Periodic bleeding from the nose. Nosebleeds: causes, emergency care, treatment

Anyone at least once, but had to deal with nosebleeds. But not everyone knows why the nose bleeds. The reasons for this phenomenon in an adult can be very different: overwork and fatigue, nose injuries, as well as other more serious diseases.

In cases where nosebleeds are quite common, you should immediately undergo a medical examination to identify the true cause or disease.

Similar symptoms can signal a disease of various internal organs - the liver, kidneys, and blood. In addition, nosebleeds can be caused by cardiovascular diseases, rheumatism and a variety of infectious diseases.

Classification

The volume of blood leaking from the nose can range from a few milliliters to half a liter.

A blood loss of a few milliliters is considered insignificant. Such bleeding is not dangerous to health and does not lead to any consequences. The only negative point may be fright, hysteria or fainting in young children.
Blood loss is assessed as moderate if its volume does not exceed 200 ml. Such blood loss causes slight weakness, dizziness, rapid pulse and flies before the eyes. Possible blanching of visible mucous membranes and skin.
O massive blood loss we are talking about cases where up to 300 ml of blood flows out in total or simultaneously. It is accompanied by more pronounced symptoms in comparison with a mild degree: weakness, tinnitus, dizziness, headache, thirst, shortness of breath.
Profuse bleeding characterized by a large volume - 500 ml and above. Massive blood loss leads to hemorrhagic shock, which is expressed in a sharp drop in blood pressure, lethargy, various disturbances of consciousness up to its loss, insufficient blood circulation in the internal organs.

Also, nosebleeds can be conditionally divided into local and general. Local are those that cause blood with local damage to the nose, and general are those that cause bleeding in general.

Why does an adult bleed from the nose: reasons

Drops or trickle of blood emerging from the nasal passages are the result of damage to the vessels. This happens as a result of either mechanical impact (nose injury) or internal processes in the body.

Let us consider in more detail the main reasons why an adult can bleed from the nose, and what to do in this case:

Trauma - most often, various blows to the face area lead to trauma to the nose, which may be accompanied by a fracture of its septum with the development of severe bleeding. In childhood, the habit of picking the nose with a finger or any objects (pencil, pen) leads to injuries of the nasal mucosa.
Impact of external conditions. Long exposure to the sun, overwork, physical activity are factors that can cause spontaneous nosebleeds. This is a solitary phenomenon, it is not a reason to go to the doctor, the blood stops quickly, and the incident is forgotten.
Sunstroke and overheating- one of the main factors of bleeding from the nose, especially in the summer. Due to high temperatures, the nasal cavity becomes dry and the vessels become fragile. They burst easily and cause nosebleeds. To protect yourself from heatstroke, you need to wear a panama or a hat, stay in a shady place more.
Can cause nosebleeds drying of the mucous membranes, as the capillaries become fragile. Drying of the nasal mucosa can be the result of a long stay in a room with dry air or in the cold.

The second group of nosebleeds is caused, as a rule, by much more serious causes, consisting in systemic disorders. In this case, epistaxis is not a separate pathological condition, but a manifestation of the symptoms of diseases of any organs and physiological systems, most often respiratory and circulatory. This group includes diseases such as:

. Elevated blood pressure or can also cause nosebleeds. But this is more of a blessing than a disaster, because it is better to lose some blood and reduce pressure than to have a stroke. By the way, most often pressure drops occur from 4 to 6 in the morning. This fact explains why some people have nosebleeds in the morning.
Inflammatory process of the nasal mucosa() or its sinuses (,) - inflammation weakens the walls of blood vessels, making them more brittle. An acute respiratory viral infection, allergic rhinitis, bacteria (streptococci, staphylococci, E. coli) can lead to the development of the inflammatory process.
Papillomas in the nose- growths on the mucous membrane. They are the result of a viral infection, dangerous mutations into malignant tumors. Polyps put pressure on blood vessels, make breathing difficult, and cause frequent bleeding in the morning.
- accompanied by weak, fragile vessels, often causing nosebleeds in an adult or child diagnosed with VVD. Additional symptoms are watery discharge of blood, pain in the head, tinnitus.
- changes in blood vessels, loss of their elasticity, frequent damage with the occurrence of various bleeding (internal and external).
Pheochromocytoma is a tumor of the adrenal glands that increases the level of stress hormones. Because of this, the pressure rises sharply and constantly bleeding from the nose. Signs of this tumor are frequent nosebleeds and dryness in the nose. With such symptoms, you should contact the clinic.
Taking medication. As a rule, bleeding is caused by drugs aimed at preventing blood clotting. These include heparin, aspirin and others. Blood from the nose can flow with prolonged and uncontrolled use of nasal sprays that dry out the mucous membranes.
Oncological diseases. Epistaxis occurs with malignant and benign neoplasms in the nose. In addition to bleeding, there may be an ulcer on the nasal mucosa, swelling of the nose, and a change in its shape.
Diseases associated with blood clotting disorder such as hemophilia.
Vitamin C deficiency. As you know, vitamin C strengthens the walls of blood vessels. If it is not enough, the vascular walls become loose and brittle. This fact may be the answer to the question of why the nose often bleeds.

