Epistaxis is an urgent problem for ENT doctors, general practitioners, because specialists often encounter it in their work. With this pathology, people of almost all ages seek help. Blood flows from the nose for various reasons. They are injuries, diseases of the nasal mucosa, somatic diseases.
Nasal bleeding statistics
This pathology is most often found in children under the age of 10 years. There is blood from the nose of the child at night and day. This symptom also affects people older than 50 years. Persons from other age groups are less likely to encounter a problem. However, there is another traceable pattern. In men aged 20 to 49 years, nosebleeds occur more often than in women from the same age group. For pathology, seasonality is also characteristic. Most often, nosebleeds are noted in the autumn-winter period.
Many people are familiar with pathology. About 60% of the inhabitants of our planet (according to medical literature) at least once in their lives have experienced nosebleeds. In most cases, it is possible to stop the blood without going to the hospital. From 14.7% to 20.5% of people need the help of doctors.
In extremely rare cases, blood from the nose is fatal. For example, in 1999 in the USA 4 people died from this pathology. The most famous death in human history from nosebleeds is associated with the name of Attila. This man was the ruler of the Huns from 434 to 453 years.
Pathology classification
Specialists have created a huge number of classifications of nosebleeds. Consider, for example, one of them, built according to the pathomorphological principle. According to this classification, bleeding is caused by:
- violations of the coagulation properties of blood (for example, with hemophilia - a rare hereditary disease, which is characterized by a violation of blood coagulation);
- a violation of the vascular system in the nasal cavity (due to injuries, tumors, dystrophic changes in the mucous membrane, curvature of the nasal septum);
- the simultaneous effect of changes in the vascular system of the nasal cavity and the coagulation properties of blood (dystrophy of the mucous membrane with atherosclerosis or hypertension, etc.).
It is also customary to classify nosebleeds by the localization of their source. They are front and rear (the source is located above the middle nasal concha or below it), and also located outside the nasal cavity (from intracranial vessels, paranasal sinuses).
Causes of nosebleeds
Everyone should know what to do if there is blood from the nose. But at the same time, it is still important to have an idea of the causes of the pathology. There are quite a few of them. They are divided into local and systemic. Local causes include:
- injuries (finger, from foreign bodies, after surgical interventions);
- upper respiratory tract infections;
- allergic processes;
- polyps of the nose;
- tumors;
- inhalation of irritants;
- the negative effects of low air humidity on the mucous membrane, etc.
The list of possible systemic causes is long. It includes arterial hypertension, vascular pathology, various coagulation disorders, systemic infections, etc.
Reasons related to some age features
In the age group of the elderly, women are most prone to bleeding. With the onset of menopause, changes occur in the body. The mucous membrane of the nose dries and wrinkles. Because of this, the pathology in question arises. In young people, nosebleeds develop against the background of physical overstrain, prolonged exposure to the sun.
In adult men and adolescents, nosebleed often occurs due to injuries sustained in fights. Traumatic bleeding is special. It is inherent in the complexity of pathogenetic mechanisms, a tendency to relapse. Such bleeding is difficult to diagnose, treat and predict.
Pathology in children
Special attention should be paid to nosebleeds in children. Every mother worries about her baby. When blood begins to flow from the nose of a child at night or in the afternoon, any woman begins to worry, look for the causes of this pathology, seeks to give her something to drink to prevent such cases from recurring in the future. Most often, there is no cause for concern. At the age of 10 years, nosebleeds are a manifestation of an individual characteristic of the nasal mucous membranes.
It is important to note that the most common cause of nosebleeds in children is finger injury. Mucus dries up in the nose, crusts form. Their child takes out his fingers and injures the mucous membrane. The consequence is bleeding.
This frightening and unpleasant symptom should be disturbing only when the bleeding is too frequent, profuse and stops for a long time. This may indicate a bleeding disorder. To confirm this, a standard clinical blood test is required to determine the level of platelets and clotting time.
Clinical picture
The condition of a person with nosebleeds can be different. With minor blood loss (from a few drops to several tens of milliliters), there are no special changes, pathological symptoms are not observed. Possible fainting or hysteria, but only children and people with an unstable psyche who usually do not know what to do if there is blood coming from the nose are faced with this.
With significant loss of blood, certain symptoms appear - weakness, noise and ringing in the ears, flickering of black dots in front of the eyes, palpitations, thirst, dizziness, pallor of the skin and mucous membranes. With blood loss from 15% to 20% of the volume of circulating blood, pressure decreases, shortness of breath, tachycardia appears. The skin acquires a bluish tint, i.e. signs of acrocyanosis appear. With even more significant blood loss (more than 20% of the volume of circulating blood), hemorrhagic shock occurs. Blood pressure drops sharply, severe tachycardia is observed. Consciousness becomes inhibited.
