What is a nose bleed?

The inside of the nose (particularly the anterior frontal part) is covered with moist, delicate tissue (mucosa) that has a rich supply of blood vessels/tissues. These blood vessels or capillaries are quite delicate and close to the surface to their maximise efficiency to moderate the temperature of each breath of air so that it is just right for the head and the lungs. When this vascular tissue is injured or the cells are ruptured as a result of trauma, even as a result of something apparently minor, the capillary blood vessels bleed, sometimes heavily. Occasionally nose bleeds are spontaneous but regardless of how they are caused they can be embarrassing and distressful even though life threatening situations are extremely rare in the case of anterior nose bleeds.

Are there different types of nose bleed?

1. Anterior Nose Bleeds

These are from the front of the nose and are most common representing about 90% of epistaxic (nose bleed) situations. The most frequent location is the nasal septum which is the wall between the two nostrils. In most cases, this type of nosebleed is not serious. It usually can be stopped with some local pressure and a little patience.

Reasons for Anterior Nose Bleed

i) Dry mucous membranes

This is the main cause for anterior nose bleeds caused by:

• a hot climate or
• hot stuffy indoor atmosphere

ii) Infection and/or Allergies

Which results in nasal inflammation and congestion causing blood vessels to widen (dilate), thus making them more vulnerable to injury. Nosebleeds occur most often in autumn/winter when upper respiratory infections which leave noses crusty and dried out are most common.

iii) Nose picking

Which results in rupture of the mucosal lining.

iv) Strenuous nose blowing

Producing ruptured vascular tissue as a result of a head cold.

v) Medications & Supplements

Including aspirin, ibuprofen, clopidogrel bisulfate (Plavix) or warfarin (Coumadin). Additionally some herbal remedies including Danshen, Dong quai, Feverfew, Garlic, Ginger, Ginko biloba, Ginseng, vitamin E and Omega 3 (fish oil) all of which exhibit blood thinning characteristics. If any these (or similar alternatives) have been prescribed you need to contact your physician and discuss the possibility of stopping them at least for a short period.

vi) Exposure to Chemicals and/or fumes

Which damage the nasal lining. The principle culprit here is secondhand cigarette smoke but nosebleeds can develop from on-the-job exposure to sulfuric acid, ammonia, gasoline or other chemical irritants.

vii) Hot Liquids & Showers

Drinking hot soup and beverages as well as hot water showers to the head can also result in undesirable blood vessel dilation.

viii) Constipation

Resulting in undue straining during bowel movements.

2. Posterior Nose Bleeds

These come from deep at the rear of the nose and are characterised by a blood flow down the throat and mouth even when the person is sitting. They occur usually in older people over 60 years and are more severe and can be difficult to control and stop. With age, arteries and blood vessels loose their elasticity and flexibility. Atherosclerosis as a consequence of high blood pressure damages arteries by scaring. These factors can hamper the contracting and retracting of an artery causing rupture and posterior nosebleed to persist. A posterior nose bleed can be life-threatening.

Reasons for Posterior Nose Bleed (in addition to those for Anterior Bleeds)

i) Medical Condition

Examples include kidney failure, thrombocytopenia (low platelet levels needed for clotting), haemophilia etc.

ii) Addictions including

Alcohol, Tobacco and Recreational Drugs (particularly cocaine) not only cause injury and bleeding to superficial blood vessels as a consequence of dilation but in addition interfere with normal blood platelet activity increasing the time needed for blood clot formation.

iii) Nose Scaring

As a result of previous trauma to nose or nose breakage. A scar (or cicatrix) can result in weakened superficial blood tissue around its edges.

iv) High Blood Pressure

Which exerts a continual, abnormally high pressure on your circulatory system.

v) Mental Stress / Tension

Stress increases the metabolic rate causing hormone surges, exhaustion, tension, headaches, irritability, aggression and hypertension.