In adults, the most common cause of blood from the nose is damage to the vessels of the anterior nasal septum (Kisselbach's place), densely penetrated by a network of small arterioles and capillaries. Such bleeding, as a rule, does not pose a threat to human health. The blood from the nose flows out in drops or a thin trickle and, with normal clotting, quickly stops on its own.

The situation is worse when the vessels of the upper and posterior sections of the nasal cavity are damaged. The arteries here are noticeably larger than in the anterior section, and therefore the bleeding is stronger, can cause significant harm to health and even lead to death due to very strong blood loss. In this case, the blood flows in a bright red, non-foamy stream, may appear from the mouth, and practically does not stop on its own.

What to do when nose bleeds?

There is no point in treating only the symptoms, since the underlying disease must be eliminated. The causes of frequent nosebleeds are determined by the doctor. It is necessary to visit a therapist or a pediatrician and an otolaryngologist. For diagnosis, you will need to take a general blood test and check the indicators of its coagulability.

Nosebleeds may not be as harmless. Many do not pay enough attention to this. If blood from the nose worries in rare cases, and then due to mechanical impact, then there is no need to worry.

If the blood from the nose bothers you often, it spurts, or the bleeding is profuse and prolonged - all this is a signal for promptly seeking help from a specialist.

How to stop nosebleeds?

If blood flows out of the nose as a result of mechanical damage and there is little of it, and apart from a slight headache, there are no signs of serious illness, you can deal with the problem yourself. The sequence of tasks is as follows: first we stop the bleeding, then with the help of analgesics, you can reduce the intensity of pain.

Take a sitting position and slightly tilt your head back. Loosen the tie knot, unbutton the collar. Do not tilt your head forward - this will cause a rush of blood to the nose area and increase bleeding. You can’t tilt your head back either - blood will penetrate into the nasopharynx and lead to vomiting.

On the bridge of the nose, you can put a piece of ice or a towel moistened with cold water - not for long, for about ten minutes. A towel moistened with cold water can also be applied to the back of the neck. It is advisable to press the nostril from which blood flows for 5-10 minutes until the bleeding stops. If the bleeding is intense or does not stop, then use tampons. For this, cotton swabs moistened with hydrogen peroxide are suitable, they must be inserted into the nose, but not too deep, and sit for 10-15 minutes.

If there is no tampon and hydrogen peroxide, then insert a bandage into the nostril from which blood flows, leaving at least 10 centimeters outside so that it can be freely removed from the nostril. This is done in order to prevent the exit of blood from the nose. Also, if you have vasoconstrictor drugs for nasal instillation, then apply a few drops to a swab and insert it into your nose. These drops will help tighten the damaged vessel, which caused the bleeding. Then place the person in a cool, quiet and dark room. Sometimes these measures are enough.

If the bleeding is profuse and it cannot be stopped quickly enough at home, the head hurts badly, speech, vision or consciousness as a whole are impaired, urgently call an ambulance.

General information

- outflow of blood from the nasal cavity due to a violation of the integrity of the walls of blood vessels. More often it accompanies injuries and inflammatory diseases of the nose, it can be caused by diseases of the blood vessels and the blood system. It is characterized by the outflow of scarlet blood in drops or a trickle from the nostrils, flowing down the back of the throat. May be accompanied by tinnitus and dizziness. Abundant recurrent nosebleeds cause a sharp drop in blood pressure, increased heart rate, general weakness, and can be life-threatening.

Nosebleeds are a widespread pathological condition. Patients with epistaxis account for about 10% of the total number of patients hospitalized in the ENT department.

Causes of nosebleeds

Allocate general and local causes of nosebleeds.

local reasons:

Nose injuries are the most common cause of bleeding. In addition to ordinary household, industrial and road injuries, this group includes injuries of the nasal mucosa during operations, ingestion of foreign bodies and medical and diagnostic manipulations (nasogastric sounding, nasotracheal intubation, catheterization and puncture of the nasal sinuses).
Pathological conditions accompanied by plethora of the nasal mucosa (sinusitis, rhinitis, adenoids).
Dystrophic processes in the nasal mucosa (with severe curvature of the nasal septum, atrophic rhinitis).
Tumors of the nasal cavity (specific granuloma, angioma, malignant tumor).

Common reasons:

Diseases of the cardiovascular system (symptomatic hypertension, hypertension, atherosclerosis, malformations accompanied by an increase in blood pressure).
Blood diseases, beriberi and hemorrhagic diathesis.
An increase in body temperature due to overheating, sunstroke or an infectious disease.
A sharp drop in external pressure (when climbing to a great height for climbers and pilots, with a rapid descent to depth for divers).
Hormonal imbalance (during pregnancy, in adolescence).

Classification of nosebleeds

Depending on which part of the nasal cavity the source of blood loss is localized, nasal bleeding is divided into anterior and posterior.

The source of anterior nosebleeds in 90-95% of cases is a rich network of blood vessels of the so-called Kisselbach zone. In this zone, there are a large number of small vessels covered with a thin mucous membrane, practically devoid of a submucosal layer. Anterior nosebleeds are very rarely the cause of massive blood loss, and, as a rule, do not threaten the patient's life. They often stop on their own.

