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Nosebleed

AGE  Most common in children and in adults over the age of 50GENDER  Not significant factors
LIFESTYLE  Not significant factorsGENETICS  Not significant factors

A nosebleed is bleeding from the nose, usually from one nostril only.

Nosebleed
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Nosebleeds are common in children, but the bleeding usually stops by itself and is minor. Nosebleeds are also common, but sometimes serious, in people over the age of 50. In this age group, bleeding may come from the back of the nose and be hard to stop. If the blood is swallowed, bleeding may not be seen.

What are the causes of nosebleeds?

Nosebleeds commonly occur spontaneously. In dry environments or during winter months, the membranes lining the nose may become dry and cracked, causing bleeding to occur. Nosebleeds may also occur if the lining of the nose is injured by a blow to the nose or by nose-picking or forceful nose-blowing. In children, nosebleeds often occur as a result of rough play. A foreign body in the nose or an infection in the upper respiratory tract may also result in a nosebleed. In people over the age of 50, the small blood vessels in the nose may be more fragile and therefore more likely to rupture and cause bleeding.

In rare cases, nosebleeds may be associated with cancer in the passage connecting the nose to the throat (see Cancer of the nasopharynx) or may indicate another underlying disease, such as the bleeding disorder thrombocytopenia or a liver disease that affects blood clotting. Nose-bleeds may also be caused by drugs that prevent blood clotting. A nosebleed is more likely to be prolonged if you have high blood pressure (see Hypertension).

What can I do?

If you have a nosebleed, you should put direct pressure on the soft part of your nose by pressing both sides together for at least 15 minutes while breathing through your mouth. You should try to avoid sniffing and/or blowing your nose afterwards because you may dislodge the blood clot that has formed and cause another nosebleed. Self-help measures are usually successful in stopping a nosebleed. If bleeding persists for half an hour or more, you should seek medical attention. If membranes in the nose are dry and cracked, rubbing water-based ointment in your nose a few times a day or using a saline spray may help to prevent recurrent nosebleeds.

What might the doctor do?

A persistent nosebleed will probably require hospital treatment. Your doctor may pack your nose with nasal sponges, which are left in place for about 2 days. Alternatively, a flexible tube with a small balloon at the tip may be inserted into the back of your nose and inflated to stop the bleeding by applying pressure to leaking vessels. Bleeding vessels may also be cauterized (sealed using heat) under local anaesthesia.

If the cause is not obvious, your doctor may arrange for you to have endoscopy of the nose (see Endoscopy of the nose and throat), in which an optical instrument is passed into each nostril in turn to look for ruptured vessels or a tumour. Rarely, CT scanning or MRI may be carried out to rule out a tumour. Blood tests may also be arranged to check how efficiently the blood clots.

Recurrent bleeding that is not caused by a tumour may be investigated by injecting a contrast medium into the blood vessels and taking contrast X-rays. A special substance is then injected into the leaking blood vessel to block it and prevent further blood loss. In other cases, surgery may be required to tie off the leaking blood vessels.

Posted 09.09.2010

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