1st Aid for Anterior (frontal) nose bleed (this covers 90% of nose bleed situations)

1. Don't panic. Keep calm. It is unlikely to be life threatening
2. Sit upright
3. Lean head slightly forward (Not backwards as this can cause choking or not too forward as this can encourage flow)
4. Do not swallow blood, if blood flows down the throat spit it out. (Swallowing blood will make you feel nauseous and will later induce a bout of vomiting resulting in straining.)
5. Breath through the mouth
6. Remove any dentures.
7. Pinch the soft part of the nose continuously for 10 mins. (between the tip and the bridge)
8. Apply a cold compress to the back of the neck. This will also reinforce the slight forward tilt of the head. (Not the forehead as the head tends to tilt backwards in an effort to maintain the compress in position or the nose itself as it will be more difficult to maintain nasal pressure with a compress in place)
9. Repeat the above twice more and if the bleeding has not ceased seek medical advice (ie a total time duration of 30 mins)
10. Do not pack the nostrils with cotton wool or similar

Homeopathics for Nose Bleed

During Bleeding

Take 2 pills of Ferrum phosphate (Ferrum-phos) 12X or 6X every 5 mins until bleeding stops. (Max 6 doses over 30 mins)

After Bleeding Stops

Continue to take 2 pills of Ferrum phosphate (Ferrum-phos) 12X or 6X every 1 hr for 4 hrs (ie 4 doses). Thereafter take AM and PM for the next 14 days.

When to Call the Emergency Services

• When the bleeding has not ceased in 30 mins
• When a Posterior Nose bleed is suspected

Recognising a Posterior Nose Bleed

1. The patient is elderly
2. When blood flows continually down the throat
3. When bleeding is of a gushing/pulsating/rapid nature
4. When bleeding continues for more than 30 mins
5. When bleeding stops but restarts
6. When there is an accompanying headache (sign of tension/high blood pressure)
7. When there has been a high loss of blood (often difficult to tell when the flow goes down the throat)
8. When the patient feels weak or faint (presumably from blood loss.)

Nasal Cautery at A & E

Cautery will seal the bleeding point in the nose. This involves using as silver nitrate stick which has the appearance of a match stick. The procedure can be performed in the Accident & Emergency Centre should further attempts at first aid fail.

Precautions to Take after Nose Bleed has Ceased

Over the next 3 Days

• Keep cool. No undue excitement
• Sneeze through the mouth (ie with the mouth open)
• No hot showers
• No facial hot water applications
• No hot drinks or hot soups
• Review your medication programme (particularly if you are on blood manipulating drugs/supplements)

Over the next 14 Days

• Sit upright
• Sleep in a semi erect position with the head raised well above heart level
• No alcohol
• Do not strain or bend down to lift anything heavy or engage in other strenuous activities. (This can produce momentary surges in blood pressure which can cause the nose to bleed again.)
• Do not strain during bowel movements (If necessary use Super Shield Probiotic to maintain proper metabolic function)
• Evaluate a Homeopathic/Supplement regime to raise the level of natural immunity against cold/cough/dry nose.

Permanently

• Blow your nose gently
• Stop nose picking
• Keep your children's nails (and yours) clipped short
• Use a humidifier (if your indoor climate is dry during the winter months)
• Avoid facial trauma by wearing a seatbelt and shoulder harness in the car and use well-fitting headgear to protect your face during contact sports, such as football or karate.
• Use protective equipment to avoid breathing irritating chemicals at work
• Moisturise the inside of your nose with Calendula cream twice daily (Not petroleum based jells or Vaseline as these contain alcohol and will dry the skin)
• Abstain from all Recreational Drug taking particularly cocaine
• Quit smoking

Homeopathics & Supplements

• Apply Calendula cream inside nostrils twice daily to moisturise.
• Take Homeopathic for hightened immunity against colds/cough/dry nose.
• 1 cap/day Super Shield Probiotic for metabolic function.

If Nose Bleeds Reoccur

If nosebleeds continue to reoccur or if in the past you have suffered from a pattern of nose bleeds you may have an underlying medical condition.