The source of posterior nosebleeds are rather large vessels of the deep parts of the nasal cavity. Due to the large diameter of the vessels, posterior nosebleeds are often massive and can pose a threat to the life of the patient. Such bleeding almost never stops on its own.

Blood loss in nosebleeds is assessed as follows:

insignificant - a few tens of milliliters;
light - up to 500 ml;
moderate severity - up to 1000-1400 ml;
heavy - over 1400 ml.

nosebleed symptoms

Symptoms of nosebleeds are divided into three groups:

signs of bleeding;
signs of acute blood loss;
symptoms of the underlying disease.

In some patients, nosebleeds begin suddenly, in others, bleeding may be preceded by dizziness, tinnitus, headache, tickling, or itching in the nose. A direct sign of nosebleeds is the outflow of blood from the nasal cavity to the outside or inside the nasopharynx. In the latter case, the blood drains into the oropharynx, where it is detected during pharyngoscopy.

With a slight blood loss, pathological symptoms, as a rule, are not determined. Some patients may feel dizzy at the sight of blood. With mild blood loss, patients complain of dizziness, tinnitus, thirst, general weakness, and palpitations. In some cases, there may be a slight pallor of the skin.

Blood loss of moderate severity is accompanied by severe dizziness, a drop in blood pressure, acrocyanosis, tachycardia and shortness of breath. With severe blood loss, hemorrhagic shock develops. The patient is lethargic, loss of consciousness is possible. During the examination, a thready pulse, severe tachycardia, and a sharp drop in blood pressure are detected.

Diagnosis and differential diagnosis

To determine the localization of the source of nosebleeds (anterior or posterior bleeding), the patient is examined, pharyngoscopy and anterior rhinoscopy. In some cases, with pulmonary and gastric bleeding, blood flows into the nasal cavity, and simulates nosebleeds. Primary differential diagnosis is based on data from an external examination of the patient. With nosebleeds, the blood is dark red; with bleeding from the lungs, it foams and has a bright scarlet color. Gastric bleeding is characterized by the outflow of very dark blood, similar to coffee grounds. It must be borne in mind that severe nosebleeds may be accompanied by hematemesis with dark blood. The cause of vomiting in this case is the ingestion of blood flowing down the oropharynx.

Additional studies are being conducted to assess blood loss and identify the underlying disease that caused the nosebleed. The volume of blood loss is estimated according to the results of a general blood test and a coagulogram. The tactics of the general examination is determined by the symptoms of the underlying disease.

Treatment of nosebleeds

In the treatment of nosebleeds, it is necessary to stop the bleeding as quickly as possible, take measures to prevent the consequences of blood loss (or compensate for blood loss) and take therapeutic measures aimed at combating the underlying disease.

With anterior nosebleeds, in most cases, in order to stop the blood, it is enough to put cold on the nose, press the nostril for 10-15 minutes, or insert a cotton ball soaked in a hemostatic agent or a weak solution of hydrogen peroxide into the nasal cavity. Anemization of the nasal mucosa is also carried out with a solution of adrenaline or ephedrine. If bleeding does not stop within 15 minutes, anterior tamponade of one or both halves of the nasal cavity is performed.

Anterior nasal tamponade often works well for posterior nosebleeds. If posterior nosebleeds cannot be stopped, posterior tamponade is performed.

With the ineffectiveness of these measures and recurrent nosebleeds, surgical treatment is performed. The volume and tactics of intervention is determined by the localization of the source of bleeding. If repeated nosebleeds are localized in the anterior sections, in some cases endoscopic coagulation, cryodestruction, the introduction of sclerosing drugs and other measures aimed at obliterating the lumen of small vessels of the Kisselbach zone are used.

Nosebleeds are a fairly common condition that complicates the course of many diseases. Its manifestations and consequences have a wide range. The root cause of this pathology is allergic, traumatic injuries of the nose or the underlying disease. In some cases, nosebleeds can also occur in a practically healthy person (for example, after severe overwork, prolonged exposure to the sun or frost). Under such conditions, the mucous membrane dries up, which is why small blood vessels are injured. Usually, medical attention is not required here, since the outflow of blood from the nose stops on its own.

Nose bleed

The discharge of blood from the nose (epistaxis) in some patients begins suddenly, while in others it is preceded by prodromal phenomena:

Dizziness.
Headache.
Tickling or itching in the nose.
Noise in ears.

You need to know that blood can enter the nose from other parts of the upper respiratory tract: the lungs, larynx, pharynx, trachea, and sometimes through the auditory tube from the middle ear. You can recognize this by examining the ENT organs.

Bleeding from the nose

There are severe (strong), moderate and minor nosebleeds.

Severe nosebleed poses a threat to life. It occurs with severe facial injuries. It is characterized not only by intensity, but also by relapses after a while. During the day, blood loss ranges from 200 ml to 1 liter or more. In this case, a person has a sharp general weakness, sweating, a drop in blood pressure.
At moderate nosebleeds blood will stand out from a few tens to 200 ml in an adult. Hemodynamics is usually within the physiological norm. In debilitated adults and children, the external discharge of blood secretions often does not give a complete picture of the real blood loss, since part of the blood is swallowed, flowing into the pharynx.
At minor bleeding blood is secreted in drops for a short time. Its volume is a few milliliters. Frequently recurring, long recurring, albeit seemingly harmless, nasal discharge can adversely affect a developing young organism. They require radical treatment.