How to quickly stop nosebleeds
To quickly stop the bleeding, take simple measures. If this unpleasant symptom occurs in you, sit on a chair and lean forward. Do not throw your head back for several reasons. Firstly, blood can get into the respiratory tract, provoke vomiting. Secondly, tipping the head does not help to quickly stop the blood flowing from the nose. As you know, this position of the body worsens the venous outflow of blood from the head and neck. As a result, blood pressure rises in the blood vessels of the head. This causes increased bleeding. Also do not blow your nose. Such an action can only increase bleeding.
If blood flows from the nose for no reason, and the bleeding is minor, take a few deep and long breaths through the nose. Exhale by mouth. The flow of inhaled air will provoke a reflex spasm of injured vessels. As a result, bleeding will decrease or stop. In case of significant bleeding, attach an ice bag or an ordinary handkerchief moistened with cold water to your nose.
Immediate contact with a specialist
If you have nosebleeds, you may need the help of a doctor. Always contact a specialist if you have the following indications:
- bleeding resumes or does not stop within 20 minutes after the first action has been taken;
- bleeding is very significant (blood flows from the nose in a stream, the amount of blood loss is more than 200-300 ml);
- general health worsens;
- there are severe concomitant diseases;
- as prescribed by the doctor, anticoagulants and antiplatelet agents (drugs that inhibit the activity of the blood coagulation system and prevent thrombosis) are taken.
In the hospital, the doctor will conduct a diagnosis. It includes a thorough history taking to establish the cause of bleeding, measuring blood pressure and heart rate, and examining ENT organs. The specialist at this stage is looking for answers to important questions - why does the blood from the nose often bother the patient, is this a consequence of the usual overwork or some serious illness. An important task is to detect the source of bleeding. It may be in the nasal cavity. Often the nose serves as an excretory route for blood. Its source in some cases is located in the underlying respiratory and digestive tracts.
Therapies used by doctors
How to stop blood from the nose of an adult? In the hospital, this issue is resolved by nasal tamponade. The effectiveness of this method is somewhere around 80–90%. Tamponing is performed using gauze turunda, which is about 60 cm long. It is placed in loops on the bottom of the nasal cavity. When using gauze turunda, blood vessels are tightly pressed against the walls of the nasal cavity. This speeds up the stop of bleeding, the formation of a blood clot. The disadvantages of the method are soreness with the introduction of a tampon, the cessation of respiratory function through the nose.
There are also tubeless methods for stopping nosebleeds:
- Chemical coagulation. The source of bleeding is affected by chemicals (10% carboxylic acid, trichloroacetic acid).
- Cryocoagulation. When choosing this method of stopping nosebleeds, doctors choose 1 of 3 methods - either cryotherapy by spraying, or cryotherapy around the bleeding zone, or freezing of the bleeding area.
Drug therapy
With nosebleeds of any etiology, one of the main stages of care is drug therapy. Standard remedies for stopping blood from the nose:
- "Dicinon." This medication is used in the form of tablets and solution. The fastest effect is achieved with intravenous administration. This method of use of the drug is chosen, as a rule, with traumatic bleeding.
- "Vikasol." This medicine is also available in the form of a solution and tablets. It is prescribed by doctors with other means to enhance the hemostatic effect. At the "Vikasol", according to experts, the effect is rather weak. The drug begins to act somewhere 12 hours after the first injection.
- Calcium chloride. This tool is used to strengthen the main hemostatic. Calcium chloride is prescribed at the beginning of therapy to more quickly form the primary thrombus. With traumatic brain injury, the drug is contraindicated.
Surgical treatments
In some cases, it is possible to stop the blood from the nose of an adult, no matter how scary it sounds, only by surgical methods. They are necessary for those people who have a recurring pathology. In such cases, surgical methods are more effective than conservative methods to stop bleeding.
Surgery may be a ligation of blood vessels. Indications for a similar procedure are the lack of effect from the posterior nasal tamponade within 48 hours and a decrease in hematological parameters (erythrocytes, hemoglobin, hematocrit, color indicator).
In conclusion, it is worth noting that you do not need to worry about health if bleeding is very rare. This symptom is not always associated with any kind of disease. Very often, the cause of bleeding is dry air in the premises at work, in housing. Abundant, prolonged and frequent leakage (in both women and men) of blood from the nose is a sign of something bad, a signal of the body about serious violations. In such cases, you need to be examined to find out the exact cause of the pathology and the appointment of the right treatment.