so-called platelet aggregation inhibitors. These are active ingredients that prevent the platelets from clotting together. This makes bleeding such as nosebleeds or bleeding gums more likely. A well-known representative of the platelet aggregation inhibitor is the pain reliever and fever killer acetylsalicylic acid (ASA).

The so-called coumarine derivatives (coumarins for short) can also trigger nosebleeds: These active ingredients lower the vitamin K level in the body, which impairs blood clotting. In this case, this is quite deliberate - the doctor prescribes coumarins (such as phenprocoumon, warfarin) to patients in whose bodies blood clots can easily form and block a vessel. This includes people with atrial fibrillation. The use of coumarins can lower your risk of heart attack and stroke.

Other drugs that can encourage nosebleeds include some antibiotics and psychotropic drugs.

Often no clear cause of the nosebleed can be found. Then doctors speak of idiopathic or habitual epistaxis.

Causes of nosebleeds in children

In addition to the reasons mentioned above, nosebleeds can also have other causes in children: Small sprouts often stick foreign bodies into their noses out of curiosity or when playing, which can cause bleeding. In other cases, nosebleeds are simply nosebleed. In older children, a bigger growth spurt can cause (more frequent) nosebleeds. The small vessels in the nasal mucosa are more sensitive and tear more easily. Usually this type of nosebleed will stop quickly.

Epistaxis: causes in pregnant women

A blocked nose and, as a result, nosebleeds are not uncommon during pregnancy. The reason for this is the changed hormone balance. The body produces larger amounts of the female sex hormone, estrogen. This loosens the connective tissue, also in the vessel walls. As a result, the vessels expand, which increases blood flow - including in the nasal mucosa. This encourages nosebleeds during pregnancy. As uncomfortable as it can be for affected women, it is usually harmless and fortunately only lasts for a limited time.

Epistaxis: Risks

Even if nosebleeds are usually harmless and stop by themselves without any consequences for those affected, there are still a few risks. If the person concerned loses a lot of blood or cannot see any blood, there is a risk that they may collapse, suffer a shock - or stand on the verge of it. This can be seen in cool, pale skin, for example. The person concerned also feels weak and dizzy.

Another risk: if the person concerned was hit in the face or if his head hit a hard surface, it could be that the nose or skull is broken. A sign of the latter is that cerebral fluid that is clear, but often mixed with blood, runs out of the nose (or the ears). An emergency!

Epistaxis: when to see a doctor?

Occasional nosebleeds need not be a cause for concern. The bleeding can usually be stopped easily on your own.

However, a visit to the doctor is advisable if the nosebleed occurs repeatedly (e.g. several times a week) or if it is something new (the person affected has not had a nosebleed so far). Then it makes sense to have the cause clarified. There may be a disease that needs treatment behind the nosebleed.

Take the person concerned to the doctor quickly if the bleeding cannot be stopped - that is, if it has not stopped after 20 minutes (in children, after ten minutes). If you have an extremely heavy nosebleed that cannot be controlled, you may even have to call an emergency doctor. Otherwise the person could lose too much blood.

You must also see a doctor if your nose is visibly injured (e.g. due to a violent blow).

Epistaxis: check with a doctor

The ENT doctor often does the examination and treatment at the same time. First, he will ask the patient or his companion whether there is an obvious reason for the nosebleed and whether it is occurring more often. Then he will try to determine the cause by means of a nasoscopy (medical rhinoscopy). The person concerned may get a local anesthetic.

Investigations in repeated nosebleeds

If the patient has frequent nosebleeds, the doctor will investigate the cause. He initially proceeds as he would with any patient who comes to him with a nosebleed: He obtains important information about the medical history (anamnesis) in conversation with the patient. For example, the doctor asks in which situations nosebleeds often occur and whether the patient has any other complaints.

This is followed by an examination of the nasal cavity with a rhinoscope (anterior nasal cavity area) or nasal endoscope (posterior nasal cavity area). The following tests can also help to get to the bottom of the cause of frequent nosebleeds:

Imaging procedures: With an ultrasound device, the doctor can, for example, assess the sinuses quite well. Magnetic resonance tomography (MRI) delivers even more precise images, but it is much more complex. Computed tomography (CT) is usually used to better assess the bones of the skull after accidents or blows to the face.
Blood analysis: Various blood values can provide information about any coagulation disorders or inflammation.
Measurement of blood pressure: A possible high pressure (hypertension) can be determined by measuring blood pressure.

If there is no local cause for frequent nosebleeds, the doctor can refer the person to a general practitioner for a thorough physical examination. In this way, diseases can be excluded or identified as a reason for the nosebleed, for example by means of a urine test.

Epistaxis: Treatment by the doctor

Depending on the type and severity of the nosebleed, the doctor will try to stop the bleeding using suitable means or methods:

In the case of bleeding in the anterior part of the nose (especially the Kiesselbachi locus), he can burn the affected area with silver nitrate, for example, or close it with the help of laser or electrocoagulation ("sclerot").
An old, but effective remedy for nosebleeds is tamponade. For bleeding in the front part of the nose, the doctor may use self-expanding packs or packs that can be inflated. The so-called Bellocq tamponade is used for nosebleeds from the back of the nose. The specialist pulls this through the nose into the back of the nasopharynx.
In the case of very heavy nosebleeds, targeted embolic closure of the affected vessel in the nasal mucosa can also be useful. The doctor uses special imaging techniques to close the vessel from the inside using a catheter. This method is usually performed by a radiologist.
Sometimes decongestant nasal sprays help with nosebleeds. Their active ingredients (e.g. xylometazoline) ensure that the blood vessels contract.

The ENT doctor will also check the patient's pulse and blood pressure. If the blood pressure is very low and the pulse accelerates, this can be a sign that the person concerned has lost a lot of blood. The doctor will then try to stabilize the circulation by giving the patient blood substitutes. A blood transfusion is only necessary in extreme cases after a nosebleed.

Prevent nosebleeds

There are a few tips that can help reduce your risk of nosebleeds. Especially people with sensitive nasal mucosa should adhere to this:

Make sure there is sufficient humidity in the apartment. Dry air is poison for the nasal mucosa. The optimal humidity is between 40 and 60 percent.
Regular walks in the fresh air are also good for your nose.
Especially in winter, when the air is particularly dry and one wave of colds chases the next, many people like to use nasal drops and sprays. These should only be used for a short time, if at all. You can in fact encourage nosebleeds. A nasal douche is more suitable. It can prevent a cold and relieve existing cold symptoms.
If you want to use nourishing sprays or ointments, make sure that they are also suitable for the nose.
In the case of allergies, it is advisable to avoid the triggers, which of course is only possible to a limited extent. In some cases, so-called desensitization is possible. Although it extends over a number of years, it helps many allergy sufferers enormously and reduces allergy symptoms in general.
A healthy, low-fat and meat-free diet as well as sufficient exercise prevent obesity and high blood pressure and thus also the calcification of vessels - hardening of the arteries can promote nosebleeds.
Tobacco and alcohol consumption can promote nasal tumors (and many other diseases). Therefore, do without the toxic stimulants.
Be careful when using different drugs at the same time. For example, if you are given blood-thinning medication, you should not take acetylsalicylic acid (ASA) if you are in pain, as it also has an anticoagulant effect and the effects add up - the tendency to bleeding (such as nosebleeds) is also increased.

Tags: organ systems medicinal herbal home remedies prevention