Causes of nosebleeds

The nasal mucosa is actively supplied with blood. And frequent nosebleeds are the initial signs of the development of severe pathological processes in the body. Causes of nosebleeds are divided into local and general.

General:

Loss of elasticity of blood vessels and their fragility are associated with diseases that are associated with hormonal regulation (ovarian dysfunction, diabetes mellitus, etc.). Also, spontaneous nosebleeds signal a serious illness - emphysema. It represents the inability of the affected areas to a normal supply of oxygen. With this pathology, blood, rushing into the upper parts of the respiratory tract, creates a high load on the venous walls.
If headache, tinnitus, weakness appear before bleeding, then it can be assumed that it is associated with an increase in blood pressure. In hypertension, the appearance of blood streams from the nose serves as a compensatory mechanism that does not allow overloading the vessels of the brain. However, intense bleeding can lead to a rapid drop in blood pressure and collapse.
Leukemia, severe blood diseases, malignant tumors in the bone marrow can cause frequent nosebleeds. Nosebleeds cause pressure surges. This can provoke diseases of the kidneys and liver, which are destructive in nature: nephrosclerosis, nephrosis, cirrhosis of the liver.
Often, nosebleeds appear due to changes in hormonal levels (during adolescence, during pregnancy).
However, nosebleeds are not always caused by serious illnesses. For example, their appearance stimulates the excessive use of drugs that act on the receptors of the mucous membranes (nazivin, otrivin, oxymetazoline). The mechanism of their action is that they reduce the release of exudate and block irritation. Therefore, their frequent use leads to vascular fragility and dryness of the mucosa.

Local:

Among the local factors, there are features of the anatomical structure. The release of blood during a runny nose, coughing, sneezing suggests that the walls of the vessels of the Kisselbach plexus are weak. Such nosebleeds appear, as a rule, from childhood.
The cause of bleeding from the nose are mucosal polyps or angioma. These diseases require immediate medical attention, as in some cases they can be malignant. Injuries are also a factor that contributes to changes in the structure of the vessels of the nasal septum. They can lead to neoplasms.
Atrophic rhinitis can lead to spontaneous bleeding from the nose. With this disease, the mucous membrane dries up, becomes thinner. This leads to the fact that the vessels are damaged even with minor touches.

Frequent nosebleeds

In adults, frequent nosebleeds are associated with factors such as:

Diseases of the blood, spleen, liver.
bacterial infections.
Excessive mental and physical stress.
Prolonged exposure to the sun.
Lack of vitamins (particularly vitamin C).

In older people:

Atherosclerosis.
Increased blood pressure.
Thinning of the walls of blood vessels.

For people of any age:

Deviation of the nasal septum.
Severe cough, runny nose, sneezing.
Excessive dryness of the air.
Dustiness of the premises.
Allergic reactions.

At an early age, the features of the development of the respiratory system determine the fact that in children, nosebleeds are not always caused by pathological conditions. Most often, nosebleeds in children occur due to damage to the nasal mucosa by mechanical means:

Trauma.
bruised.
Fall damage.
The introduction of small foreign objects into the nose.

If a child has mucus with thick blood clots along with blood from the nose, it means that an inflammatory process (sinusitis, rhinitis, etc.) occurs in his nasal cavity, this condition requires additional treatment.

Prolonged and persistent nosebleeds in children, which are combined with the occurrence of bruises and bruises, may indicate hemophilia and a violation of blood clotting processes.

Nosebleed in a child

Often, the general weakness of the immune system leads to the fact that the nose bleeds in a child. One reason is hypovitaminosis. With a lack of vitamins C and A in the body, the walls of blood vessels become fragile and brittle, and the slightest physical activity can cause an increase in pressure, resulting in rupture of blood vessels and nosebleeds.

Dry indoor air thins the mucous membrane. If in the room where the child is, you often use heaters and ventilate him little, he may start bleeding from the nose.

Chronic runny nose causes brittleness and fragility of the vessels of the nose. If a child is often sick with acute respiratory infections, nosebleeds are also possible.

With endocrine disorders and vegetative-vascular dystonia in children, blood pressure rises, which is a potential cause of bleeding from the nose.

The victim should be given the following assistance for nosebleeds:

Monitor the general condition and carry out first aid measures for bleeding.
When the bleeding stops, lubricate the nasal mucosa with vaseline oil.
Increase air humidity (using a humidifier or wet sheets).
Subsequently, it is good to instill preparations based on sea water (saline, aquamaris) into the nose.

How to stop nosebleeds

There are many ways to stop nosebleeds. Depending on the causes that caused it, as well as the individual characteristics of the organism, different methods of treatment are used. The main thing is not to make mistakes:

It is not recommended to tilt your head back, as blood (along the back of the nose) will drain into the throat. This can lead to the fact that (if it enters the respiratory tract) you can suffocate or swallow it until you vomit. For the same reason, you can not go to bed. Keep your head upright or slightly tilted forward.
Secondly, do not forget to blow your nose, because blood clots do not allow the vessels of the nose to contract.
You need to slow down the blood flow by applying ice to the bridge of your nose.

