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Symptoms and Signs of Nosebleed Causes, Symptoms, First Aid Remedies, and Treatments

Doctor's Notes on Nosebleed Causes, Symptoms, First Aid Remedies, and Treatments

A nosebleed refers to bleeding through the nostrils of the nose due to any cause. The medical term for nosebleed is epistaxis. The most common causes of nosebleed include drying or cracking of the nasal membranes from dry climates and trauma from nose-picking. Other factors that increase the likelihood of nosebleed include infection, trauma, allergic and non-allergic rhinitis, hypertensionalcohol abuse and inherited bleeding problems. Taking medications that interfere with blood clotting can also increase the risk of getting a nosebleed.

Signs and symptoms of nosebleed include mild to severe bleeding from the nostrils. Some people experience associated symptoms like feeling weak or faint if the bleeding is extensive. If blood collects in the throat and is swallowed, it may cause nausea, vomiting, or diarrhea.

Medical Author:
Medically Reviewed on 3/30/2019

Nosebleed Causes, Symptoms, First Aid Remedies, and Treatments Symptoms

Bleeding usually occurs only from one nostril. If the bleeding is heavy enough, the blood can fill up the affected nostril and overflow into the nasopharynx (the area inside the nose where the two nostrils converge), causing simultaneous bleeding from the other nostril as well. Blood can also drip into the back of the throat or down into the stomach, causing a person to spit up or even vomit blood.

Signs of excessive blood loss include:

Excessive blood loss from nosebleeds does not often occur.

Nosebleed Causes, Symptoms, First Aid Remedies, and Treatments Causes

Most nosebleeds do not have an easily identifiable cause. However, trauma to the nose is a very common cause of nosebleeds. Nosebleeds can be caused by trauma to the outside of the nose from a blow to the face, or trauma to the inside of the nose from nose picking. Other conditions that predispose a person to nosebleeds include:

  • exposure to warm, dry air for prolonged periods of time,
  • nasal and sinus infections,
  • allergic rhinitis,
  • nasal foreign body (object stuck in the nose),
  • vigorous nose blowing,
  • nasal surgery,
  • deviated or perforated nasal septum, and
  • cocaine use.

Less commonly, an underlying disease process or taking certain medications may cause a nosebleed or make it more difficult to control.

  • Inability of the blood to clot is most often due to blood-thinning medications such as warfarin (Coumadin), clopidogrel bisulfate (Plavix), nonsteroidal anti-inflammatory drugs (NSAIDs), or aspirin.
  • Topical nasal medications, such as corticosteroids and antihistamines, may sometimes lead to nosebleeds.
  • Liver disease, chronic alcohol abuse, kidney disease, platelet disorders, and inherited blood clotting disorders can also interfere with blood clotting and predispose to nosebleeds.
  • Vascular malformations in the nose and nasal tumors are rare causes of nosebleeds.
  • High blood pressure may contribute to bleeding, but is rarely the sole reason for a nosebleed. It is often the anxiety associated with the nosebleed that leads to the elevation in blood pressure.

The most common cause of nosebleeds in children is from minor trauma, typically from nose picking. Other common causes of nosebleeds in a child include:

  • Direct trauma to the nose
  • Upper respiratory infections
  • Foreign body in the nose
  • Allergic rhinitis
  • Exposure to warm, dry air
  • Nasal medications (for example, corticosteroids)

Less common causes of nosebleeds in children include vascular malformations, leukemia, nasal tumors, and various blood clotting abnormalities. An accidental ingestion of blood-thinning medication, for example, warfarin (Coumadin, Janotven) also is a rare cause of nosebleeds in children.

The treatment for nosebleeds in children is similar to that of adults (see Treatment section). The prognosis in children is generally excellent; however, nosebleeds caused by serious underlying medical conditions vary.

The diagnosis of a nosebleed is generally self-evident and apparent upon seeing the patient, though some individuals may not have any active bleeding by the time they arrive to seek medical care. More importantly, however, your health care practitioner will need to locate the source of bleeding and determine whether the person has an anterior or posterior nosebleed. Furthermore, other less common causes of nosebleeds may need to be sought depending upon the individual's medical history and the findings on the physical exam.

  • To examine the nose, the health care practitioner will place medications into the nostrils (usually with a cotton ball) in order to numb the inside of the nose and constrict the blood vessels in that area. Numbing medications make the examination less painful. The medication that constricts the blood vessels shrinks the nasal tissue and may even control the bleeding to make it easier to see inside this small, dark cavity and identify the exact site of bleeding. A metallic instrument called a nasal speculum is then inserted into the nostrils to visualize the inside of the nose.
  • The diagnosis of a posterior nosebleed is usually made when attempts to control the bleeding with measures used for an anterior nosebleed have failed, or when an anterior source is not identified. Seeing the source of a posterior nosebleed is nearly impossible. Other findings suggestive of a posterior nosebleed include heavy bleeding from both nostrils or visualizing blood draining down the back of the throat.
  • Laboratory tests are usually not needed. For severe nosebleeds, however, a blood count may be checked to assess the degree of blood loss. For individuals with blood clotting disorders or for those taking blood thinners, additional blood tests may also be ordered. If there are concerns about malignancy or other less common causes of nosebleeds, further blood tests and/or imaging studies may be considered.

The diagnosis of a nosebleed is generally self-evident and apparent upon seeing the patient, though some individuals may not have any active bleeding by the time they arrive to seek medical care. More importantly, however, your health care practitioner will need to locate the source of bleeding and determine whether the person has an anterior or posterior nosebleed. Furthermore, other less common causes of nosebleeds may need to be sought depending upon the individual's medical history and the findings on the physical exam.

  • To examine the nose, the health care practitioner will place medications into the nostrils (usually with a cotton ball) in order to numb the inside of the nose and constrict the blood vessels in that area. Numbing medications make the examination less painful. The medication that constricts the blood vessels shrinks the nasal tissue and may even control the bleeding to make it easier to see inside this small, dark cavity and identify the exact site of bleeding. A metallic instrument called a nasal speculum is then inserted into the nostrils to visualize the inside of the nose.
  • The diagnosis of a posterior nosebleed is usually made when attempts to control the bleeding with measures used for an anterior nosebleed have failed, or when an anterior source is not identified. Seeing the source of a posterior nosebleed is nearly impossible. Other findings suggestive of a posterior nosebleed include heavy bleeding from both nostrils or visualizing blood draining down the back of the throat.
  • Laboratory tests are usually not needed. For severe nosebleeds, however, a blood count may be checked to assess the degree of blood loss. For individuals with blood clotting disorders or for those taking blood thinners, additional blood tests may also be ordered. If there are concerns about malignancy or other less common causes of nosebleeds, further blood tests and/or imaging studies may be considered.

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REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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