You can drip into the nose vasoconstrictor drugs (solution of ephedrine, galazolin), take 100-200 mg of ascorbic acid and heart drops.

First aid for nosebleeds

First aid for nosebleeds and should be provided as soon as possible. To do this, you need to know the basic methods of its provision:

Have the patient sit down with the torso slightly leaning forward.
If there are no signs of a nose fracture, then you can slightly press the wings of the nose against the nasal septum with your index and thumb (for 3-5 minutes). At the same time, ask the victim to tilt his head slightly forward and breathe through his mouth.
Soak a cotton swab in 3% cold water or hydrogen peroxide. Insert a swab into the nostril (bleeding) and pinch it with your fingers. Put a piece of cloth soaked in cold water or an ice pack on the nose. Stay in this position for 10-20 minutes.
To make sure that bleeding does not continue inside the nasopharynx, you need to look into the patient's mouth, ask him to spit out saliva and make sure that there is no blood in it. After carefully remove the swab (after moistening it with cold water with a pipette.)

Important: the victim should not be laid horizontally and his head thrown back. Blood, if it enters the nasopharynx, can cause vomiting.

If, despite all efforts, the blood cannot be stopped, you need to call an ambulance as soon as possible.

Treatment of nosebleeds

The treatment of nosebleeds is to stop the bleeding as soon as possible, as well as to compensate for blood loss or to take therapeutic measures to combat the underlying disease.

In case of anterior nosebleed, to stop the blood, you need to put cold on the nose for 15 minutes, press the nostril or insert a swab soaked in a hemostatic agent into the nasal cavity. Also, an anemization of the nasal mucosa is done with a solution of ephedrine or adrenaline. If the bleeding does not stop within 15 minutes, nasal tamponade is done.

If these measures are ineffective, surgical treatment is carried out. The tactics and scope of the operation is determined by localizing the source of bleeding. If nosebleeds recur and are localized in the anterior parts of the nose, then apply:

Cryodestruction (freezing with liquid nitrogen).
Endoscopic coagulation.
The introduction of sclerosing drugs.
Other measures that are aimed at obliterating the lumen of the vessels of the Kisselbach zone.

Treating nosebleeds at home

At frequent nosebleeds take a small iron key, hang it on a woolen thread (on a woolen one) around your neck so that the key is on your back between your shoulder blades. The nosebleed will stop immediately.
1/3 st. l. alum powder (in pharmacies) dissolve in a glass of water and this solution rinse your nose when bleeding. The blood stops quickly, attacks become less frequent, and then completely disappear.
With frequent nosebleeds for 10-15 days, eat a piece of aloe tree leaf 2 cm long before eating. If blood comes from the right nostril, raise the right hand up above the head, and hold the nostril with the left and vice versa.
Put cotton wool moistened with fresh nettle juice into the nose. 10-15 minutes will be enough for the bleeding to stop. The next day, the procedure can be repeated.
Traditional medicine recommends that for nosebleeds, soak a cotton swab in alcohol and put it on the bridge of the nose, a bone, cover it with a cloth on top. It will pinch your eyes, nothing, close your eyes and be patient. Lie down for 5-10 minutes. If bleeding continues a month or two after this procedure, although it should not, repeat again.
At very severe nosebleeds pour half a bucket of cold water on the patient's head (conveniently from a watering can), and pour half a bucket on the upper back.

With timely assistance, nosebleeds are not dangerous. In some cases (with an increase in blood pressure), it can lower it, thereby preventing cerebral hemorrhage. However, if the bleeding is threatening, it must be stopped immediately.

Recurrent bleeding from the nose gives reason to suspect a general disease and requires examination in the hospital. In such cases, only classical methods of treatment should be used.

But, fortunately, in most cases, traditional medicine can help, the recipes of which are given in our article.

Nosebleeds are not always a harmless symptom. A quarter of all patients with nosebleeds are hospitalized for assistance.

According to statistics, about 60% of people suffer from nosebleeds at least once in their lives. The mucous membrane of the nasal passages is very richly supplied with blood capillaries from the system of external and internal carotid arteries. Even a harmless nosebleed is accompanied by vivid symptoms and often causes panic.

Bleeding from the nose can be an isolated accident - a reaction to dry air in the apartment or the result of inaccurate hygienic manipulations in the nose. Sometimes blood from the nose is a signal of serious health problems, a sign of various diseases that require prompt intervention.

The causes of nosebleeds can be diseases of the nasal cavity and paranasal sinuses, trauma, blood diseases and disorders of the coagulation system, pathology of internal organs and the whole organism as a whole (atherosclerosis, hypertension, systemic scleroderma, and others).

Nosebleed is a sign of high blood pressure

Arterial hypertension, hypertensive crisis are the causes of nosebleeds in adults in more than half of the cases. Against the background of high blood pressure figures, the thin walls of the capillaries in the nose do not withstand the load and break, which leads to the outflow of blood. Usually it is this mechanism that underlies nosebleeds during excitement, stress, excessive physical exertion, and overwork.

Blood from the nose during a hypertensive crisis is a protective reaction of the body,
saving from cerebral hemorrhage. Similar "bleeding"
allows you to slightly reduce the off-scale figures of pressure and save
integrity of the cerebral vessels. Unfortunately, such
The "fuse" does not work for everyone.

As a rule, medical pressure reduction quickly leads to the cessation of bleeding. To prevent nosebleeds, it is extremely important to monitor the level of pressure daily and maintain it at an optimal level using non-drug and drug methods.

Injuries and surgical interventions in the nose

The second most common cause of nosebleeds is trauma. This cause has the greatest weight among children, who often damage the delicate loose mucous membrane with fingers and foreign objects in an attempt to remove crusts from the nose. Sometimes nosebleeds develop after various nose surgeries.

Traumatic bleeding most often develops from the front of the nasal passages. To stop bleeding, first aid must be provided according to the usual rules.

In case of severe injuries, you should seek medical help as soon as possible, after placing an ice pack on the bridge of the victim's nose. If the nose bleeds in a continuous or pulsating stream without clots, emergency medical attention is needed.

Bleeding from the nose - a consequence of taking medication

The third cause of damage to the nasal capillaries is long-term (more than 10 days) intake of certain medications. Among them are drugs that reduce blood clotting (acetylsalicylic acid drugs, antiplatelet agents), vitamin K antagonists, hormones.

The time to stop bleeding in such cases is significantly lengthened, and it is not always possible to cope with the problem without medical help. As a rule, in order to prevent bleeding in such cases, the dose of the drug responsible for the development of the pathology is canceled or reduced.

Liver disease and alcoholism

The fourth most common cause of nosebleeds is liver disease. In some diseases of the hepatobiliary system, the ability of blood to form blood clots decreases, the walls of the blood capillaries become thinner, the vessels expand and experience increased pressure. The most common cause of such bleeding in our country is alcoholic liver disease.

According to legend, it was from a nosebleed that the greatest warrior died.
Attila is the leader of the Huns. It is probable that his immoderate
drunkenness, which caused profuse hemorrhage from the vessels
nasal cavity. According to the description of the Byzantine historian Priscus of Panius,
Attila died at night, choking on his own blood. The day before he
was celebrating his own wedding and was very drunk.

How to Stop a Bleeding Nose: First Aid

In the case of nosebleeds, it is necessary to give the victim a semi-sitting or semi-recumbent position. Throwing the head back allows you to somewhat reduce the blood supply to the nasal mucosa. However, it is advisable to avoid swallowing blood that may drain down the back of the throat. In case of heavy bleeding, this can lead to vomiting.
Cold is applied to the bridge of the nose (a cold wet towel, a bladder with ice, cold water, etc.).
A cotton swab is soaked in a 3% hydrogen peroxide solution and gently inserted into the anterior part of the nasal passage. After that, the wing of the nose is pressed against the bridge of the nose with a finger for 10-15 minutes. Such measures accelerate thrombus formation in broken capillaries.
As an auxiliary measure, vasoconstrictor drops or spray can be used.
If the performed manipulations did not lead to a stop of bleeding, you need to call an ambulance.

Expert: Natalia Dolgopolova, therapist
Tatiana Uzonina

The material uses photographs owned by shutterstock.com

Epistaxis - Nosebleeds or Nosebleeds?
Strange as it may seem, but these two phrases, close in content, reflect completely different concepts, united by a common name - epistaxis.

Nosebleeds occur in people of all ages. It can be spontaneous, or due to various external causes that caused a violation of the integrity of multiple networks of capillaries that actively supply the mucous layer of the nasal sinuses or nasopharynx. It is with this pathology that up to 10% of patients are treated in polyclinic otolaryngological departments.

The frequent manifestation of nosebleeds can be one of the symptoms of serious pathologies. Such cases in medicine are already considered as nosebleeds, which can provoke intracavitary vascular damage to the skull or nasal mucosa.

The respiratory system, esophagus or stomach may well serve as a source of pathology. With such vascular disorders, blood flows out as a result of leakage through natural openings (choanae) connecting the oropharynx with the nasal cavity.

Forms of manifestation

Nosebleeds, according to their manifestation, are divided into several forms - mild, moderate and severe. In addition, they differ according to certain criteria:

By location- vascular lesion of the vestibule (anterior) or posterior vessels, bleeding from one sinus or bilateral.

Bleeding from the anterior parts of the nasal cavity is due to multiple branching of the vessels in the anterior zone of the Kiesselbach plexus of both nostrils. It is the defeat of the anterior circulatory system of the nose that is the main cause of nosebleeds from one nostril.

Bleeding from the back of the nose is caused by damage to the circulatory systems in the deep areas of the nose and is very dangerous. Blood loss can be unpredictable, it is almost impossible to stop it and stop it at home.

In terms of time the duration and short duration of the pathological process is determined.

The quantitative indicator is due to a profuse course (abundant), or insignificant (a small amount, drops).

According to the number of manifestations- rarely occurring (or single), repeatedly repeated (recurrent) and spontaneous (trauma or surgery). The risk of recurrent manifestations is due to the development of anemia.

According to the type of vascular lesion- blood capillaries, deep arterial vessels, or venous network.

Etiology of nosebleeds

causes of nosebleeds, photo

The manifestation of epitaxis in patients of any age is due to various general and local causes, among which the following prevail:

drying of the mucous epithelium in a hot and unventilated room, which leads to capillary fragility. Normally, sleeping in these conditions causes nosebleeds at night.
thinning and thickening of the intracavitary mucous membrane of the nasal sinuses during the development of specific atrophic rhinitis;
the presence of angiofibroma of the nasopharynx, tumor-like growths (hemangiomas) or polypous formations.

What can nosebleeds tell about in adults?

The causes of nosebleeds in adults and children of a local nature are supplemented by many pathologies.

They can be caused by physiological, traumatic and compensatory curvature of the cartilaginous septum of the nose, which entails changes in the air flow in both nasal sinuses, provokes irritation and dryness in them and in the maxillary sinuses, the development of prolonged infectious processes, swelling and congestion, articular fragility.

Thermal, radiation and chemical burns cause necrosis of the mucosal epithelium in the nasal cavity and damage to the capillary vascular walls.

The manifestation of unilateral or bilateral epistaxis is facilitated by surgical manipulations and interventions (punctures, endoscopy, probing, piercing).

Common reasons include:

Cardiovascular pathologies that provoke increased permeability of the vascular walls. For example, various types of atherosclerosis that cause hardening of the arterial walls and the development of hypertension.
Vascular anomalies in the cervical area and head, caused by an increase in intravascular pressure provoked by disseminated syndrome of intravascular hemostasis.
Pathological conditions in hemorrhagic diathesis, manifested by increased vascular bleeding due to the presence of pathologies associated with the process of impaired blood coagulation (clotting).
A sharp change in barrological pressure, characteristic of certain professions (for divers, pilots, climbers).
Pathology of the kidneys and diseases of the liver. For example, cirrhosis, accompanied by high blood pressure and severe vascular fragility, and renal pathologies are often accompanied by uremic bleeding syndrome, manifested by epistaxis.
Taking medications that interfere with normal hemostasis.
Congenital anomalies - hemorrhagic angiomatosis or hemophilia.

In a perfectly healthy person, signs of epistaxis can manifest themselves with prolonged exposure to the nasopharynx of frosty and dry air, which causes dryness of the mucous membrane and vascular damage.

In the older generation, bleeding from the nose occurs more often, due to age-related features, when the vessels in the posterior part of the nasal sinuses lose their elastic properties, are damaged, causing posterior vascular hemorrhage.

With posterior bleeding, blood drains into the throat, and may go unnoticed and cause significant blood loss. In aged women, the cause of dystrophic changes in the mucosal endothelium and blood vessels is due to a hypertensive crisis or a natural factor in menopause.

The delicate and easily injured mucous layer of the children's nasopharynx is supplied with blood by the largest vascular branch - the artery of the neck and head. The greatest predisposition to bleeding is noted in the vessels of the lower nasal passage.

In children, the causative factors are in many ways similar to the manifestation in adults, but are also supplemented by an external factor caused by pathologies in the mucous epithelial layer due to the introduction of foreign irritants - peas, pencils, buttons and many objects that young children often put into their nose.

The registry of common causative factors includes:

Infections that cause high fever, provoke headache and nosebleeds under the influence of viral toxins (cold viral infections or general intoxication with scarlet fever).
Diseases that cause failures in coagulation processes, or congenital pathology of the hemostasis system.
Sunstroke and overheating, or the influence of atmospheric pressure surges.
Problems of intracranial and arterial pressure. They often appear in puberty as a result of overload (physical, emotional or sports-related). The blood goes through the nose, the pressure drops. The good news is that it comes out through the nose and not into the brain. This is how a kind of protection of the body is manifested, trying to stabilize the state at least for a while.
Hormonal restructuring - the release of hormones in children at puberty is accompanied by a narrowing of capillary vessels and an increase in blood pressure. Cyclic manifestations of nosebleeds in girls are observed during the formation of the menstrual "lunar" cycle.
Avitominosis is an imbalance with vitamin C, manifested by vascular fragility and fragility in the spring, vitamin K deficiency is the main cause of poor hemostasis, which is manifested by epistaxis.

Epistaxis during pregnancy

Nosebleeds during pregnancy can be caused by a variety of reasons. Manifestations at the beginning of the 1st trimester are caused by the restructuring of the woman's body.

Increased estrogen synthesis provokes extensive accumulation of fluid in the intercellular space of the upper layer of the mucous epithelium and overflow of the vascular network with blood, which provokes increased fragility and capillary permeability

Natural stress during pregnancy, and lying position causes increased sniffing. To alleviate the condition, a woman is forced to use vasodilators that dry the mucous membrane, damage blood vessels and cause signs of dry rhinitis. Usually they are manifested by bleeding in the morning, even with a slight blowing of the nose.

In subsequent trimesters - the 2nd and 3rd, epistaxis may be the result of beriberi, followed by the development of pathological changes in the walls of the capillaries.

The presence of hypertension contributes to pathology and provokes fetal hypoxia and problems with fetal development. In the state of pregnancy, to ensure fetal nutrition, blood circulation in the female body increases significantly, which increases the load on the heart and blood vessels.

Not abundant, rare manifestations of epistaxis do not cause a threat, but the appearance of blood from the nose every day threatens to terminate the pregnancy and requires timely correction and medical care.

Main symptoms of nosebleeds

The vast majority of pathologies begin without previous symptoms. The characteristic symptoms include: vertigo (manifestation of dizziness), migraine attacks, tachycardia, hearing loss with tinnitus caused by impaired blood flow. Pass accompanied by hypertension and severe weakness, represent a serious problem.

Different forms of pathology correspond to certain symptoms:

In the initial form of pathological manifestations, the symptoms are manifested by insignificant blood loss with signs of slight dizziness.
In a mild form, weakness and tachycardia, tinnitus, signs of thirst and vertigo are noted.
The average severity of the manifestation is characterized by severe dizziness, shortness of breath, a drop in blood pressure and tachycardia, signs of cyanotic changes in the skin.
The severe form is manifested by hemorrhagic shock, severe lethargy, a drop in blood pressure, tachysystolic disorders, and fainting.

A severe form of bleeding with large blood loss can acquire a recurrent character, periodically repeating to cause mental disorders due to oxygen starvation.

First aid for nosebleeds will not cause difficulties if you clearly know how to do it correctly. It is necessary to firmly grasp - it is impossible to wait for an independent solution to the problem. Serious complications from the cardiovascular system, the manifestation of fainting and anemia can aggravate the situation.

To quickly stop the blood, you need to sit down, slightly tilting your head. Press the nose with two fingers for 10-15 minutes. During this time, the blood inside should clot and block the passage of the damaged vessel. Pay attention to the fact that breathing through the mouth was free.

You can stop bleeding with a tamponade, after moistening the tampon with peroxide or apple cider vinegar. The tampon is inserted into one nasal opening, or both. An ice or cold compress is applied to the bridge of the nose. For hours 2, 3, you should refrain from blowing your nose and breathing through your nose.

When bleeding from one nasal opening, for example, on the left side, you should raise your left hand above your head and vice versa, if on the right side.

Helping a child with nosebleeds is similar. But with babies, the psychological factor should be taken into account, because young children are usually very afraid of this condition. It is necessary to distract him, calm him down and arrange medical assistance as quickly as possible.

Diagnostic examination

Often the manifestation of a single minor epistaxis is due to a traumatic cause. In this case, a rhinoscopic examination of the anterior zone of the Kisselbach plexus gives a complete picture of the source of bleeding.

If the source is located in the deep zone of the nasal cavity, the method of endoscopic examination (probing) is used.

To determine the general characteristics of the lesion (hemodynamics), in the recurrent stage, a blood examination is prescribed - a coagulogram (coagulability test), thromboelastogram, which allows making a general assessment of the patient's condition based on the result of hemoglobin and platelet parameters.

Biochemical and general analyzes, blood pressure indicators, help to establish the background cause that provokes epistaxis and make the correct treatment therapy.

Methods for treating nosebleeds

Drug therapy is the main stage in the treatment. Due to the careful selection of appointments:

Hemostatic drugs - "Epsilon", "Abmen", calcium and hemostatic agents are widely used.
Enhances the therapeutic effect of Vikasol. Its appointment is justified in case of background hepatic pathology.
To strengthen the vascular walls, drugs are prescribed that increase hemostatic functions - Ascorutin, Vipraksin.
Drugs that prevent thrombosis - "Kontrykal" or "Trasilol".
Coagulation correctors and immunoglobulin preparations that eliminate heavy bleeding.
Complex therapy includes therapeutic agents that eliminate background pathologies that caused epistaxis.

All appointments, dosages and treatment regimen are purely individual for each patient.

1. As a local treatment, swabs soaked in plasma or citrated (sterilized) blood, hemostatic hemostatic sponges, fibrinous antiseptic biological swabs are used to stop nosebleeds.

2. For nosebleeds from small vessels, various methods of cauterization are used - laser cauterization and electrocoagulation, cryodestruction or ultrasonic disintegration.

3. An effective effect is provided by catheter oxygen therapy (inhalation of humidified oxygen), anterior or posterior tamponade - tampons moistened with a hemostatic preparation from long bandages are inserted into the nasal cavity to stop blood secretions.

As a surgical technique apply:

1. Vestibuloplasty - incision of the mucous membrane with and without detachment, removal of the submucosal layer from the nasal septum, scraping of granulation growths.

2. For more serious pathologies - vascular ligation, dermoplasty, replacement of the mucous membrane with a skin behind the ear flap.

Characteristics of possible complications

Large blood loss during epistaxis can lead to an acute process of circulatory disorders (collapse) with a sharp violation of blood supply and acute hypoxia of tissues, organs and systems. Especially, it is reflected in the brain, kidneys and heart tissues.

The progression of this condition causes shock and loss of consciousness in the patient, which, without medical intervention, can result in death.